Liver & GIT
The presence of anti-Saccharomyces cerevisae antibody is a surrogate marker of one of the following:(MAY 10)
a. Rectal sparing b. Aphthous ulceration
c. Fistula d. Skip lesions.
a. Thickened folds.
b Aphthous ulcer.
c. Cobble stoning of small intestine.
d. Stricture, fistula in advanced disease.
e. ‘ String sign’ represents long areas of circumferential inflammation and fibrosis.
f. CT findings include mural thickening> 2cm, perianal disease and adenopathy.
a. Fistula formation.
b. Perforation leading to peritonitis.
c. Intestinal obstruction.
d. Massive hemorrhage.
f. Carcinoma especially with colonic involvement.
Condition predisposing to colo rectal carcinoma
a. Capecitabine: This is an anti pyrimidine drug that could be given orally for breast and colorectal cancer.
b. Cetuximabis used in treatment of metastatic colorectal cancer and head and neck cancer.
Active disease Severe Perianal / Fistulizing disease
Mild –Mod 5 ASA Metronidozole / ciprofloxacin
(a) 5-ASA Metronidazole Azathioprine / 6 MP
(b) Metronidazole / ciprofloxacin Ciprofloxacin
(c ) Oral Glucocorticoids Oral.I/V Glucorticoid Infliximab
(d) Azathioprine Azathioprine I/V Cyclosporine
(e) 6 Mercaptopurine 6-Mercaptopurinle
(f) Infliximab Infliximab
Azathioprine / 6MP
Newer drugs for the treatment of IBD
1. Tacrolimus 2. Mycophenolate
3. 6 Thioguanine 4. Thalidomide 5.Natalizumab
The differences between ulcerative colitis and Crohn’s disease (Ref. H-18thedi, Pg 2486,Table-295.5)
Features Ulcerative colitis Crohn’s disease
1. Monozygotic twins 8%concordance 67%concordance
2. Gross blood in stools present rare
3. Systemic symptoms rare present
4. Pain rare present
5. Abdominal mass rare present
6. Perineal disease absent present
7. Fistula absent present
8. Small int. obstruction absent present
9. Colonic obstruction rare present
10. Response to antibiotic absent present
11. Recurrence after surgery- absent present
12. ANCA positivity 60-70% 5-10%
13. Rectal sparing rare present
14. Continuous disease present rare
15. Cobblestone appearance- absent present
16. Granuloma absent present
17. Abnormal small int. absent present
18. Abnormal terminal ileum- rare present
19. Segmental colitis absent present
20. Asymmetrical colitis absent present
21. Stricture rare present
Serological markers for inflammatory bowel disease
1. Perinuclearantineutrophil Cytoplasmic Antibodies (p-ANCA)
a. Positive in 60 – 70% of U.C. patients (and 5 – 10% of CD patients)
b. p ANCA +ve with ASCA –ve = 97% specificity for UC
c. p ANCA +ve with ASCA +ve = 97% specificity for CD
2. Anti saccharomycesCerevisiae Antibodies (ASCA)
a. Positive in 60 – 70% of CD patients (& 10-15% of U.C. patients)