Back to ELM2: Gastrointestinal
Inflammatory Bowel Disease & Chronic Liver Disease
~1 min read
Lesson 2 of 16
Notes
IBD & Chronic Liver Disease
Crohn's vs Ulcerative Colitis
| Feature | Crohn's Disease | Ulcerative Colitis |
|---------|----------------|--------------------|
| Distribution | Any part GI tract, skip lesions | Colon only, continuous from rectum |
| Layer | Transmural | Mucosa/submucosa |
| Histology | Granulomas | Crypt abscesses |
| Complications | Fistulae, strictures, abscess | Toxic megacolon, colorectal cancer |
| Smoking | Worsens | Protective |
IBD Management
- Remission induction: corticosteroids (prednisolone/budesonide)
- Maintenance: aminosalicylates (UC), azathioprine/6-MP, methotrexate (Crohn's)
- Biologics: anti-TNF (infliximab, adalimumab) for moderate–severe disease
Chronic Liver Disease & Cirrhosis
Common causes: alcohol, NAFLD/NASH, viral hepatitis (B, C), autoimmune hepatitis, PBC, haemochromatosis
Child-Pugh score (bilirubin, albumin, PT, ascites, encephalopathy): A/B/C
Complications of Cirrhosis
- Ascites: Ôåæ portal pressure + Ôåô oncotic pressure; treat: salt restriction, spironolactone ┬▒ furosemide
- SBP: fever, abdominal pain, confusion in ascitic patient; diagnose: ascitic neutrophils >250 cells/mm┬│; treat: IV cefotaxime
- Hepatic encephalopathy: ammonia accumulation; treat: lactulose, rifaximin
- Variceal bleeding: IV terlipressin, broad-spectrum antibiotics, endoscopic banding
- HRS: type 1 (rapidly progressive AKI), type 2 (gradual); treat: terlipressin + albumin