GASTRO/GENSURG

ResponseMural thickening of large bowel splenic flexure
Thumbprinting (thickening and oedema of haustra)
Stricture first part of transverse colon
Second bowel left flank with haustra/plicae ? lead pipe changes

Differential (17M 8 weeks GI bleed), DDx of Thumbprinting:
IBD (UC+Crohns)
Infection eg: pseudomembranous colitis
Bowel ischaemia
Diverticulitis
mucosal/submucosal haemorrhage
Lymphoma
Amyloid
Thypitis

Lead pipe = complete loss of haustral markings >> smooth appearance. Classic for UC
Thumbprinting - Lare bowel wall thickening usually secondary to oedema. Think inflammatory/infective process. Normal haustra become thickened at regular intervals and appear like thumbprints projecting into the lumen.

Note radiopaedia says this XR was probably infective colitis!

ResponseStool MCS - Rule out enteric pathogens
Foecal calprotectin - differentiat bowel inflammation from functional causes
CRP/ESR - Severity marker/monitor response to treatment
FBC - ? anaemia
LFT / hypoalbuminaemic
B12/iron/folate - B12/iron deficiency from chronic loss
CTAP - extent/severity of disease, assess for complications (Eg: abscess formation

ResponseIV hydration
IV steroids eg: methylpred 1mg/kg/day
IV antibiotics (broad spectrum)
Analgesia
Mesalazine 500 mg TDS maintenance of remission in mild to moderate colitis
Immunosuppression - methotrexate/azathioprine
Biologic - infliximab 5mg/kg if no improvement
Mesalazine = salycilate antiinflammatory + immunosuppressant. MOA not well undeerstood
Really??