142 - IBD Flashcards
1
Q
Where is pain usually present in UC in distal disease?
A
Left lower quadrant
2
Q
Which part of the GIT is always affected in UC?
A
Rectum
3
Q
In which disease are skip lesions of the mucosa observed in endoscopic investigations?
A
Crohn’s disease
4
Q
In which disease are granulomas present in histological samples of GIT biopsy?
A
Crohn’s
5
Q
Which genes are implicated in the susceptibility of developing Crohn’s/ Ulcerative Colitis
A
Genes - 14, 12, 6
Chromosome 16 strong
6
Q
What disease are orofacial granulomatosis a sign of?
A
Crohn’s
7
Q
Which disease is perianal disease and fistulae a sign of?
A
Crohn’s
8
Q
What is this? What disease is it associated with?
A
Pyoderma gangrenosum → pyoderma gangrenosum
9
Q
What ophthalmic complications are associated with IBD?
A
- Episcleritis
- Uveitis
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
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
12
Q
Thi incidence of which IBD has risen in the past 20 year?
A
Crohn’s
13
Q
What is meant by the bimodal age distribution of IBD?
A
- peak at 15-40
- 2nd peak 50-80
14
Q
Which race is more susceptible to developing IBD?
A
Jews
15
Q
What percentage of patients with IBD have a first degree relative with IBD?
A
10-25%
16
Q
Which disease is CARD-15 gene associated with?
A
Crohn’s
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
18
Q
In which disease is smoking protective?
A
UC
19
Q
In which disease is an appendicectomy shown to be protective?
A
UC
20
Q
In which IBD have P-ANCA (antibodies) been found to be elevated?
A
UC
21
Q
In which IBD have ASCA (anti-Saccheromyces cerevisiae antibodies) shown to be elevated?
A
Crohn’s
22
Q
Which IBD is a Th1 cytokine profile most likely to be generated?
A
Crohn’s
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
24
Q
In which IBD is cobblestoning a feature of endoscopy?
A
Crohn’s
25
What are UC patients in danger of developing?
Toxic megacolon
26
In which IBD can steatorrhoea be a feature?
Crohn's
27
In which disease is rectal bleeding common?
UC
28
In which IBD are cryptitis and crypt abscesses found?
UC
29
Which cells infiltrate the crypts to form cryptitis?
Neutrophils
30
Which IBD has tenesmus as a clinical symptom?
UC
31
What percentage of pts need to have a colectomy in the 1st 3 years post diagnosis of UC?
30%
32
What is the risk associated with more than 10 years of pan-colitis?
Colorectal cancer
33
Which lymphocyte is involved with UC?
TH2 lymphocyte (CD4+ T helper cells)
34
Which lymphocyte is involved with Crohn's disease?
TH1 lymphocyte (CD4+ T Helper cell)
35
What feature of Crohn's can cause obstruction of the bowel?
Strictures
36
What can ileal disease in Crohn's disease lead to?
(4 listed)
* defective B12 absorption
* defective bile salt absorption
* loss of bile salts → gall stones
* steatorrhoea from malabsoption of fat soluble vits
37
In which IBD is there mucin depletion?
UC
38
What is Meckel's diverticulum?
* 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
What is Hirschsprung's disease?
* 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
What do the viscid secretions in CF cause in the GIT, lungs and reproductive tracts?
* meconium ileus in infants
* pancreatic atrophy
* biliary cirrhosis of liver
* bronchiectasis
* infertility
41
Which adherent bacteria produces secretagogue toxins common in traveller's diarrhoea?
*E.coli*
42
Which adherent bacteria produces a secretagogue toxin which stimulates fluid secretion up to 14 L/day?
*Vibrio cholerae*
43
Which 2 adherent bacteria produce cytotoxins causing epithelial cell necrosis?
* Shigella
* entero-haemorrhagic *E coli*
44
Which bacteria produces a fever by invading the bowel wall causing:
* endocarditis
* meningitis
* osteomyelitis
*Salmonella typhimurium*
45
Which enzyme is elevated in Coeliac?
TTG (Tissue Transgutaminase)
46
What are the microscopic changes of the GIT mucosa in Coeliac disease?
(4 listed)
* poorly formed villi
* inflammed lamina propria
* crypt hyperplasia
* increased number of intra-epithelial lymphocytes
47
What are the long term risks of Coeliac disease?
* adenocarcinoma
* T cell lymphoma
48
What is abnormal about the muscularis propria of acquired diverticular disease?
Attenuated/absent
49
What is diverticulosis?
Outpouchings of the mucosa of the mucosa and submucosa through the muscular wall of the GIT
50
What do the higher luminal pressures of divertilulosis lead to?
* 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
Where is the pain usually felt in diverticulosis?
Right iliac fossa
52
What are the S&S of diverticulosis?
* abdo pain
* diarrhoea/constipation
* rectal bleeding
53
What is the result of radiation poisoning on the bowel?
(4 listed)
* sloughing of intestinal lining
* fibrous obliteration of bv's
* chronic diarrhoea and bleeding
* visceral cancer → prostate, uterus, ovary
54
What is familial adenomatous polyposis?
* inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine
* APC gene chromosome 5
55
What is Lynch syndrome? (Was called HNPCC)
* 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
Which cancer do polyps usually turn into?
Adenocarcinoma
57
Give an example of an aminosalicylate used in the treatment of IBD
Mezalanine
58
Name a corticosteroid used in the treatment of IBD
Prednisolone
59
Name an immunosuppressant used in the treatment of IBD
(3 listed)
* ciclosporin
* azathioprine
* methotrexate
60
Name a biological therapy drug used in the treatment of IBD
(2 listed)
* infliximab
* adalimumab
61
What is the first line treatment of UC?
ASA's (aminosalicylate) → mesalanine
62
What are the aims of ASA treatment for UC?
(3 listed)
* induce remission
* maintain remission
* prevent colonic Ca
63
What is the MOA of mezalanine? (treatment of UC)
* anti-inlflammatory
* inhibitis synthesis of
* prostaglandins
* thromboxane
* platelet activating factor
* scavengers O2 radicals
64
Sulfazaine was 1st on the market for the Tx of UC but had SE's:
?
(3 listed)
* allergic
* rash
* fever
* leucopaenia
* agranulocytosis
* male infertility
* orange secretions
65
Where in the GIT is mezalanine rapidly and completely absorbed?
Upper jejunum
66
What drug class are:
* osalazine
* balsalazide
examples of? (Tx of UC)
* aminosalycilates
67
What are the main risks of long-term corticosteroid use?
(e.g. in the treatment of IBD)
Cushingoid symptoms → OP + increased susceptibility to infection
68
What drug treatment should be prescribed in addition to corticosteroids?
(to counteract SE's)
Calcium and bisphosphonates as bone protection
69
When should immunosuppressants be used in UC?
* severe/frequent relapse
* those who require \>2 courses of corticosteroids within 1 year period
* relape within 6 weeks of stopping corticosteroids
70
Which blood tests should done routinely when treating with immunosuppressants?
* FBC
* check bone marrow
* leukopaenia
* LFTs
* hepatoxicity
71
What is the biggest risk when treating IBD with the immunosuppressant TPMT?
Bone marrow suppression
72
What is the MOA of ciclosporin?
* calcineurin inhibitor
* prevents expansion of T cell subsets
73
Which IBD is ciclosporin used to manage severe episodes of?
UC → no therapeutic value in Crohn's
74
What is notible about the type of giving sets which should be used in adminstration of IV ciclosporin?
Should be non-PVC → interacts with PVC giving sets
75
Which IBD is methotrexate used to induce and maintain the remission of?
Crohn's
76
What should be given to pt's in addition to methotrexate?
Folic acid (5mg once weekly)
77
Which cytokine do infliximab and adalimumab inhibit in IBD?
TNF-α
78
When is treatment of IBD with infliximab contraindicated?
Severe infection and severe HF
