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2nd Year - Alimentary Diseases > 5.5. Intestinal Disease - Ulcerative Colitis (IBD) > Flashcards

5.5. Intestinal Disease - Ulcerative Colitis (IBD) Flashcards

1
Q

What is the Aetiology of Ulcerative Colitis?

A

This is unknown, but it is clear that there is an interaction between several co-factors

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2
Q

What co-factors are thought to cause Ulcerative Colitis?

A
  1. Genetic Susceptibility - This is a complex Polygenic Disease
  2. Environmental Factors
  3. Intestinal Microbiota - The number of Mucosal Adherent Bacteria is increased
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3
Q

What are the Risk Factors which make up the Genetic Susceptibility to Ulcerative Colitis?

A
  1. Family History - the largest independent risk factor
  2. People with mutations of the (Chromosome 16) NOD2 gene - expressed on the Epithelial/Endothelial Cells, and Macrophages
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4
Q

What are the Risk Factors which make up the Environmental Factors for the Susceptibility of Ulcerative Colitis?

A
  1. NSAID’s
  2. Nutritional Factors
  3. Psychological Factors
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5
Q

How are NSAID’s associated with the Aetiology of Ulcerative Colitis?

A

This is associated with the Onset and Flaring of the disease

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6
Q

How is Nutrition associated with the Aetiology of Ulcerative Colitis?

A
  1. Some foods are suggested to play a role but none have been proven
  2. Breast feeding may provide protection against the developing within offspring
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7
Q

How are Psychological Factors associated with the Aetiology of Ulcerative Colitis?

A

Chronic Stress / Depression increase relapses in patients

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8
Q

What Environmental Factors appear to be “Protective” of Ulcerative Colitis?

A
  1. Smoking

2. Having had an Appendectomy

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9
Q

What are the Risk Factors which make up the Intestinal Microbiota for the Susceptibility of Ulcerative Colitis?

A
  1. Bacterial Antigens
  2. Defective Chemical Barrier
  3. Imparied Mucosal Barrier
  4. Butyrate
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10
Q

How are Bacterial Antigens associated with the Aetiology of Ulcerative Colitis?

A

There is an increase of Bacteria which exert their influence by Ligands, which interact with Host-Pattern Receptors in Ulcerative Colitis

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11
Q

How is a Defective Chemical Barrier associated with the Aetiology of Ulcerative Colitis?

A

Evidence suggests a decrease in Human Intestinal Defensin “Alpha-Defensin-1” (HD-1) can lead to Ulcerative Colitis

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12
Q

How is a Impaired Mucosal Barrier associated with the Aetiology of Ulcerative Colitis?

A

This can explain the presence of unusual and potentially pathogenic bacteria, which can lead to Ulcerative Colitis

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13
Q

What is Butyrate?

A

A type of fatty acid which helps with Intestinal Function

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14
Q

How is a Butyrate associated with the Aetiology of Ulcerative Colitis?

A
  1. A Sulphate-Producing Bacteria which increases Luminal Levels of Hydrogen Sulphide
  2. This decreases Butyrate Oxidation in the Colonic Mucosa
  3. This leads to Mucosal Inflammation which can precede Ulcerative Colitis
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15
Q

How does Ulcerative Colitis spread?

A

Distally to Proximally

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16
Q

What areas can Ulcerative Colitis effect?

From Best to Worst case scenario

A
  1. The Rectum alone (Proctitis)
  2. This can then extend to effect the Sigmoid and Descending Colon (Left Sided Colitis)
  3. This can then extend to involve the whole colon (Extensive / Total Colitis)
  4. There can also be inflammation on the Terminal Ileum (Backwash Ileitis)
17
Q

Why does the inflammation in Ulcerative Colitis occur?

A

Due to the Mucosal Immune System exerting an inappropriate Response to Luminal Antigens (e.g. Bacteria). These Bacteria may enter into the Mucosa via a Leaky Epithelium

18
Q

What are the Macroscopic Changes which occur in Ulcerative Colitis?

A
  1. Reddened, Inflamed Mucosa which Bleeds Easily (Friability)
  2. Inflammatory (Pseudo-)Polyps
19
Q

What are Inflammatory (Pseudo-)Polyps?

A

These are present in sever disease, where there is extensive Ulceration with the Adjacent Mucosa appearing as Inflammatory

20
Q

What are the Microscopic Changes which occur in Ulcerative Colitis?

A
  1. Chronic Inflammatory Cell Infiltrates in the Lamina Propria
  2. Lymphoid Hyperplasia
  3. Grypt Abscesses
  4. Goblet Cell Depletion
21
Q

What are the Clinical Features of Ulcerative Colitis?

A
  1. Diarrhoea with Blood
  2. Constitutional Symptoms (Mailaise, Fever, Lethargy)
  3. Nausea and Vomiting
  4. Anorexia / Weight Loss
  5. Aphthous Ulceration of the Anus and Mouth only
  6. Lower Abdominal Discomfort
22
Q

What investigations are necessary for Ulcerative Colitis?

A
  1. Colonoscopy
  2. Abdominal Ultrasound / X-Ray / CT scan
  3. Stool Cultures and Clostridium Difficile Toxin
  4. Blood Tests
23
Q

What is the purpose of the Colonoscopy?

A

To view the inside of the Colon, looking for Macroscopic Changes and to see how far the ulceration reaches

24
Q

What is the purpose of the Abdominal Ultrasound / X-Ray / CT scan?

A

To view the outside of the Colon and to loo

25
Q

What is the Stool Culture looking for?

A
  1. Clostridium Difficile Toxin assay when Diarrhoea is present
  2. Faecal Calprotectin and Lactoferrin are raised in Active Colonic Disease
26
Q

What are the Blood Tests looking for?

A
  1. Iron Deficiency Anaemia with a raised White Cell Count and platelets
  2. Serum Inflammatory Markers (CRP and ESR) are normally raised
  3. Liver Biochemistry may be abnormal due to the potential decrease in re-absorption of Bile
  4. pANCA is normally positive (it is normally negative in Crohn’s)
27
Q

What is the treatment of Ulcerative Colitis?

A
  1. 5-aminosalicylic acid (5-ASA), from Oral - Rectal - Topical administration, for induction and maintenance of Remission
  2. Oral Prednisolone - to initiate remission
  3. Azathioprine - a steroid sparing agent used over a longer period of time
  4. Anti-TNF antibodies (Infliximab)
  5. Proctocolectomy - the surgical removal of the effected area
28
Q

What is the term given to Colitis which cannot be distinguished between Crohn’s Disease and Ulcerative Colitis origin?

A

Colitis of Unknown Type and Aetiology (CUTE)

2nd Year - Alimentary Diseases (41 decks)

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