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Gastroenterology IBD - Coggle Diagram
Gastroenterology IBD
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Epidemiology
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Follows Urbanisiation and industrialisation
Immune mediated disease - greater hygiene - less exposure to disease
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Pathophysiology
- Disease of the immune system
- Dysfuntional immune response in genetically susceptible indiduals
- Chronic intestinal inflammation due to the abnormal T-cells and macrophaes activity
- Releases inflammatory cytokines like TNF-aloha, IL -1 and IL-6
- Intestinal barrier becomes compromised, allowing further microbial entry ad activation of the immune systen
- Tissue destruction and systemic complications
- Actination: APC activated, stimulate CD4 T cells which active macrophages
- Activated immune cells release inflam cytokines that promote chronic inflammation and tissue damage
Medicaitions
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Fast efficacious reasonably safe compared to steroid, now cheap
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Newer Medication
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Safety profile
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- Bloot clots - thromboembolism
- Major adverse cadiovasular
- Particular older pts , smoking
Meta analysis Data
Crohn's
- Infliximab 5mg/kg ranked first for induction of clinical remission
- Rizankizumab 600mg 1st in biologic naive and biologic exposed pts
- Upadacitinib 30mg dialy 1st for maintanance and remission
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Crohn's Disease
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Disease Behaviours
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- Fistulating (Penetrating)
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- 30% Non stricturing non-penetrative
Upper GI Crohn's
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More frequently have pain, cramp, nausea and poor appetite
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Perianal Crohn's
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- Usually sevre rectal inflammation
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Associated with worse outcomes, significant psych burden, impacts QoL
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Similarities CD and UC
- Chronic Incurable involve inflammated gut
- Can occcur at any age, but more commly 16-30
- Different from IBS but both can occur
- Symptoms based on disease behaviour and distribution
Acate Severe Colitis
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EArly flexible unprepared sigmoidscopy and stool culture to rule out infection
Need to outrule C.diff and CMV - biopsies and PCR
Need to be ready to escalate to rescue therapy
Check Quantiferon, UBV, HCV, HIV, VZV on admission
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Acute Management
- All patient medically-admitted with new IBD or complications of known IBD should be under he care of Gastroenterolo
- Stool chart, monitor HR, tempertaure, BP very carefully
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Small Intestine
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Function
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- Onward movement of digestive contents
- Complete chemical digestion
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Character of Symptoms
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Large Bowel
- Frequet, regular, small volume
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Introduction to IBD
Definition
Umbrella term for a group of inflammatory conditions of the colon and small intestine with Crohn's disease and Ulcerative colitis being the prinipals
Crohn's disease affects the small intestine and large intestine, mouth oesophagus stomach and the anus
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LArge bowel
Function
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- Stool storage before egestion
Pre-Empting Disease
- PRe-diagnosis, primary prevention
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