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JG Year 1 > 142 - IBD > Flashcards

142 - IBD Flashcards

1
Q

Where is pain usually present in UC in distal disease?

A

Left lower quadrant

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2
Q

Which part of the GIT is always affected in UC?

A

Rectum

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3
Q

In which disease are skip lesions of the mucosa observed in endoscopic investigations?

A

Crohn’s disease

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4
Q

In which disease are granulomas present in histological samples of GIT biopsy?

A

Crohn’s

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5
Q

Which genes are implicated in the susceptibility of developing Crohn’s/ Ulcerative Colitis

A

Genes - 14, 12, 6

Chromosome 16 strong

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6
Q

What disease are orofacial granulomatosis a sign of?

A

Crohn’s

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7
Q

Which disease is perianal disease and fistulae a sign of?

A

Crohn’s

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8
Q

What is this? What disease is it associated with?

A

Pyoderma gangrenosum → pyoderma gangrenosum

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9
Q

What ophthalmic complications are associated with IBD?

A
  • Episcleritis
  • Uveitis
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10
Q

Which diseases can have primary sclerosing cholangitis (PSC) associated with?

A
  • IBD
    • fibrosing inflammation and obliteration of the bile ducts
    • chronic cholestatic liver disease
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11
Q

Which blood tests would be useful for the diagnosis of IBD?

A
  • FBC
    • ?anaemia
    • ?leukocytosis
    • ?thrombocytosis
  • ESR
  • CRP
  • U&E
    • low albumin
  • liver enzymes
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12
Q

Thi incidence of which IBD has risen in the past 20 year?

A

Crohn’s

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13
Q

What is meant by the bimodal age distribution of IBD?

A
  • peak at 15-40
  • 2nd peak 50-80
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14
Q

Which race is more susceptible to developing IBD?

A

Jews

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15
Q

What percentage of patients with IBD have a first degree relative with IBD?

A

10-25%

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16
Q

Which disease is CARD-15 gene associated with?

A

Crohn’s

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17
Q

What effect does CARD-15 protein have in IBD?

A
  • activates nuclear factor kappa B in macrophages
  • makes them more responsive to bacterial LPS
  • NFκB responsible to activation of inflammatory mediators
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18
Q

In which disease is smoking protective?

A

UC

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19
Q

In which disease is an appendicectomy shown to be protective?

A

UC

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20
Q

In which IBD have P-ANCA (antibodies) been found to be elevated?

A

UC

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21
Q

In which IBD have ASCA (anti-Saccheromyces cerevisiae antibodies) shown to be elevated?

A

Crohn’s

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22
Q

Which IBD is a Th1 cytokine profile most likely to be generated?

A

Crohn’s

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23
Q

Which 3 broad categories can Crohn’s disease be divided into?

A
  • inflammatory disease
    • diarrhoea and abdo pain
  • fibro-stenotic disease
    • intestinal/ colonic strictures → bowel obstruction
    • abdo pain, N&V, fever
  • fistulising disease
    • transmural inflammation → sinus tracts
    • localised peritonitis
      • fever, abdo pain, abscess
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24
Q

In which IBD is cobblestoning a feature of endoscopy?

A

Crohn’s

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25
Q

What are UC patients in danger of developing?

A

Toxic megacolon

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26
Q

In which IBD can steatorrhoea be a feature?

A

Crohn’s

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27
Q

In which disease is rectal bleeding common?

A

UC

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28
Q

In which IBD are cryptitis and crypt abscesses found?

A

UC

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29
Q

Which cells infiltrate the crypts to form cryptitis?

A

Neutrophils

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30
Q

Which IBD has tenesmus as a clinical symptom?

A

UC

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31
Q

What percentage of pts need to have a colectomy in the 1st 3 years post diagnosis of UC?

A

30%

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32
Q

What is the risk associated with more than 10 years of pan-colitis?

A

Colorectal cancer

33
Q

Which lymphocyte is involved with UC?

A

TH2 lymphocyte (CD4+T helper cells)

34
Q

Which lymphocyte is involved with Crohn’s disease?

A

TH1 lymphocyte (CD4+ T Helper cell)

35
Q

What feature of Crohn’s can cause obstruction of the bowel?

A

Strictures

36
Q

What can ileal disease in Crohn’s disease lead to?

(4 listed)

A
  • defective B12 absorption
  • defective bile salt absorption
  • loss of bile salts → gall stones
  • steatorrhoea from malabsoption of fat soluble vits
37
Q

In which IBD is there mucin depletion?

A

UC

38
Q

What is Meckel’s diverticulum?

A
  • Remnant of vitello-intestinal duct linking embryonic gut with yolk sac
  • 2% of population, 2 ft from I/C valve, 2 inches long
  • heterotypic gastric mucosa - glands with acid producing parietal cells
39
Q

What is Hirschsprung’s disease?

A
  • Absense of ganglion cells in nervous plexus
  • Spasm of segment of rectum - ‘normal’ bowel looks dilated in comparison to segment devoid of ganglion cells
  • congenital megacolon with severe constipation
40
Q

What do the viscid secretions in CF cause in the GIT, lungs and reproductive tracts?

A
  • meconium ileus in infants
  • pancreatic atrophy
  • biliary cirrhosis of liver
  • bronchiectasis
  • infertility
41
Q

Which adherent bacteria produces secretagogue toxins common in traveller’s diarrhoea?

A

E.coli

42
Q

Which adherent bacteria produces a secretagogue toxin which stimulates fluid secretion up to 14 L/day?

A

Vibrio cholerae

43
Q

Which 2 adherent bacteria produce cytotoxins causing epithelial cell necrosis?

A
  • Shigella
  • entero-haemorrhagic E coli
44
Q

Which bacteria produces a fever by invading the bowel wall causing:

  • endocarditis
  • meningitis
  • osteomyelitis
A

Salmonella typhimurium

45
Q

Which enzyme is elevated in Coeliac?

A

TTG (Tissue Transgutaminase)

46
Q

What are the microscopic changes of the GIT mucosa in Coeliac disease?

(4 listed)

A
  • poorly formed villi
  • inflammed lamina propria
  • crypt hyperplasia
  • increased number of intra-epithelial lymphocytes
47
Q

What are the long term risks of Coeliac disease?

A
  • adenocarcinoma
  • T cell lymphoma
48
Q

What is abnormal about the muscularis propria of acquired diverticular disease?

A

Attenuated/absent

49
Q

What is diverticulosis?

A

Outpouchings of the mucosa of the mucosa and submucosa through the muscular wall of the GIT

50
Q

What do the higher luminal pressures of divertilulosis lead to?

A
  • increased elastin deposition in muscularis propria with thickening and shortening of muscle coat
  • redundant folds of mucosa pushed out through weakness in muscle coat where blood vessels enter
51
Q

Where is the pain usually felt in diverticulosis?

A

Right iliac fossa

52
Q

What are the S&S of diverticulosis?

A
  • abdo pain
  • diarrhoea/constipation
  • rectal bleeding
53
Q

What is the result of radiation poisoning on the bowel?

(4 listed)

A
  • sloughing of intestinal lining
  • fibrous obliteration of bv’s
  • chronic diarrhoea and bleeding
  • visceral cancer → prostate, uterus, ovary
54
Q

What is familial adenomatous polyposis?

A
  • inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine
  • APC gene chromosome 5
55
Q

What is Lynch syndrome? (Was called HNPCC)

A
  • autosomal dominant genetic condition
  • high risk of colon cancer (as well as other cancers including endometrial cancer (second most common), ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin.)
  • increased risk for these cancers is due to inherited mutations that impair DNA mismatch repair
56
Q

Which cancer do polyps usually turn into?

A

Adenocarcinoma

57
Q

Give an example of an aminosalicylate used in the treatment of IBD

A

Mezalanine

58
Q

Name a corticosteroid used in the treatment of IBD

A

Prednisolone

59
Q

Name an immunosuppressant used in the treatment of IBD

(3 listed)

A
  • ciclosporin
  • azathioprine
  • methotrexate
60
Q

Name a biological therapy drug used in the treatment of IBD

(2 listed)

A
  • infliximab
  • adalimumab
61
Q

What is the first line treatment of UC?

A

ASA’s (aminosalicylate) → mesalanine

62
Q

What are the aims of ASA treatment for UC?

(3 listed)

A
  • induce remission
  • maintain remission
  • prevent colonic Ca
63
Q

What is the MOA of mezalanine? (treatment of UC)

A
  • anti-inlflammatory
  • inhibitis synthesis of
    • prostaglandins
    • thromboxane
    • platelet activating factor
  • scavengers O2 radicals
64
Q

Sulfazaine was 1st on the market for the Tx of UC but had SE’s:

?

(3 listed)

A
  • allergic
    • rash
    • fever
    • leucopaenia
    • agranulocytosis
  • male infertility
  • orange secretions
65
Q

Where in the GIT is mezalanine rapidly and completely absorbed?

A

Upper jejunum

66
Q

What drug class are:

  • osalazine
  • balsalazide

examples of? (Tx of UC)

A
  • aminosalycilates
67
Q

What are the main risks of long-term corticosteroid use?

(e.g. in the treatment of IBD)

A

Cushingoid symptoms → OP + increased susceptibility to infection

68
Q

What drug treatment should be prescribed in addition to corticosteroids?

(to counteract SE’s)

A

Calcium and bisphosphonates as bone protection

69
Q

When should immunosuppressants be used in UC?

A
  • severe/frequent relapse
  • those who require >2 courses of corticosteroids within 1 year period
  • relape within 6 weeks of stopping corticosteroids
70
Q

Which blood tests should done routinely when treating with immunosuppressants?

A
  • FBC
    • check bone marrow
    • leukopaenia
  • LFTs
    • hepatoxicity
71
Q

What is the biggest risk when treating IBD with the immunosuppressant TPMT?

A

Bone marrow suppression

72
Q

What is the MOA of ciclosporin?

A
  • calcineurin inhibitor
  • prevents expansion of T cell subsets
73
Q

Which IBD is ciclosporin used to manage severe episodes of?

A

UC → no therapeutic value in Crohn’s

74
Q

What is notible about the type of giving sets which should be used in adminstration of IV ciclosporin?

A

Should be non-PVC → interacts with PVC giving sets

75
Q

Which IBD is methotrexate used to induce and maintain the remission of?

A

Crohn’s

76
Q

What should be given to pt’s in addition to methotrexate?

A

Folic acid (5mg once weekly)

77
Q

Which cytokine do infliximab and adalimumab inhibit in IBD?

A

TNF-α

78
Q

When is treatment of IBD with infliximab contraindicated?

A

Severe infection and severe HF

JG Year 1 (27 decks)

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