1 / 32

Inflammatory Bowel Disease

Inflammatory Bowel Disease. Dawn Kershaw (FY1). Recognise the possibility of IBD in patient’s presenting with lower GI symptoms Recognise the possibility of systemic symptoms associated with IBD

sugar
Download Presentation

Inflammatory Bowel Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Inflammatory Bowel Disease Dawn Kershaw (FY1)

  2. Recognise the possibility of IBD in patient’s presenting with lower GI symptoms • Recognise the possibility of systemic symptoms associated with IBD • Recognise the differences in presentation between Crohn’s and UC – and how these relate to underlying pathology • Initiate appropriate investigations in a patient with suspected IBD • Initiate appropriate management in a patient with IBD • Explain to patients the nature of and the rationale for maintenance treatment of IBD Objectives

  3. Recognise the possibility of IBD in patient’s presenting with lower GI symptoms = GI symptoms of IBD • Recognise the possibility of systemic symptoms associated with IBD = Extra-intestinal symptoms • Recognise the differences in presentation between Crohn’s and UC – and how these relate to underlying pathology = Differences between UC and Crohn’s: Pathology and presentation • Initiate appropriate investigations in a patient with suspected IBD = Investigations • Initiate appropriate management in a patient with IBD = Management of IBD • Explain to patients the nature of and the rationale for maintenance treatment of IBD = Explain in lay terms why we give medications to prevent flare ups Objectives

  4. Definition? • Aetiology? Crohn's verses UC

  5. Definition • Chronic • Relapsing and remitting • Inflammatory bowel disease • Chrons: any part of GI tract - often terminal ileum • UC: large bowel • Aeitology • Unknown • Genetic • Environmental Crohn's verses UC

  6. Pathology?

  7. Crohn’s

  8. Crohn’s • Tranny Granny Skipped down Cobblestone street • Strictures • Fistulae • Abscesses

  9. Crohn’s

  10. Ulcerative colitis • Starts from rectum • Extends proximally • Continuous • Mucosa only • Proctitis = rectum • Proctosigmoiditis = rectum and sigmoid colon • Left sided Colitis • Pancolitis – Whole of large colon

  11. Objectives • Recognise the differences in presentation between Crohn’s and UC – and how these relate to underlying pathology • Recognise the possibility of IBD in patient’s presenting with lower GI symptoms

  12. Crohn’s

  13. Crampy abdominal pain • Inflammation; fibrosis; bowel obstruction • Diarrhoea • Blood • Steatorrhea • Weight loss • Fever • Anaemia • Obstruction: Distension, Vomiting • Abscesses • Fistulae: Enteroenteral; Anorectal; Vesicointestinal; Rectovaginal Crohn’s

  14. Ulcerative Colitis

  15. Crampy abdominal pain • Relieved by defecation • Left iliac fossa • Diarrhoea • Blood ++ • Mucous • Urgency • Tenesmus • Weight loss • Fever • Anaemia • Severity: Truelove Witts Criteria Ulcerative Colitis

  16. Objectives • Recognise the possibility of systemic symptoms associated with IBD.

  17. Eyes • Iritis; uveitis; episcleritis • Skin • Erythema nodosum; pyoderma gangrenosum • Joints • Seronegative spondyloarthropathy • Large joints; Spine; Sacroiliitis; Can affect small joints • Other • Clubbing • DVT • Primary sclerosing cholangitis (UC) • Heamolytic anaemia (autoimmune) (Crohn’s) • Osetoporosis (Crohn’s) Extra-intestinal symptoms

  18. Erythema nodosum • Pyoderma gangrenosum

  19. Uveitis • Clubbing

  20. Complete first 3 boxes on form based on what we have just done. • What are your differential diagnosis to consider in a patient presenting with IBD symptoms? • Abdominal pain • Diarrhoea • PR bleeding/ mucous • Weight loss • Malabsorption (Thanks to Zoe Campbell for providing the basis to this form) Get into 2 groups

  21. Initiate appropriate investigations in a patient with suspected IBD • Bedside • Bloods • Imaging • Special tests

  22. Bedside • Stool MC&S • Faecal calprotectin • Bloods • FBC (low Hb; High WCC) • ESR; CRP (high) • LFTs: Low albumin • U&Es: Chronic diarrhoea – electrolyte imbalance • Heamatinics: ferritin, Vitamin B12, folate • Amylase • Cross match Investigations

  23. Imaging • Abdominal X-ray • Erect Chest X-ray • Barium Meal (Crohn's) • Fibrosis, Strictures, Ulceration (‘rose thorn’) • Barium enema (UC) • Featureless narrow colon, Loss of haustral pattern • CT/MRI enterography (Crohn’s) • Special test • Flexible sigmoidoscopy • Colonoscopy • Gastroscopy • BIOPSY Investigations Not in acute flare!!!

  24. Initiate appropriate management in a patient with IBD • Acute • Chronic • Lifestyle • MDT

  25. Acute • A-E; Bowel rest; Analgesia (not NSAIDs); • Steroids: IV; oral; rectal • Antibiotics • 5-ASAs • Chronic • 5-ASAs • Per rectum steroids • Immunosuppressant's • Azathioprine • Methotrexate (Crohn’s) • Anti-TNF: Infliximab • Surgery: Resection Management

  26. Lifestyle • Diet: Elemental • Stop smoking? • MDT • Consultant’s: Gastroenterologist; Surgeons • IBD specialist nurse • Dietician • Smoking cessation • Stoma nurse Management

  27. 5-ASAs • Steroids • Azathioprine/ Mercaptopurine (Immunosuppressant) • Methotrexate (Crohn's) • Infliximab (Anti-TNF) Medications used in IBD

  28. Complete the rest of the form Get back into groups

  29. Objectives • Explain to patients the nature of and the rationale for maintenance treatment of IBD

  30. Patient.co.uk • Once a flare-up has settled, without treatment, there is ~1 in 2 chance that another flare-up will develop within a year. • Increased likelihood of flares depends on: • extent of the disease in your gut • age, • the extent of treatment needed to control the initial flare-up. • If flares not frequent/mild/ respond well to acute treatment then - may not need to /wish to take regular meds • For others regular meds can improve QOL ++

  31. The treatment options that may be considered to prevent flare-ups) include: • Immunosuppressants – take daily • Mesalazine – used daily (less common now) • Anti-TNF – selected cases where flares severe and other treatments not worked: Have infusion in hospital every 8 weeks. • Steroid medication is not generally used long-term to prevent flare-ups • These treatments increase the chance of remaining free of flare-ups, but they do not always work. • Balance between benefits and the possible side-effects.

  32. Understanding the pathophysiology of UC and Crohn’s is actually useful! • Symptoms • Investigations • Management • Communication is key- in exams AND in real life: • Patient.co.uk • Easy marks in exams if you practice! • Structured answers in exams • Investigations • Bedside; Bloods; Imaging; Special tests • Acute; chronic • Management • Acute; Chronic; lifestyle; MDT • Conservative; Medical; Surgical 3 key points to take away

More Related