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Relapsing / remitting inflammatory disorder of colonic mucosa; never spreads proximal to ileocaecal valve

Hyperaemic / haemorrhagic granular colonic mucosa +/- pseudopolyps


Pathology
Inflammation is normally not transmural
Inflammatory infiltrate; goblet cell
depletion; glandular distortion; mucosal
Histology ulcers; crypt abscesses

Prevalence: 100 - 200 / 100,000


Epidemiology Incidence: 10 - 20 / 100,000 a year
Most present 15 - 30 yrs; 3 x more common in non-smokers
T cell mediated autoimmune disease of small bowel in which prolamin Gradual onset of diarrhoea (+/- blood and mucus); crampy abdo
intolerance causes villous atrophy and malabsorption
pain; increased frequency of bowels; systemic symptoms
Can occur at any age (peaks in infancy and 50s) Symptoms common during attacks (fever, malaise, anorexia, weight loss)
One third are asymptomatic
Presentation
Steatorrhoea; abdo pain; bloating; nausea & vomiting; angular Symptoms / Signs May be none
Signs
stomatitis; weight loss; fatigue; incidental iron def anaemia In acute / severe episodes: fever, tachycardia, tender / distended abdo
An IgA antibody, 95% specific Clubbing; oral ulcers; erythema nodosum (purple, painful nodules on
Duodenal biopsy via endoscopy: villous atropy and crypt Diagnosis Peripheral Manifestations shins); conjuctivitis; iritis (inflammation of iris); large joint arthritis; fatty liver
Coeliac disease
hyperplasia - reversing on gluten free diet
Usual bloods FBC, ESR, CRP, U&E, LFT, cultures
Lifelong gluten free diet
Ulcerative Colitis
Rice, maize, soya, potatoes, oats and sugar are Ok Management Stool cultures to exclude infection
Gluten free biscuits, flour, bread and pasta are prescribable Tests AXR: no faecal shadows, mucosal thickening
Anaemia; secondary lactose intolerance; increased risk of malignancy Sigmoidoscopy: inflamed, friable mucosa
Complications
Rectal biopsy: inflammatory infiltrate, goblet cell depletion, mucoal ulcers, crypt abscesses
Typically alcohol Perforation and bleeding
Rarely familial, CF. haemochromatosis, Causes Complications
Malabsorption Syndromes Toxic dilatation of colon; venous thrombosis; colonic cancer
pancreatic duct obstruction
Mild UC (< 4 motions / day) Prednisolone for 2 weeks (oral or retention enemas)
Epigastric pain through to pack (relieved by sitting forward or hot
water bottles on epigastrium / back)
Moderate UC (4 - 6 motions / day) Oral Prednisolone for 2 weeks + 5-ASA + steroid enemas
Bloating, steatorrhoea, weight loss, brittle diabetes Presentation Inducing remission
Symptoms relapse and worsen
Severe UC (> 6 motions / day) Treat as inpatient
Ultrasound (pseudocyst), CT, AXR IBD
(speckled pancreatic calcification) Tests 5-ASA
Malabsorption Management Maintaining remission
Chronic pancreatitis Infliximab
Analgesia
Drugs 20% will require surgery at some point
Lipase + fat soluble vitamins
Proctocolectomy and terminal ileostomy
No alcohol; low fat diet Diet Management Surgery
Perforation; haemorrhage; toxic dilatation;
Indications for surgery failure of medical therapy
Indications: unremitting pain, weight loss Surgery
Chronic inflammatory disease characterised by transmural granulmatoud inflammation; can affect any part
Pseudocyst; diabetes; bilary obstruction; of the gut but favours terminal ileum and proximal colon; skip lesions (unaffected bowel areas between
local arterial aneruysm; gastric varices Complications areas of disease) differentiate Crohn's from UC
Prevalence: 50 - 100 / 100,000
Epidemiology Incidence: 5 - 10 / 100,000 per year
Associations: high sugar, low fibre diet, altered cell mediated immunity, smoking, NSAIDs
Common in UK: coeliac disease, chronic
pancreatitis, Crohn's Diarrhoea, abdo pain, weight loss
Symptoms
Fever, malaise, anorexia (with active disease)
Decreased bowel; pancreatic Malabsorption
insufficiency; small bowel mucosa; Abdo tenderness, right iliac fossa mass,
bacterial overgrowth; infection; intestinal perianal absecess / fistulae / skin tags,
hurry Symptoms / Signs anal / rectal strictures
Signs

Ahthous ulceration (oral mucous ulcer),


clubbing, erythema nodosum, iritis, fatty
Crohn's Disease liver, large joint arthritis
Peripheral Manifestations

Small bowel obstruction; toxic dilatation; abscess formation; fistulae;


Complications rectal haemorrhage; colonic cancer (rarer than in UC)
Absorbed in the terminal ileum
Deficiency causes: macrocytic anaemia, Vitamin B12 FBC, ESR, CRP, U&E, LFT, cultures, serum iron, vit B12
Usual bloods
neuropathy, glossitis Tests
Nutrients required for Health
Colonoscopy to assess disease extent
Absorbed in the proximal ileum
Deficiency causes: scurvy Vitamin C Mild attacks Prednisolone

Management IV steroids, nil by mouth, IV hydration


Severe attacks
Hydrocortisone IV, topical steroids for rectal disease

Malabsorption.mmap - 07/09/2010 -