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Number 1 = Anal Fissure
Crack in the wall of the anal mucosa so that the circular muscle is exposed
Usually directly posterior and in the midline
Associated with IBD esp Crohn’s
Treatment focused on the primary condition
Number 2 = Clubbing
All four of the features outlined below should be present before the fingernails can be said to be clubbed:
Increased sponginess of the nail bed
Loss of the usual acute angle between the nail and the nail bed
Increased curvature of the nail
Increased mass of the soft tissues over the terminal phalanges
Number 3 =Erythema Nodosum
Characteristically the lesions are:
Painful, palpable, dusky blue nodules or plaques:
may vary from 1-10 cm in diameterpoorly demarcatedmost commonly on the shins and calvesmay spread to the thighs and extensor surfaces of the forearm and the trunktend to be symmetricalinitially the nodules are firm but becomes more fluctuant as the disease progress
Lesions resolve completely over 1-2 months
Ulceration of the nodules cannot be seen and usually heal without atrophy or scarring
Number 4 = Pyoderma Gangrenosum
Lesions begin in the dermis with secondary
Necrosis of the epidermis
The first sign is a pustule with surrounding erythema
With time an ulcer develops - the walls of the ulcer are blue and well defined
Number 6 = Episcleritis
The episclera is the thin layer of vascular tissue overlying the sclera.
Inflammation of this layer is referred to as episcleritis.
May be accompanied by scleritis.
It is benign and self-limited.
It is a good indicator of disease activity in IBD.
Number 9 = Primary Sclerosing Cholangitis
75% associated with IBD – esp UC
Should be suspicious of this in a pt with IBD and abnormal LFTs – esp raised Alk Phos
Majority of patients will be asymptomatic at time of diagnosis – but will have advanced disease
Pruritus and fatigue are early symptomsNight sweats, fevers and RUQ pain.
Mean survival for patients is 7 years (biliary cirrhosis, portal hypertension & cholangitis, cholangiocarcinoma.)