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\author{MJC3}
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  /Title (ibd-crohn-s.pdf)
  /Creator (Cheatography)
  /Author (MJC3)
  /Subject (IBD/ CROHN'S Cheat Sheet)
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\noindent
\begin{multicols}{3}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{IBD/ CROHN'S Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{MJC3} via \textcolor{DarkBackground}{\uline{cheatography.com/212269/cs/46133/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}MJC3 \\
  \uline{cheatography.com/mjc3} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 16th April, 2025.\\
   Updated 16th April, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{4}

\begin{tabularx}{3.833cm}{x{1.30454 cm} x{2.12846 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment – Ulcerative Colitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Mild-Moderate disease}} & 5-Aminosalicylates (suppository or enema possibly combined with oral aminosalicylates) If unable to tolerate aminosalicylates: Steroids (topical corticosteroid or oral prednisolone) \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
{\bf{Resistant Disease}} & Immunosuppressants (eg Azathioprine, Mercaptopurine) Anti-TNF monoclonal Ab (Infliximab, Adalimumab) \tn 
% Row Count 13 (+ 5)
% Row 2
\SetRowColor{LightBackground}
{\bf{Severe colitis}} & Intravenous corticosteroids Ciclosporin Infliximab (5 mg/kg infused over 2 hours at 2 and 6 week intervals) (Assuming 3 doses, average cost per patient = £5,035) Surgery \tn 
% Row Count 21 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{0.85825 cm} x{2.57475 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Therapeutic Pyramid for Active UC}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Mild:}} & Topical Steroids: Aminosalicylates \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Moderate:}} & Infliximab, Systemic Corticosteroids, Oral steroids \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Severe:}} & Surgery, Cyclosporine, Infliximab \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{IBD and Cancer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Increased risk of colorectal cancer (CRC) in UC and Crohn's colitis \newline 20-30\% risk at 30 years from diagnosis \newline Regular surveillance colonoscopy performed from 8-10 years post-diagnosis \newline 5-ASAs are protective \newline  \newline Risk of CRC particularly high in  \newline     patients with UC +  \newline     Primary Sclerosing Cholangitis \newline PSC also carries a high			   	           risk of cholangiocarcinoma}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Ciclosporin}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Calcineurin inhibitor \newline Prevents clonal expansion of T cell subsets \newline Rapid onset of action \newline  \newline Used as salvage therapy for severe UC not responding to IV steroids \newline Usually introduced on day 3 of steroids \newline IV 2mg/kg/day \newline Responders converted to oral Ciclosporin for 3-6 months and switched to Azathioprine/6-MP (Ciclosporin not used long-term) \newline  \newline Requires regular monitoring of   \newline Drug levels/Full blood count/Renal function/Blood pressure}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Immunosuppressants}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Indicated for severe or refractory IBD}} & Thiopurines. Methotrexate. Ciclosporin. \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{BSG guidelines advise use in following situations}} & Severe relapse or frequently relapsing disease. 2 or more steroid course required within 12 months. Relapse below 15mg prednisolone. Relapse within 6 weeks of stopping steroids. \tn 
% Row Count 12 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Pathology of UC}}  \tn
% Row 0
\SetRowColor{LightBackground}
Idiopathic chronic inflammatory disorder of the colonic mucosa, with the potential for extraintestinal inflammation. & The disease extends proximally  from the anal verge in an uninterrupted pattern to involve all or part of the colon \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.30454 cm} x{2.12846 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Diagnosis of IBD}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Endoscopy and biopsy}} & Flexible sigmoidoscopy or Colonoscopy \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Radiology}} & Contrast enhanced ultrasound, Barium studies, CT, MRI, Capsule endoscopy \tn 
% Row Count 5 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Exclude infection \newline  \newline Blood tests helpful but not diagnostic}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{p{0.3033 cm} x{1.30419 cm} x{1.42551 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{3.833cm}}{\bf\textcolor{white}{UC vs CD}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & UC & CD \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
SKIN & Erythema nodosum Pyoderma gangrenosum & Erythema nodosum Pyoderma gangrenosum \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
EYE & Iritis Episcleritis  (inflammation of the episclera : white of the eye) & Iritis Episcleritis \tn 
% Row Count 9 (+ 5)
% Row 3
\SetRowColor{white}
\seqsplit{KIDNEY} & Calculi (kidney stones) Pyelonephritis (inflammation of the kidney due to bacterial infection) & Calculi pyelonephritis \tn 
% Row Count 15 (+ 6)
% Row 4
\SetRowColor{LightBackground}
LIVER & Sclerosing cholangitis (inflammation of bile ducts: impeding bile flow) & Systemic amyloidosis (deposition of amyloid proteins) \tn 
% Row Count 20 (+ 5)
% Row 5
\SetRowColor{white}
\seqsplit{JOINTS} & Seronegative polyarthritis (blood test –ve for rheumatoid factor protein and \seqsplit{cyclic-citrulinated} peptide) & Seronegative polyarthritis \tn 
% Row Count 27 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Aetiology}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Inappropriate immune response}} & Increased pro-inflammatory cytokines eg {\bf{TNF-α, IL-1β, IL-6}} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Breakdown in tolerance to gut microbial load}} & Altered gut flora. Defects in mucosal immunity. \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Combination of factors}} & Enviromental factors. Triggered by particular bacterial pathogen. \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
 & Genetic – increased risk in twins/other relative \tn 
% Row Count 14 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & Diet \tn 
% Row Count 15 (+ 1)
% Row 5
\SetRowColor{white}
 & Smoking \tn 
% Row Count 16 (+ 1)
% Row 6
\SetRowColor{LightBackground}
{\bf{Genetics}} & 47 loci associated with UC  (and counting) \tn 
% Row Count 19 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Smoking (May prevent UC and may cause CD)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Histopathology of UC}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Superficial diffuse inflammation in the lamina propria affecting the colon only}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Characteristics}} & Continuous from the rectum up to the caecum \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & Crypt abscesses, goblet cell depletion and crypt distortion \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
 & Can affect the distal few cm of small bowel – 'backwash ileitis' \tn 
% Row Count 12 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & Non-smokers \tn 
% Row Count 13 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{The most intense inflammation begins :}} & the lower right in the sigmoid colon and extends upward and around to the ascending colon. At the lower left is the ileocecal valve with a portion of terminal ileum that is not involved. \tn 
% Row Count 23 (+ 10)
% Row 6
\SetRowColor{LightBackground}
{\bf{Repeated ulceration and healing cycles result in:}} & Granulation tissue resembling polyps \tn 
% Row Count 26 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Anti-TNFs adverse effects}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Infections \newline Steroids/Immunosuppressants/Anti-TNF all increase risk of infection \newline Two or more therapies in combination increases risk 15 fold \newline Active infection/abscesses must be excluded before commencing anti-TNF treatment \newline Patients should be screened for exposure to TB (CXR/Tuberculin skin test) \newline  \newline Malignancy \newline Increased risk of lymphoma (but overall risk still v low) \newline  \newline Heart failure \newline Anti-TNFs contraindicated in severe heart failure}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Ciclosporin – side effects}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Tremor} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Paraesthesia} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Malaise} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Headache} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Abnormal liver function tests} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Hirsutism} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Gingival hyperplasia} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.54594 cm} x{1.33452 cm} x{1.15254 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{3.833cm}}{\bf\textcolor{white}{Thiopurines}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Side effects}} & Nausea & Advise patients to take it at night \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & Allergic reaction & \seqsplit{Fever/Rash/Arthralgia} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Myelosuppression &  \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
 & Hepatotoxicity &  \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Pancreatitis &  \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{Monitoring}} & FBC/LFT every 2 weeks for first 2 months, Then every 4-8 weeks up to \textasciitilde{}6/12, Then every 3/12 &  \tn 
% Row Count 14 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{3.833cm}}{Azathioprine (Aza) \newline Mercaptopurine (6-MP) \newline Purine antimetabolites inhibiting DNA synthesis \newline Aza is metabolised to 6-MP \newline {\bf{Doses}} mg/kg/day \newline 6-MP 0.75-1mg/kg/day}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment – Crohn's}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Initial diagnosis if mild to moderate:}} & 5-ASA's less effective but may have a chemoprotective effect against cancer risk. \seqsplit{Glucocorticosteroids} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
{\bf{ Severe active Crohn's (including fistulising Crohn's)}} & Immunosuppressants  Azathioprine, Mercaptopurine, Methotrexate Anti-TNF therapy (Infliximab) (sever active Crohn's) \tn 
% Row Count 12 (+ 6)
% Row 2
\SetRowColor{LightBackground}
{\bf{For perianal Crohn's:}} & Antibiotics (Metronidazole, Ciprofloxacin) – \tn 
% Row Count 15 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Smoking cessation \newline Nutritional Support \newline Surgey \newline Emotional support: possible delayed growth and onset of puberty in young people \newline Possibility of requiring surgery}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{0.99557 cm} x{2.43743 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Distribution of Crohn's disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Small Bowel}} & 80\% of cases small bowel involved. Majority distal ileum. 1/3 exclusively ileitis. \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Ileo-colonic}} & 50\% have ileocolitis \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Colonic}} & 20\% colonic disease only \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Anus}} & 33\% have anal disease. Other (gastroduodenal, oesophageal, oral). Rare. \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{UC and Crohn's are lifelong relapsing-remitting conditions \newline  \newline Treatment is not curative but aims to suppress inflammation and thereby maintain normal gut structure and function}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.0299 cm} x{2.4031 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Corticosteroids}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Oral}} & Prednisolone (eg 40mg od, 8 week reducing course). Budesonide (lower systemic effects). Beclomethasone (Clipper).  Used for moderate flares of UC/Crohn's. \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
{\bf{Intravenous:}} & For severe UC or Crohn's Hydrocortisone (eg 100mg qds) \tn 
% Row Count 8 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Topical}} & Steroid Suppositories/Enemas (eg Predsol supps, Predfoam enemas). Less effective than topical 5-ASA but can be used in combination. \tn 
% Row Count 13 (+ 5)
% Row 3
\SetRowColor{white}
{\bf{Side effects:}} & Skin thinning. Osteoporosis. Osteonecrosis Easy bruising. Cushing's syndrome (moon face, acne, hirsutism, striae). Cataracts. Diabetes. Hypertension. Psychosis. \tn 
% Row Count 19 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Corticosteroids are very effective at inducing remission  \newline They are not a long-term maintenance therapy because of the effect on cortisol levels on the hypothalamus and anterior pituitary.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.06155 cm} x{1.66815 cm} p{0.3033 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{3.833cm}}{\bf\textcolor{white}{Ciclosporin \& Tacrolimus (FK506)}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ciclosporin}} & Inhibits dephosphorylation of nuclear factor of activated T cells (NFATc) &  \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Tacrolimus (FK506)}} & Binds to FK-506 binding protein (FKBP). Calcineurin inhibitor. &  \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Both prevent}} & interleukin 2 release and  clonal expansion of T cell subsets &  \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.61351 cm} x{1.81949 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Differential Diagnosis of UC}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Crohn's Colitis}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Infective colitis:}} & {\emph{E.coli}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & {\emph{Campylobacter}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
 & {\emph{Salmonella}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & {\emph{Yersinia}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
 & {\emph{Amoebic Dysentery}} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Ischaemic Colitis}}} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
{\emph{*Pseudomembranous Colitis}} & Clostridium difficile infection \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Anti-TNF Therapy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Tumour Necrosis Factor α  \newline Inflammatory cytokine involved in pathogenesis of Crohn's (and UC) \newline You tube TNF McAB Therapy \newline Monoclonal anti-TNF antibodies \newline Infliximab – \newline Route: IV \newline Licensed for Refractory Crohn's or UC/Fistulating Crohn's \newline Also used for severe UC \newline  \newline Adalimumab (Humira) \newline Subcutaneous \newline Licensed for refractory Crohn's}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Pathology of Crohns Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Idiopathic chronic inflammatory disorder of the full thickness of the intestine}} & Most commonly the ileum and the colon, with the potential to involve the gastrointestinal tract at any level from the mouth to the anus and perianal region. \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
{\bf{Typically there is patchy disease in the gastrointestinal tract}} & with intervening areas of normal mucosa "Skip lesions" \tn 
% Row Count 12 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Transmural inflammation with lymphoid aggregates }} & (clusters of lymphoid cells- include T-cells, B-cells and NK cells.) \tn 
% Row Count 16 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{Non caseating granulomas (60\% cases)}} & Caseating "turning to cheese" \tn 
% Row Count 18 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Skip Leisons}}} \tn 
% Row Count 19 (+ 1)
% Row 5
\SetRowColor{white}
{\emph{*Strictures and fistula formation}} & In Crohn's, strictures make the bowel too tight, and fistulas create unnatural pathways—both are serious complications. \tn 
% Row Count 26 (+ 7)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Perianal disease}}} \tn 
% Row Count 27 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Can affect any part of the GI tract}}} \tn 
% Row Count 28 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Smokers}}} \tn 
% Row Count 29 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatments Summary}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Crohn's \& Ulcerative Colitis}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Salicylates} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{5-Amino salicylic acid (5-ASA); mesalamine (Asacol)} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Steroids (glucocorticoids): Methylprednisolone (Medrol)} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Immunosuppressants: Azathioprine \& mercaptopurine} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Ciclosporin A (Sandimmun or Neoral) Tacrolimus (FK-506, Fujimycin) (Prograf, Advagraf, Protopic)} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{NOVEL TREATMENTS}} \newline Nicotine: useful in UC? \newline LTB4 antagonists eg zileuton. \newline Fish oils, eicosopentanoic acid diverts LT production towards LTB5 production. \newline IL1 receptor antagonists (UC). \newline Short Chain fatty acids. \newline CuZnSOD and desferrioxamine (Peroxyl scavenger).}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Epidemiology}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Crohn's disease}} & {\bf{Ulcerative Colitis}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Incidence 8-10/100,000 in UK Prevalence \textasciitilde{}150 per 100,000 (1 in 660 people) & Incidence \textasciitilde{}15/100,000 in UK Prevalence \textasciitilde{}200 per 100,000 (1 in 500 people) \tn 
% Row Count 6 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Peak age at diagnosis 20-40, second smaller peak aged \textasciitilde{}60}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.68217 cm} x{1.75083 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{5-ASAs}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{5 Aminosalicylic acid (Mesalazine)}} & Moderate inflammatory cells and cytokine release from epithelial cells. Mechanism not fully understood but involves inhibition of cyclooxygenase and prostanoid formation and N-acetyl-5-ASA through PPAR gamma (Peroxisome Proliferator Alpha Receptor gamma) \tn 
% Row Count 13 (+ 13)
% Row 1
\SetRowColor{white}
{\bf{Uses - UC}} & Maintainence of remission – mainstay of long-term treatment for UC. Treatment of mild-moderate flares. Chemoprotective effect against colorectal cancer. \tn 
% Row Count 21 (+ 8)
% Row 2
\SetRowColor{LightBackground}
{\bf{Uses – Crohn's}} & Limited effectiveness compared to UC. Limited effectiveness in active Crohn's or maintaining remisson. May reduce risk of relapse after surgery. \tn 
% Row Count 29 (+ 8)
% Row 3
\SetRowColor{white}
{\bf{Side Effects:}} & Diarrhoea! Nausea. Headache Rash (rarely Stevens-Johnson syndrome). Nephrotoxicity (Interstitial nephritis \& Nephrotic syndrome). Agranulocytosis (low white blood cell count). Pancreatitis. \tn 
% Row Count 39 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Oral}} \newline pH dependent resin (Asacol, Salofalk, Mesren) \newline Time-controlled (Pentasa) \newline Multimatrix pH dependent delivery (Mezavant) \newline Carrier molecules split by colonic bacterial enzymes (Sulfasalazine, Olsalazine, Balsalazide \newline {\bf{Dose}} \newline 1.6-4.8g/per day \newline Single daily dosing seems as effective as traditional bd/tds \newline {\bf{Topical}} \newline Suppositories - Proctitis \newline Foam or Liquid enemas  \newline - Distal colitis (rectum and sigmoid) \newline Check FBC/Renal function annually}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{UC vs CD}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ulcerative colitis}} & {\bf{Crohn's disease}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Affects the colon only & Affects any part of the GI tract \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Male:Female 1:1 & Male: Female 1:2 \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
Bloody diarrhoea Abdominal pain & Abdominal pain Weight loss Perianal disease Bloody diarrhoea \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
Continuous, always begins in rectum & Skip lesions \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
No strictures & Stricture and fistula formation with perianal disease \tn 
% Row Count 13 (+ 3)
% Row 6
\SetRowColor{LightBackground}
Mucosal inflammation Diffuse inflammation in the lamina propria Patchy ulceration with crypt abscesses, goblet cell depletion and crypt distortion & Transmural inflammation throughout bowel wall, lymphoid aggregates and non-necrotising granulomas.  Can develop fissuring ulcers, crypt abscesses, goblet cell depletion and crypt distortion \tn 
% Row Count 23 (+ 10)
% Row 7
\SetRowColor{white}
Terminal ileum in 10\% cases & Often affects the terminal ileum (80\%) Any part of alimentary tract can be affected \tn 
% Row Count 28 (+ 5)
% Row 8
\SetRowColor{LightBackground}
No fistulas & Fistulas \tn 
% Row Count 29 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{x{1.16722 cm} x{2.26578 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Clinical Presentation – Crohn's}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Typical Features:}} & Abdominal Pain. Diarrhoea. Weight loss. Anorexia. \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Obstruction secondary to strictures \newline Abscesses, Fistulae \newline Depends on portion of GI tract involved}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Histopathology Crohn's Disease of Ileum}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Inflammatory cells (the bluish infiltrates) extend from mucosa through submucosa and muscularis.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{On the serosal surface inflammatory cells appear as nodular infiltrates with pale granulomatous centres.} \tn 
% Row Count 5 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{3.833cm}{p{0.3433 cm} p{0.3433 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Clinical Presentation of UC}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{'Bloody diarrhoea' and passage of mucus}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Urgency}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Abdominal Discomfort  (pain unusual)}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Usually insidious onset}}} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Can be severe with systemic upset, fever \newline Requires hospitalisation \newline May need urgent surgery}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{UC AND CROHNS}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ulcerative Colitis}} & {\bf{Crohn's Disease}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Only affects colon & Affects mouth to anus \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
No fissures, horizontal ulcers & Deep ulcers \& fissures \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
Malignant change common & Malignant change rare \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Fistulae less common & 10\% have fistulae \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
25\% have anal involvement & 60\% have anal involvement \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Muscular shortening of the colon & Fibrous shortening \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
No skip lessons & Skip lesions \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
No fat or vitamin malabsorption & Fat \& vitamin malabsorption \tn 
% Row Count 16 (+ 2)
% Row 9
\SetRowColor{white}
No granulomas (collection of macrophages) & Granulomas in 50\% \tn 
% Row Count 19 (+ 3)
% Row 10
\SetRowColor{LightBackground}
Mild lymphoid reaction & Marked lymphoid reaction (increased WBC) \tn 
% Row Count 21 (+ 2)
% Row 11
\SetRowColor{white}
Mild fibrosis & Fibrosis \tn 
% Row Count 22 (+ 1)
% Row 12
\SetRowColor{LightBackground}
Mild Serositis & Serositis (inflammation, serous membranes) \tn 
% Row Count 25 (+ 3)
% Row 13
\SetRowColor{white}
Raised ANCA (antineutrophil cytoplasmic antibodies. Autoantibodies directed against own neutrophils.) & ANCA normal \tn 
% Row Count 31 (+ 6)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{UC AND CROHNS (cont)}}  \tn
% Row 14
\SetRowColor{LightBackground}
More common in non-smokers or ex smokers & Increased incidence in smokers \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}