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Inflammatory Bowel Disease

From Mediwikis

Two major forms of inflammatory bowel disease (IBD) are recognised: Crohn's Disease and Ulcerative Colitis. There is some overlap between these conditions.

Crohn's Disease Vs Ulcerative Colitis

Crohn's Disease

Ulcerative Colitis

UK Prevalence (per 100 000)

145

250

Affected Organs

Mouth to anus

Terminal ileum to anus

Inflammation
  • Deep (transmural)
  • Patchy "skip lesions"
  • Granulomas often present
  • Mucosal
  • Continuous
Macrosopic Changes
  • Narrow, thickened small bowel
  • Deep ulcers & fistulas - "cobblestones"
  • Apthous ulceration
  • Reddened, inflamed, bleeding
  • Extensive ulceration & polyps in severe cases
Symptoms
  • Diarrhoea (with blood if colonic involvement)
  • Abdominal pain
  • Weight loss
  • Non-specific
    • Malaise
    • Lethargy
    • Anorexia
    • Nausea
    • Vomiting
  • Diarrhoea with blood & mucus
  • Lower abdominal discomfort
  • Weight loss
  • Non specific
    • Malaise
    • Lethargy
    • Anorexia
Signs
  • Weight loss
  • General ill-health
  • Apthous ulceration of mouth
  • Abdominal tenderness
  • Mass in right iliac fossa
  • Anus
    • Oedematous anal tags
    • Fissures
    • Perianal abscesses
  • Abdominal distension/tenderness
  • Blood in rectum
Common Non-GI Manifestations
  • Eye inflammation
  • Gall stones
  • Kidney stones (oxalate)
  • Inflammatory back pain
  • Skin:
    • Erythema nodosum
    • Pyoderma gangrenosum
  • PSC
  • Arthralgia
  • Eye inflammation
  • VTE
Investigations
  • Blood tests
    • Anaemia (normocytic - chronic disease) (Megaloblastic anaemia from ileal damage is unusual)
    • Raised ESR, CRP, WCC
    • Hypoalbuminaemia (if severe)
    • LFTs
    • Cultures (if septicaemia)
    • Serological tests
    • -ve pANCA
  • Stool cultures
  • Barium follow-through/CT scan with contrast
    • Asymmetrical alteration in mucosal pattern
    • Deep ulceration
    • Areas of narrowing/stricturing
  • Colonoscopy (if colon involvement suspected)
  • Blood tests
    • Iron deficiency anaemia
    • Raised ESR, CRP, WCC
    • Hypoalbuminaemia
    • LFTs
    • +ve pANCA
  • Stool cultures
  • Abdominal X-Ray & ultrasound
    • Air distribution in colon
    • Colonic dilatation
    • Thicking of colonic wall
  • Colonoscopy - define extent (not in severe attacks - perforation risk)
Management
  • Polymeric Diet
  • Steroids
  • Immunosupression
  • Surgery- may not be curative, but used to prevent complications
  • Aminosalicylates- Mesalazine
  • Steroids- oral or topical
  • Immunosupression e.g. Azathioprine
  • Surgery- Pancolectomy