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Lucy Knox - Year 1 > 142 - IBD Inflammatory Bowel Disease > Flashcards

142 - IBD Inflammatory Bowel Disease Flashcards

1
Q

What 2 diseases make up IBD?

A

Ulcerative Colitis

Crohn’s disease

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2
Q

What age of onset is common in IBD?

A

Peak in childhood and another peak in 60s

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3
Q

What are the symptoms of IBD?

A

Diarrhoea Blood + mucous in stooles Lower abdo pain/cramping Dyspeptic symptoms (crohn’s)

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4
Q

What is an important pointer towards IBD in terms of someone’s diarrhoea?

A

Nocturnal diarrhoea - waking from sleep.

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5
Q

What is the difference between the distribution of crohn’s and UC?

A

UC is only in the colon, always starting in the rectum and travlling up Crohn’s can be spread throughout the GI tract, with skip lesions between.

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6
Q

What different distributions of UC are there?

A

Proctitis - just in rectum Left sided colitis - travels up descending colon Pan colitis - extensive, most of colon

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7
Q

What is toxic megacolon?

A

When inflammation gets into the muscularis muscosa, which loses its integrity and expands - perforation.

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8
Q

What common intra-intestinal complications are there in Crohn’s?

A

Stenosis Fistulas Peri-anal disease

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9
Q

What diet helps Crohn’s patients?

A

An elemental diet - broken down into its smallest constituent parts already

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10
Q

What effect does smoking have on IBD?

A

Crohn’s - makes it worse, 2x more likely to get it UC - Protective - 40% lower risk of developing it

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11
Q

What risk factors are there for IBD?

A

Smoking (crohn’s) Family history (doesn’t matter if Crohn’s or UC) Infections?

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12
Q

What extraintestinal features are there of IBD ? (6 general, 2 crohn’s)

A

Fevers Weight loss Arthralgia Skin lesions Eye inflammation (episcleritis, uveitis) Hepatobilary disease Crohn’s = oral aphthous ulcers, orofacial granulomatosis

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13
Q

What investigations can you do on suspected IBD?

A

Haematology - micro/macro anaemia, leucocytosis, thombocytosis, CRP, ESR Biochemistry - low albumin, liver enzymes Stool examination - bacteria, toxins, calprotectin Colonoscopy - establish if inflamed, biopsies Radiology - Barium studies, CT

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14
Q

What kind of imflammation is seen in Crohn’s?

A

Granulomatous inflammation

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15
Q

Which out of Crohn’s or UC affects just the mucosa and which is transmural?

A

Crohn’s - transmural Uc - muscosa

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16
Q

What do Crohn’s ulcers look like macroscopicaly?

A

Cobble stones - longitudinal linear ulcers

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17
Q

Which disease of IBD causes crypt distortion?

A

UC Focal cryptitis possible in Crohn’s

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18
Q

Describe the ulceration in UC

A

Mucosal islands are formed around the ulcers that look like polyps

19
Q

What is tenesmus? Which condition of IBD is it most seen in?

A

The feeling of needing to go to the bathroom to poo - never feel empty Seen in UC

20
Q

Is there an increased risk of cancer in UC?

A

Yes, 20-30% increased risk of colorectal cancer Often part of surveillance program

21
Q

List 7 differences between Crohn’s and UC

A
22
Q

What malabsorbative effects can Crohn’s have for the patient?

A

B12 malabsorption

Bile salt malabsorption (leadinf to gall stones and wartery diarrhoea)

Fat malabsorption (steatorrhoea)

Obstructed lymphatics

23
Q

What is the difference in aims of surgery in UC and Crohn’s?

A

UC - surgery is curative

Crohn’s surgery is just to alliviate complications

24
Q

What opperation types are done in UC?

A

If urgent (due to failed medical management, toxic dilatation, perforation or blood) then they do a subtotal colectomy

Then electively they do:

Proctocolectomy + permenent ileostomy

Ileo-anal pouches ( joing SI up with anal canal, making a pouch to store stoole in)

25
Q

What are the 3 main theories of pathogeneis of IBD?

A

Autoimmune

Dysfunctional immune response agains commensal bacteria

Infection with pathogenic organisms

26
Q

What is the chromosomal locus that is related to IBD?

A

NOD2/CARD15

27
Q

What is the aim of drug treatment in IBD?

A

Induce remission

Maintain remission

Prevent secondary effects

28
Q

What drug regime would you use in Active UC?

A

1st: Mesalazine, then add in a corticosteroid

2nd: ciclosporin or inliximab

3rd: colectomy

29
Q

What drugs would you use yo maintain remission of UC?

A

Mesalazine

If needed add Azathioprine

30
Q

What drugs would you use for active Crohn’s?

A

!st: Corticosteroids

2nd: Azathrioprine or monoclonal antibodies (infliximab, Adalimubab)

31
Q

What are the 2 main ASAs (aminisalicylates)

How do they work?

A

Sulfasalazine (1st on market)

Mesalazine (current 1st line)

Topical antiinflammatories

Inhibit synthesis of inflam mediators

Scavengers of O2 free radicals

32
Q

How do corticosteroids act in IBD? What examples are there?

A

Potent anti-inflammatory agents

Inactivate pro-inflammatory factors

Eg. Hydrocortisone IV

Oral Prednisolone

33
Q

What is a side effect of long term corticosteroids? What can be given to combat this?

A

Osteroperosis - give Bisphosphonates, Ca and Vit D

Cushing’s like side effects - mood face, central adiposity

34
Q

What Immunosuppresant therapies are used in IBD?

A

Thiopurines (Azathioprine)

Cyclosporin

Methotrexate

35
Q

Is cyclosporin used in UC or Crohn’s?

A

UC only

36
Q

Is methotrexate used in UC or Crohn’s?

A

Crohn’s only

37
Q

What must you do when prescribing methotrexate?

A

Must prescribe and dose weekly - crossing out any unwanted days .

Toxicity common - report all early signs

38
Q

What is biological therapy for IBD?

A

The furture of medicine

Targets specific inflammatory and immuno pathways

39
Q

What are the 2 drugs currently used in biological therapy of IBD?

A

Infliximab

Adalimumab

40
Q

How does Infliximab work?

A

Targets membrane bound TNFalpha

Kills host cell

Has anti inflammatory function

41
Q

How is adalimimab different to infliximab?

A

Infliximab is a chimeric antibody, however adalimumab is humanased - so has less side effects

42
Q

What is Meckel’s Diverticulum?

A

An embryonic reminent

2% of population, 2 ft from ileocoecal valve, 2 inches long

Lined with villous mucosa

43
Q

What is hirshsrung’s disease?

A

When there is an absense of ganglion cells in the neural plexus of some parts of the colon (they usually migrate from neural crest)

Present with a dilated megacolon - the thin section is the section that is abnormal, as can’t do proper peristalsis

44
Q

Why wouldn’t you give NSAIDs as an antiinflammatory in IBD?

A

You want to minimise gut irritation

Lucy Knox - Year 1 (36 decks)

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