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What is the relationship between PSC and IBD? Associated with both UC and Crohn's. Colectomy does not prevent PSC, does not parallel severity of disease.
Are constitutional symptoms common in UC? Generally, no.
Do fistuals occur in UC, Crohn's or both? What is the treatment? Fistulas are specific to Crohn's diesase. Treatment is infliximab.
Is CRC associated with UC, Crohn's or both? What screening recommended? Is both (if colon involved in Crohn's), although risk is probbly higher in UC. Colonoscopy and biopsies after 8-10 years post-diganosis. If high grade dyplasia found - colectomy. If low grade - increase screening frequency.
What are the eye lesion associated with IBD? Episcleritis & anterior uveitis (urgent).
What are the skin lesions associated with Crohn's and UC respectively? Erythema nodosum (tender red nodules, self-limiting)- especially in Crohn's; parallels disease activity. Pyoderma gangrenosum - espeically in UC, parallels bowel disease activity in 50% of cases.
What is the treatment of pyoderma gangrenosum? Systemic corticosteroids + cyclosporine. If ineffective - mycophenalate, infliximab.
What investigations are essential for diagnosis of IBD? Colonoscopy = biopsy. Never scope during an acute flare!
What are the goals of manamagene to IBD? 1. Treat acute attacks. 2. Prevent relapses. 3. Detect carcinoma at an early stage. 4. Select patients for surgery.
What is the most common extra-inestinal manifestation of IBD? Arthritis.
Describe the arthritis that occurs in IBD. Migratory monoarticular arthritis - parallels bowel disease activity (coincides with exacerbation of colitis). Ankylsoing spondylitis, sacroilliits.
Is Ankylosing Spondylitis more associated with Crohn's or UC? Does it correlate with disease activity or is it independent? UC. The course if independent of the colitis.
Can sacroiliitis occur? Does ti parallel bowel disease activity? Yes; No.
Describe two haematological abnormalities associated with IBD. 1. Thromboembolic - hypercoagulable state - can lead to DVT, PE or CVA. 2. ITP
Do gallstones occur in Crohn's or in UC? Associated with Crohn's - due to ileal involvement.
Treatment of Crohn's: How is mild, active disease treate? (No fistulas). Either oral budesonide or mesalasine (orallay).
Management of Crohn's: How is moderately active disease (steroid refractive) managed? Anti-TNF (infliximab), oral steroid tapers.
How is a severe episode of Crohn's disease treated? IV steroids - exclude abscesses or fistulas before starting. IV hydrocortisoen sodium succinate/IV methyylpred.
How is extensive small bowel disease treated in Crohn's? Steroids and early introduction of immunomodulators (azathoprine, 6-mercaptopruine).
How is colonic Crohn's treated? Mildly active: 5-ASSA (Sulfasalazine, mesalazine - orally, or rectal). Can add hydroctorisone enemas or supposites. Oral corticosteroids can be given as an initial treatment but not budesonide - give prednisolone.
how is Crohn's per-anal or fiistulating disease treated? Surgical: perianal or itnra-abdomainl abscess should be excluded - exclude with CT. Treat with non-cutting seton or a fistulotomy. Adjunct: Azathioprine, 6-mercapto-inflizimab - infliximab has been proven to induce closure of perianal fistulae.
Is surgery curative in UC? What about Crohn's? Yes in UC; for Corhn's - surgery is often done - obstruction, fistulas, not is not curative (disease will recur).
In the diagnosis of Crohn's, when is capsular enteroscopy indicated? When imaging, colonoscopy and OGD fail to establish a diagnosis.
What blood tests are indicated in investigation of Crohn's? FBC, inflammatory markers, LFTs, B12, iron, red cell folate.
Describe the antibodies associated with UC and Crohn's: UC: positive pANCA, negative ASCA. Crohn's: positive ASCA, negative pANCA.
How is Pyoderma Gangrenosum treated? With corticosteroids - systemic, +/- ciclosporin.
How is erythema nodosum treated?
Created by: tnei5002