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Gastroentrology > 2: Inflammatory Bowel Disease > Flashcards

2: Inflammatory Bowel Disease Flashcards

1
Q

What are the two types of inflammatory bowel disease

A

Ulcerative Colitis

Crohn’s disease

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2
Q

Where does UC affect

A

Large colon

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3
Q

Where does Crohn’s disease affect

A

Entire GI tract - especially the terminal ileum

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4
Q

Where does crohn’s disease most commonly affect

A

Terminal ileum

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5
Q

Where is inflammation in UC

A

Confined to mucosa

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6
Q

Where is inflammation in Crohn’s disease

A

Transmural

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7
Q

What are two microscopic changes associated with UC

A
  • Crypt abscesses

- Decrease goblet cells

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8
Q

What are two macroscopic changes associated with UC

A
  • Continuous inflammation

- Pseudopolyps

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9
Q

What is a microscopic sign of crohn’s disease

A
  • Non-cesating granuloma
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10
Q

What are two macroscopic signs associated with crohn’s disease

A
  • Discontinuous inflammation = cobblestonong

- Fistula

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11
Q

What age does Crohn’s disease present

A

Bimodal:

  • 13-30
  • 60-80
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12
Q

Which ethnicity is Crohn’s disease more common in

A

Ashkenazi Jews

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13
Q

What are 3 RF for Crohn’s disease

A
  1. Smoking
  2. FH
  3. Appendectomy - increases risk post-op crohn’s
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14
Q

What are 5 symptoms of crohns disease

A
  1. Colicky abdominal pain
  2. Diarrhoea - may contain blood or mucus
  3. Low-grade fever
  4. Anorexia
  5. Malaise
  6. Peri-anal disease
  7. Oral aphthous ulcers
  8. In late stages can present as malnourishment and failure to thrive
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15
Q

What are 4 presentations of perianal disease associated with crohn’s

A
  1. Skin tags
  2. Skin fistulas
  3. Perianal abscess
  4. Bowel stenosis
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16
Q

What are extra-intestinal manifestations of Crohn’s disease that affect the following

a. Joints
b. Skin
c. Eye

A

a. enteropathic arthritis (SI Joints)

b.
erythema nodosum
pyoderma gangrenosum

c.
Anterior Uveitis
Episcleritis
Iritis

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17
Q

What is erythema nodosum

A

Inflammation subcutaneous fat - presents as tender erythematous nodules over the shins

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18
Q

What is pyoderma gangrenosum

A

Usually on the lower limbs. Starts as a red papule then develops to have a necrotic base with vialaceous borders

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19
Q

What investigations are ordered for all patients with Crohn’s disease

A
  • Faecal calprotectin
  • FBC
  • CRP
  • U+E
  • Colonoscopy w/biopsy
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20
Q

What does faecal calprotectin shown in Crohn’s disease

A

Raised

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21
Q

How will FBC present in crohn’s disease

A

Microcytic anaemia

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22
Q

How will U+Es present in Crohn’s disease

A

Low albumin

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23
Q

How will CRP present in Crohn’s disease

A

Raised

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24
Q

What is gold-standard investigation of Crohn’s disease

A

Colonoscopy and biopsy

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25
Q

What will colonoscopy with biopsy shown

A
  • Cobblestonong (Skip Lesions)

- Histologically: non-cesating granuloma

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26
Q

When is CT used and what does it show

A

Used in severe Crohn’s disease to look for fistulas

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27
Q

When will examination under anaesthesia and protosigmoidoscopy be useful

A

If peri-anal disease is present

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28
Q

What is important for acute-flares of Crohn’s disease and why

A

IV Fluids
Nutrition
LMWH - as crohn’s puts individuals in a pro-thrombotic state

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29
Q

What is first-line medication to induce remission in Crohn’s disease

A

Glucocorticoids

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30
Q

What glucocorticoids are used

A

Methylprednisolone
Prednisolone
Hydrocortisone

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31
Q

What is second-line to induce remission in Crohn’s disease

A

5-ASA drugs, such as mesalazine

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32
Q

What is third-line to induce remission in Crohn’s disease

A

Azathioprine or Metcartopurine

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33
Q

What needs to be assessed before giving aziothioprine

A

Thioprine methyl transferase levels (TPMT)

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34
Q

If individuals have low TPMT levels what can be given

A

Methotrexate

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35
Q

What is used as fourth-line for inducing remission in Crohn’s disease

A

Infilximab

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36
Q

What are two indications for use of infliximab

A

Refractory crohn’s

Fistulas

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37
Q

What may be used to manage isolated peri-anal disease

A

Metronidazole

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38
Q

What is first-line to maintain remission in Crohn’s disease

A

Azathioprine and Mercatopurine

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39
Q

If low TPMT activity, what may be an alternative to azathioprine to maintain remission

A

Methotrexate

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40
Q

What % of crohn’s patients will have surgery

A

70-80

41
Q

What are three indications for surgery in Crohn’s disease

A
  1. Refractory to medical therapy
  2. Child with FTT
  3. Complication
42
Q

What is a common procedure offered to crohn’s patients

A

Ileocaecal resection

43
Q

What is used to manage peri-anal abscesses

A

Abscess drainage

44
Q

What is stricutoplasty

A

Removal strictures in crohn’s

45
Q

Why are fistulas more common in crohn’s

A

trans-mural inflammation - means more likely to be a fistula between adjacent structures

46
Q

What fistulas can form in Crohn’s disease

A
  • Perianal (54%)
  • Enteroenteric (24%)
  • Enterovaginal (9%)
47
Q

What is a stricture and the problem with it

A

Inflammation heals by fibrosis which can occlude the lumen resulting in obstruction.

48
Q

What does Crohn’s disease increase the risk of

A

Small bowel cancer

49
Q

What can Crohn’s disease in children cause

A

Failure to thrive

50
Q

What is a long-term complication of steroid-use in crohn’s disease

A

Osteoporosis

51
Q

Why are gall stones more common in crohns disease

A

Crohn’s disease reduces absorption of bile salts in the terminal ileum. Therefore disrupting concentration of bile leading to increased risk of gall stones.

52
Q

Why are renal stones more common in Crohn’s disease

A

Calcium - leads to malabsorption of fat in small bowel causing calcium to retain in lumen.

53
Q

What is the most common form of IBD

A

Ulcerative colitis

54
Q

What ethnicity is IBD more common

A

Caucascian

55
Q

What age-group is IBD more common

A

15-25

55-65

56
Q

What are the symptoms of ulcerative colitis

A

Left-quadrant abdo pain
Tenesmus
Blood diarrhoea
Urgency

57
Q

How can attacks of ulcerative colitis be graded

A

Mild
Moderate
Severe

58
Q

What are the following in mild UC

a. bowel movements
b. blood in stool
c. pyrexia
d. pulse >90
e. anaemia
f. ESR

A

a. <4
b. Minimal
c. No
d. No
e. No
f. <30

59
Q

How many bowel movements define mild UC

A

< 4

60
Q

What are the following in moderate UC

a. bowel movements
b. blood in stool
c. pyrexia
d. pulse >90
e. anaemia
f. ESR

A

a. 4-6
b. Mild
c. No
d. No
e. No
f. 30

61
Q

What are the following in severe UC

a. bowel movements
b. blood in stool
c. pyrexia
d. pulse >90
e. anaemia
f. ESR

A

a. >6
b. Yes
c. Yes
d. Yes
e. Yes
f. >30

62
Q

How many bowel movements define mild UC

A

<4

63
Q

How many bowel movements define moderate UC

A

4-6

64
Q

How many bowel movements define severe UC

A

> 6

65
Q

What are two biliary conditions associated with UC

A
  • Primary sclerosing cholangitis

- Cholangiocarcinoma

66
Q

What is a joint condition associated with UC

A
  • Enteropathic arthritis
67
Q

What nail sign is associated with UC

A

Nail pitting

68
Q

What eye signs are associated with UC

A
  • Anterior Uveitis
  • Episcleritis
  • Iritis
69
Q

Explain inflammation in UC

A

Inflammation starts at the rectum and works proximally in the large colon but does not pass the ileocaecal valve

70
Q

What may repeat inflammation in UC lead to

A

Pseudopolyps

71
Q

What investigations are ordered for UC

A 
Faecal calprotectin 
FBC
CRP/ESR
U+Es
Flexible sigmoidoscopy and biopsy 
AXR
72
Q

What will faecal calprotectin show

A

Raised

73
Q

Why is stool MC+S still ordered in UC

A

To exclude infection

74
Q

How will FBC present in UC

A

Anaemia

Raised wCC

75
Q

How will albumin present in UC

A

Low

76
Q

How will CRP present in UC

A

Raised

77
Q

What will flexible sigmoidoscopy and biopsy show

A
  • Continuous inflammation
  • Pseudopolyps

Biopsy:

  • Crypt abscesses
  • Mucosal inflammation
  • Decrease goblet cells
78
Q

Why is an AXR or CT ordered

A

Investigate for toxic megacolon in acute-exacerbation

79
Q

How will UC present initially on AXR

A

Thumb-printing sign - due to oedema of mucosal wall

80
Q

How will chronic UC present on AXR

A

Led-pipe colon

81
Q

Why is a flexibly sigmoidoscopy ordered for UC, but colonoscopy ordered for crohn’s

A

UC = confined to large-intestine.

Crohn’s = entire GI tract.

82
Q

What is proctitis

A

Inflammation of the rectum

83
Q

What is first-line to manage proctitis in UC

A

Topical aminosalicyates (mesalazine)

84
Q

What is second-line to manage proctitis in UC

A

Oral prednisolone + tacrolismus

85
Q

What is tacrolismus

A

Calcineurin inhibitor

86
Q

What is first-line to manage mild-moderate UC in GI tract

A

Oral aminosalicyates (mesalazine)

87
Q

What is second-line to manage mild-moderate UC in GI tract

A

Oral prednisolone and tacrolismus

88
Q

What is used to manage severe UC

A

IV glucocorticoids

89
Q

If individual with severe UC does not respond to IV corticosteroids, what is the next step

A

Infliximab

90
Q

What is given to maintain remission in UC as first line

A

Aminosalicylates - mesalazine

91
Q

What is given to maintain remission in Crohn’s first line

A

Azathiprone, Metcartopurine

92
Q

What is second-line medication to maintain remission in UC

A

Infliximab

93
Q

What does UC increase risk of

A

Colorectal cancer

94
Q

Which individuals with UC should have colonoscopy surveillance

A

Disease >10years

>1 segment bowel affected

95
Q

What are 4 complications of UC

A
  • Pouchitis
  • Colorectal cancer
  • Toxic megacolon
  • Osteoporosis due to steroids
96
Q

How will toxic megacolon present

A

Acute abdominal pain
Acute distention
Pyrexia
Absolute constipation

97
Q

What sign are strictures in Crohn’s disease called

A

Kantor string sign

98
Q

What ulcers may be seen in crohn’s disease

A

Rosethorn ulcers

99
Q

What surgery is often offered to patients with Crohn’s disease

A

Total protocolectomy with ileostomy

Gastroentrology (18 decks)

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