• Crohn's Disease:
  • Early onset and colitis are poor prognostic features. Gender; women have better prognosis than men'
  • Transmural inflammation
  • Typically rectal sparing indicates Crohn's. However, is patient had previously used rectal enemas of mesalamine etc, this can change appearance of rectum.
  
  

  Posted 06/07/16 09:08:47 AM by Adam Faye

• When examining a patient with IBD always ask about extraintestinal manifestations:
  1. Rashes
  2. Eyes
  3. Joints
  
  Also always ask if the current symptoms are typical of their usual flare. 
  
  

  Posted 06/07/16 09:10:50 AM by Adam Faye

• RIsk of disease in children of patients with IBD:
  • Crohn's - child with 9% risk of disease
  • UC - child with 6% risk of disease
  
  
  
  

  Posted 06/07/16 09:14:07 AM by Adam Faye

• Ulcerative Colitis:
  • Disease tends to progress proximally in terms of location. Thus if disease begins in rectum, many years later may involve much of the colon whereas with Crohn's typically disease is localized to specific areas (terminal ileum etc.)
  • Majority of patients with PSC have underlying UC. Conversely only ~5% of patients with UC have PSC.
  • mild-moderate disease usually therapy begins with 5-ASA
  
  

  Posted 06/07/16 09:26:14 AM by Adam Faye

• IBD flare:
  • Steroids are usually used for induction of remission. Better prognosis if resolution of symptoms within 72hrs. of starting therapy
  • For manitenance therapy with TNF-inhibitors can decide between IV formulation and self-injection. IV formulation will begin working right away as opposed to self-injections, but self-injections allow patients to do deliver the medication themselves at home. 
  • Can trend CRP as a prognostic indicator. Rapid reduction in CRP portends good prognosis.
  • Always consider infections including CMV:
    • CMV PCR in blood/stool has varied sensitivity/specificity. If high suspicion can get Bx with H&E stain which would show enlarged cells usually with eosinophilic intranuclear inclusions. Can also use immunoperoxidase staining
  
  

  Posted 06/07/16 09:37:06 AM by Adam Faye

• Smooth Muscle Ab- Associated with Autoimmune hepatitis
  peri-nuclear ANCA - Associated with PSC
  Anti-mitochondrial Ab - Associated with PBC
  
  

  Posted 06/07/16 09:42:44 AM by Adam Faye

• PSC:
  • Consider PSC in IBD patients with elevated Alk Phos.
  • MRCP typically shows multifocal stricturing and dilation of intra/extrahepatic bile ducts on cholangiography (beads on a string)
  • Median survival after diagnosis without liver transplantation is ~10-12 years
  
  

  Posted 06/07/16 09:47:26 AM by Adam Faye

• For further reading...

  Review of IBD Pathogenesis
  CRP use in UC
  PSC (NEJM)
  
  

  Posted 06/07/16 10:08:36 AM by Adam Faye

Created by Christopher Kelly

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The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.