Summary Irritable Bowel Disease physiology and drug summaries

Irritable Bowel Disease
https://www.youtube.com/watch?v=UJw2WUtHLIk
Two types:
 Ulcerative Colitis
 Crohn’s disease
To know:
 A chronic progressive condition in ages 15-40
 Diarrhoea is the most common.
Definition: chronic inflammation of the gastric mucosa
Crohn’s disease
 The whole GI tract is affected.
 Skip lesions: patchy.
 All layers of the intestinal wall (transmural)
 Inflammation leads to thickening of the intestinal walls, ulceration and narrowing of
the lumen.
UC
 Mucosa of large intestine only (colon and rectum)
 Mucosal and submucosal layers.




Pathophysiology
 Unknown cause
 Triggered by a weaker immune system.
 Alteration in the composition of gut bacteria.
 Causing ongoing inflammation
Risk factors
 Stress
 Diet
 smoking
 medicine
 genetic
 altered gut microbiota.
Symptoms
 diarrhoea
 blood in faeces (UC)
 abdominal pain
 tiredness

,  weight loss
 anaemia
 fever
 nausea and vomiting
 bloating (Crohn’s is more obstruction-like)
 swollen joints
 eye problems
 erythema nodosum: swollen fat under the skin
 pyoderma gangrenosum: skin ulceration
Complications of Crohn’s




 narrowed segments of the bowel
 blockages caused.
 Fistulas: GI tract fusing together
Diagnosis:
 Full history
 Full blood count:
o inflammatory markers
o urea and electrolytes
o thyroid function
o liver function
o bone profile
 stool culture: rule out clostridium difficile.
 coeliac screen
 faecal calprotectin: released when inflammation present in the intestines (distinguish
between IBD and IBS)
 endoscopy
 colonoscopy
 biopsies
UC severity index
 Truelove and Witt’s Severity index
 Mild moderate or severe
 Looks at symptoms.
 determines treatment.
Crohn’s severity index
 Crohn’s disease activity index
 Like UC but with different questions.
 Severe flare-up: step up treatment.
 Active flare-up: lots of symptoms that need treatment to stop.

Monitoring during a flare up
 Faecal calprotectin
 Stool frequency