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Inflammatory bowel disease

Explore the definition, presentation, and management of inflammatory bowel disease (IBD), including differences between ulcerative colitis and Crohn’s disease. Learn about systemic manifestations, symptoms, signs, and diagnostic investigations for IBD, as well as conservative and acute management strategies. This comprehensive guide provides insights into the complexities of IBD for medical professionals and patients alike.

jerrymccormick
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Inflammatory bowel disease

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  1. Inflammatory bowel disease Dr Sam Gausden FY2 February 2015

  2. Contents/aims/objectives • Definition • Presentation • Investigations • Management • Clinical scenario • Explanation station

  3. Definition

  4. Definition • Umbrella term

  5. Definition • Umbrella term • Chronic

  6. Definition • Umbrella term • Chronic • Relapsing-remitting

  7. Definition • Umbrella term • Chronic • Relapsing-remitting • Acute non-infectious inflammation

  8. Differences

  9. Differences • Distribution

  10. Differences

  11. Differences • Distribution • Smoking

  12. Smoking in IBD • 95% of UC pts are non-smokers or ex-smokers • 2/3 Crohn’s pts are smokers and cessation halves relapse

  13. Smoking in IBD • You see people smoking with UC • Smoking in Crohn’s makes you want to GROAN

  14. Differences • Distribution • Smoking • Histology

  15. UC histology

  16. UC histology • Hyperaemic/haemorrhagic colonic mucosa • Pseudopolyps • Usually on affects mucosal layer • Absence of goblet cells

  17. Crohn’s histology • Transmural granulomatous inflammation • Cobblestoning • MACROSCOPICALLY: • Strictures, abscesses, fistulae, skip lesions

  18. Systemic manifestations

  19. Systemic manifestations • Hepatic - autoimmune hepatitis (UC), gallstones (Cr), PSC (UC)

  20. Systemic manifestations • Hepatic • Other - VTE, osteoporosis (Cr), amyloidosis (Cr)

  21. Systemic manifestations • Hepatic • Other • Rheum - arthritis, sacro-ileitis, AS

  22. Systemic manifestations • Hepatic • Other • Rheum • Skin – EN and PG (UC>Cr)

  23. Systemic manifestations • Hepatic • Other • Rheum • Skin • Eyes – iritis, uveitis

  24. Eyes Uveal tract = iris, ciliary body and choroid

  25. Systemic manifestations • H epatic • Other • Rheum • S kin • E yes

  26. Symptoms - UC

  27. Symptoms - UC • Diarrhoea + blood/mucous • Faecal urgency/incontinence • Tenesmus • Lower abdominal pain • Tiredness/malaise • Weight loss/failure to thrive or grow • Fever

  28. Symptoms – Crohn’s

  29. Symptoms - Crohn’s • Diarrhoea +/- blood/mucous • Malabsorption • Abdominal pain (crampy) • Mouth ulcers • Bowel obstruction • Fistulas (perianal) • Abscesses (perianal/intrabdominal) • Tiredness/malaise • Weight loss/failure to thrive or grow • Fever

  30. Signs - UC

  31. Signs - UC • Clubbing • Pallor • Eyes • Legs • Abdominal tenderness • PR

  32. Signs – Crohn’s

  33. Signs – Crohn’s • Clubbing • Pallor • Eyes • Mouth • Legs • Abdominal tenderness • Mass in RIF • PR – skin tags, abscesses, fistulas

  34. Investigations

  35. Bedside tests • Bedside tests

  36. Faecal calprotectin • Protein common in neutrophil cytoplasm • Bacteriostatic and resistant to enzyme degredation NICE guideline: • To differentiate IBD from IBS in pts where cancer is NOT suspected Also: can also be used to evaluate IBD Rx and predict flares

  37. Blood tests

  38. Imaging (acute)

  39. Imaging (acute)

  40. Special test (acute)

  41. Special tests (acute)

  42. Management (long-term)

  43. Conservative

  44. Conservative

  45. Inducing remission in mild-mod UC1

  46. Inducing remission in mild-mod UC1 • 1) Aminosalicylates • 2) Steroids • 3) Immunosuppression (tacrolimus)

  47. Inducing remission in severe UC (inpatient)1

  48. Inducing remission in severe UC (inpatient)1 • 1) IV steroids • 2) Immunosuppression (ciclosporin) • 3) Biologics (infliximab)

  49. Assessing UC severity

  50. Assessing UC severity • TRUELOVE AND WITTS’ CRITERIA1

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