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IBD - Coggle Diagram
IBD
UC
general
recurrent infl.+ulcerative disease of colon and rectum
presentation
diarrhoea
bleeding
cramp-like pain
loss of appetite
weight loss
mucosal disease
types
ulcerative proctitis
distal colitis
left-sided colitis
total colitis
monitoring
sigmoidoscopy
colonscopy
US/CT
ESR, leukocytes, CRP, faecal calproctetin
DX
colonoscopy
Xray of s.i.
measure
ESR
leukocytes
CRP
potassium
calcium
magnesium
gamma-GT
AST
PTT
vit a/b12
ALT
Cancer
long standing IBD as risk factor for CRC
recommendations for surveillance
pancolitis >8yrs
left sided UC for 15yrs
chromoendoscopy
diffuse infl.
ulcers
crypt abscesses
infiltration
reduced goblet cell count
no strictures/fistulas/granulomas
diffuse cryptitis
mucin depletion
paneth cell metaplasia
erythema
toxic megacolon
pseudopolyps
thin wall
general
definition
infectious colitis
secondary to infectious organisms
acute
resolves quickly(in days)
dont come to attention
pathology
oedema
neutrophils
organisms
bacterial
campylobacter jejuni
yersinia
Enterohaemorrhagic E.Coli
Enteroinvasive E.Coli
C.Difficile colitis
pseudomembranes
tan
neutrophils
emanate from crypts
dead epi. cells
infl. debris
easily seen on gross exam
variant forms
lymphocytic colitis
usually due to medications
collagenous colitis
not chronic
features
chronic watery diarrhoea
normal endoscopy/radiology
pathology
lymphocytes
collagen
responds well to localised steroids
Suspicion
diarrhoea>4wks
bowel movements >2/day
liquid/soft stools
abd. pain
haemorrhagic stools
complications
intestinal
strictures
more CD
fistulas
more CD
abscesses
more CD
neoplasia
more UC
toxic megacolon
more UC
massive haemorrhage
extra-intestinal
pyoderma gangrenosum
sclerosing cholangitis
pericholangitis
ankylosing spondylitis
growth retardation
scleritis
arthritis
Chronic IBD
incidence
low
UC
1 in 10,000
Crohn's
0.5 per 10,000
prevalence
high
220 new cases per yr in Ireland
UC the most
serious dx but most mild
medical treatments
surgery
pan-proctocolectomy
can cure UC
for more severe forms
pathogenesis
chronic recurring infl.
2° to abnormal prolonged immune response to normal stimulus in genetically susceptible individuals
genetic
crohns
susc. gene on 16q
NOD2/CARD15
infl. response to bacterial triggers
cytosolic receptor for bacterial muramyl dipeptide
activation of NFkappa B
also results in paneth cells being deficient in 'defensins
high degree of risk in homozygous
absolute risk=1/25
other IBD genes
5q
10q
infectious
candidate micro-organisms
mycobacterium paratuberculosis
normal luminal bacteria
irritate and perpetuate and abnormal infl. response
disordered immune regulation
defects in innate immunity
crucial
TLRs
TLR2 keeps NOD2 in check
^T-helper & reduced t suppressor cells
specific to luminal bacteria
Crohn's
Th1
IL-2
interferon-gamma
TNF
UC
Th2
IL-4
IL-5
IL-10
1L-13
IL-12/23?
Crohn's
features
transmural
any part of intestinal tract
skip lesions
strictures
fistulas
erythema
thickened lining
ulcers throughout thickness
granulomas
DX
colonoscopy
gastroscopy
X-ray of s.i.
measure
ESR
leukocytes
CRP
potassium
calcium
magnesium
gamma-GT
AST
ALT
PTT
vit a/b12
stool micro-organisms
monitoring
US
CT
ESR, leukocytes, CRP, faecal calproctetin