Makindo Medical Notes

Inflammatory Bowel Disease (IBD) refers to chronic, relapsing inflammation of the gastrointestinal tract, mainly encompassing Ulcerative Colitis (UC) and Crohn’s Disease (CD). It results from a dysregulated immune response in genetically predisposed individuals, triggered by environmental factors 🌍.

⚙️ Pathophysiology

• 🧬 Immune dysregulation: Excessive T-cell activation → cytokine release (TNF-α, IL-12, IL-23) → chronic inflammation.
• 🌱 Environmental triggers: Smoking 🚬 worsens Crohn’s but protects against UC.
• 👨‍👩‍👧 Genetics: Strong family history; mutations (e.g. NOD2 in Crohn’s).
• 💩 Microbiome imbalance: Altered gut flora contributes to inflammation.

📊 Comparison: Crohn’s vs Ulcerative Colitis

🩺 Clinical Features

• 💩 GI: Chronic diarrhoea, abdominal pain, rectal bleeding, weight loss.
• 🌍 Systemic: Fatigue, fever, anaemia.
• ⚠️ Red flags: Severe bloody diarrhoea, toxic megacolon, sepsis.
• 👁️🦴 Extra-intestinal: Joints, eyes, skin, liver (PSC).

🔬 Investigations

• 🩸 Bloods: FBC (anaemia, ↑ platelets), CRP/ESR (inflammation), LFTs (esp. ALP if PSC).
• 💩 Stool: Faecal calprotectin ↑, exclude infections (C. diff, cultures).
• 📹 Endoscopy: Colonoscopy with biopsy (diagnosis + histology: granulomas in Crohn’s, crypt abscesses in UC).
• 🖼️ Imaging: MRI/CT enterography (Crohn’s small bowel involvement), AXR for toxic megacolon.

🛠️ Management

• Induction of remission:
  • 💊 Corticosteroids (prednisolone, budesonide).
  • 💉 Biologics for severe/refractory disease (anti-TNF e.g. infliximab, adalimumab; vedolizumab).
• Maintenance of remission:
  • 🌹 UC: Aminosalicylates (mesalamine, sulfasalazine).
  • 🌿 Crohn’s: Immunomodulators (azathioprine, 6-MP, methotrexate).
  • Continue biologics if needed.
• Surgery:
  • UC: colectomy is curative.
  • Crohn’s: surgery for complications (strictures, fistulas).
• Supportive: Nutrition 🥗, smoking cessation 🚭, vaccination 💉, osteoporosis prevention, psychological support 🧠.

⚠️ Complications

• 🔄 Relapsing-remitting flares → chronic disability.
• 🧪 Colorectal cancer risk (screening colonoscopy after 8–10 yrs disease).
• 🌡️ Acute severe UC → toxic megacolon, perforation.
• 🚑 Crohn’s → strictures, fistulas, abscesses.

📚 Teaching Pearls

💡 Key Exam Clues:
– Crohn’s = transmural, skip lesions, perianal disease, fistulas.
– UC = continuous from rectum, mucosal only, bloody diarrhoea.
– Smoking 🚬 worsens Crohn’s, protects UC.
– Surgery cures UC, not Crohn’s.
– Always exclude infection (esp. C. diff) before starting steroids or biologics.