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IBD - Coggle Diagram

- - - - oral lesions
      - perianal skin tags
      - uveitis
      - arthralgia
      - erythema nodosum
  - - - upper GI
      - ileocolonoscopy
    - - histological hallmark = non-caseating epithelioid cell granuloma (often not identified)
    - - narrowing
      - fissuring
      - mucosal irregularities
      - bowel wall thickening
  - - - normal diet replaced by whole protein modular feeds for 6-8wks
      - polymeric diet
      - effective in 75%
      - if not effective use systemic steroids
    - - azathioprine, mercaptopurine, MTX
      - may be required to maintain remission
    - - infliximab, adalimumab
      - may be needed when conventional tx fails
    - - overnight NG/gastrostomy feeds
    - - for comps (obstruction, fistulae, abscess)
      - severe localised disease unresponsive to medical tx
- - - - systemic steroids for acute exacerbations
      - immunomodulation (e.g. azathioprine) +/- low dose corticosteroids to maintain remission
    - - IV fluids
      - steroids
      - ciclosporin
    - - for severe fulminating disease +/- toxic megacolon, or for chronic poorly controlled disease
      - colectomy with ileostomy or ileorectal pouch
  - - - upper GI
      - ileocolonoscopy
      - will see confluent colitis extending from rectum proximally for a variable length
      - unlike adults (usually confined to distal colon), 90% of children have pancolitis
    - - mucosal inflamm
      - crypt damage (cryptitis, architectural inflamm, crypt loss, abscesses)
      - ulceration