The inflammatory bowel diseases (IBD), Ulcerative Colitis and Crohn’s disease are chronic autoimmune relapsing and remitting inflammation of the intestine.
Can effect any part of GI tract from mouth to anus More difficult to manage due to this
Causes/Factors
Inappropriate immune response against (?abnormal) colonic flora in genetically susceptible individuals - failure to maintain tolerance
Smoking risk 3-4 times
Symptoms
- Diarrhoea
- Abdominal pain
- Weight loss/failure to thrive
- Systemic symptoms: pyrexia, malaise, anorexia
Signs
- bowel ulceration
- abdominal tenderness
- Perianal abscess/fistulae/skin tags
- anal strictures
- patchy inflammation
Extraintestinal signs:
- clubbing
- skin joint and eye problems
Diagnostic Tests
- Calprotectin - protein released from neutrophils into stool → inflammatory marker, highly sensitive
- Blood tests for inflammatory markers/Anaemia (FBC, ESR, CRP, U&E, LFT)
- Full colonoscopy or sigmoidoscopy → biopsy
- Crypt abcesses on histology
- AXR - no feacal shadows, mucosal thickening/islands
Management
Optimise nutrition
- Azathioprine (immunosuppressant)
- Biologics, Anti-TNFa, Anti-integrin, anti-IL12/23
- Surgery due to complications
Complications/red Flags
- small Bowel Obstruction
- toxic dilation
- for rest see diagram