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GI (Semester 4) > 7.2 Inflammatory bowel disease > Flashcards

7.2 Inflammatory bowel disease Flashcards

1
Q

What defines IBD

A

A group of related conditions characterized by idiopathic inflammation of GIT

Conditions that cause macroscopic inflammation.

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2
Q

What are the 2 main non-specific IBDs?

What part of the GIT do they normally affect?

A

1) Ulcerative Colitis: only large bowel

2) Crohns Disease: small and or large bowel

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3
Q

Give 4 other causes of Colitis

A
  • Drugs esp NSAIDs
  • Ischaemic colitis
  • Radiation colitis
  • Diverticular colitis
  • Microscopic colitis
  • Collagenous colitis
  • Infectious colitis
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4
Q

What are the 3 mains causes of IBD

A

1) Genetic susceptibility
2) Immune dysregulation
3) Environmental trigger

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5
Q

Give 4 triggers of IBD

A 
Antibiotics
Diet
Acute Infections
NSAIDs
Smoking 
Stress
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6
Q

What is Crohn’s disease?

A

Chronic relapsing and remitting inflammatory disease of the digestive tract

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7
Q

What are the characteristics of Crohn’s disease

A
  • Asymmetric
  • Transmural involvement of the bowel wall
  • Chronic Inflammatory process with non-caseating granulomas
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8
Q

Where are granulomatous infections seen in Crohn’s most commonly located

A

Frequently affects terminal ileum (but can affect any part of the GI tract)

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9
Q

What are the 2 main histological features of Crohn’s

A

1) Large epitheloid granulomas

2) Multinucleated giant cells

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10
Q

Compare the association with autoimmune disease in Crohn’s vs UC

A

UC: strong association with autoimmune disease eg hashimoto’s thyroiditis, SLE

Crohns: weak association with autoimmune disease

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11
Q

Compare the association with autoantibody production in Crohn’s vs UC

(Humoral component)

A

UC: common associated with autoantibody production eg anticolon antibody, perinuclear antineutrophil cytoplasmic antibody (pANCA)

Crohn’s: rare association with autoantibody production

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12
Q

Compare the Mucosal infiltration in Crohn’s vs UC

cell-mediated component

A

UC: Non granulomatous and neutrophil prominent

Crohn’s: Granulomatous and T cells prominent

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13
Q

Compare the T-cell reactivity in Crohn’s vs UC

cell-mediated component

A

UC: Normal or decreased

Crohn’s: Increased

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14
Q

List the clinical features of Crohn’s

A
  • Diarrohea (chronic or nocturnal)
  • Abdominal pain
  • Weight loss
  • Fatigue
  • Anorexia or fever
  • Abdominal mass or tenderness
  • Intestinal obstruction
  • May present with acute onset abdominal pain
  • May mimic appendicitis
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15
Q

What is Ulcerative colitis

A

Chronic inflammation of part or the whole of the mucosa of the large bowel, diffusely inflamed and may ulcerate

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16
Q

What are the characteristics of UC

A
  • only effects the colon (usually starts in rectum and extends proximally)
  • continuous inflammation– no skip lesions (symmetrical)
  • Circumferential
  • Uninterrupted pattern
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17
Q

What parts of the GI tract does UC affect

A

The colon, Inflammation effects only the mucosa and submucosa

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18
Q

What are the 3 types of pattern of distributions seen in UC

A

1) Proctitis (rectum)
2) Left sided colitis (extends from the rectum up the colon and stops at the splenic flexure)
3) Pancolitis (entire large intestine)

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19
Q

What is the aetiology is UC/ what is a potential theory?

A

aetiology is unclear

theory: autoimmune disease caused by an inflammatory response to normal colonic microflora

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20
Q

What are the 3 main histological features of UC

A

1) Intense inflammatory cell infiltrate of the lamina propria
2) Goblet cell depletion
3) Crypt abcesses

21
Q

List 4 other types Inflammatory Bowel diseases?

A

1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis

22
Q

what is the link between non-smokers and UC?

What is another thing that reduces risk of UC?

A

x3 more common in NON smokers

Appendecctomy before age 20

23
Q

List 4 clinical features of UC?

A
  • Bloody diarrohea
  • Urgency
  • Tensemus
  • Nocturnal defecation
  • Crampy abdominal pain or ache in left iliac fossa
  • Pre-defactation pain relieved by passing stools
24
Q

Tensemus is a clinical feature of UC, what does this mean?

A

a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness

25
Q

List 4 UC clinical SIGNS?

A
  • Pallor
  • Dehydration
  • Mouth ulcers
  • Abdominal tenderness
26
Q

List 4 conditions associated with UC?

A
  • Erythema Nodosum
  • Pyoderma gangrenosum
  • Uveitis
  • Arthritis
27
Q

In brief sentences how would you compare Crohn’s vs UC

A

Crohns Disease (CD) is a condition of chronic inflammation potentially involving any location of the GIT from mouth to anus in a discontinuous manner.

Ulcerative Colitis (UC) is an inflammatory disorder that affects the rectum (in 90% pts) & extends proximally in continuity to affect a variable extent of the colon.

28
Q

What are the 2 main early findings of Crohn’s disease

A

1) Aphthous ulcer

2) The presence of granulomas

29
Q

What are 4 main late findings of Crohn’s disease

A

1) Linear ulcers
2) The classic cobble stoned appearance may arise
3) Transmural inflammation
4) Sinus tracts, and strictures
5) Fibrosis.

30
Q

UC can be classified as specific and non-specific, what do these mean?

A

Non-specific -> seen with any acute inflammation

Specific -> suggest chronicity

31
Q

Describe 3 things that would be seen in non-specific UC

A

1) The lamina propria becomes oedematous.
2) Inflammatory infiltrate of neutrophils
3) Neutrophils invade crypts, causing cryptitis & ultimately crypt abscesses.

32
Q

Describe 3 things that would be seen in specific UC

A

1) Distorted crypt architecture
2) crypt atrophy
3) a chronic inflammatory infiltrate

33
Q

What is Toxic megacolon?

List a complication of Toxic Megacolon and its prognosis?

A

TM is a serious side effect of IBD: transverse colon becomes extremely dilated (above 6cm) resulting in ineffective function and serious infection.

Complication: perforation and rupture which can lead to peritonitis (in the presence of steroids physical signs may be absent)

Prognosis: four to five percent mortality without perforation and about 20% with perforation

34
Q

List in order the treatment plan for IBD patients

A

1) 5-ASAs eg. Mesalazine
2) Steroids (short term) and Azathioprine (long term)
3) Clylosporine/ Infliximab
4) Surgery

(then Probiotics, alternative therapies, antibiotics)

35
Q

What is thumb printing and what does it indicate?

A

Radiological sign: thickening at regular intervals throughout lumen which appear like thumb prints

TMC Indicative of Crohn’s

36
Q

What is the Fat Halo sign and what does it indicate?

A

CT scan: infiltration of the mucosal layer of the fat causing a halo around it

Indicative of Crohn’s

37
Q

What is Mesalazine (also known as mesalamine) and what is its mode of action

A
  • also known as 5-aminosalicylic acid (5-ASA) it is a derivative of salicylic acid
  • more effective in UC than Crohns
  • used for IBD maintenance

Mode of Action: mesalazine is thought to be an antioxidant that traps free radicals

38
Q

List 4 side effects of Mesalazine

A
  • renal impairment
  • diarrhoea
  • allergy
  • hepatitis
  • myopericarditis
39
Q

What is the mode of action of steroids in use of IBD treatment?
What is its route of administration?

A
  • Potent anti inflammatory actions via multiple inflammatory pathways
  • used to obtain control in active disease (more effective than 5 ASA)

Route of administration: Oral / Topical / IV

40
Q

List 4 side effects of Thiopurines

A
  • Allergic ( fever, arthralgia, rash)
  • Hepatoxic,
  • Bone marrow toxicity
  • long term …. malignancy

Need regular monitoring of bloods FBC / LFT

41
Q

List 4 side effects of Thiopurines

A
  • Allergy
  • Hepatoxic
  • Bone marrow toxicity
  • long term …. malignancy

Need regular monitoring of bloods FBC / LFT

42
Q

What is the mode of action of Methotrexate in use of IBD treatment?

When would you use it and at what dose?

A

Mode of action: inhibits dihydrofolate reductase hence cytotoxic BUT its anti inflammatory action is by inhibiting cytokine and eicosanoid synthesis.

Use: second line drug of azothioprine failes or is not tolerated.

Dose: Once weekly with folic acid

43
Q

List 4 side effects of Methotrexate

A

Short term: nausea, diarrhoea
Long term : hepatoxicity, pneumonitis

Note: Very Teratogenic

44
Q

What is the Mode of action of calcineurin inhibitors?
Give an example of one
How is it administered?

A

eg. Ciclosporin and Tacrolimus

Mode of action : inhibition of calcineurin which inhibits clonal expansion of T cell subsets

Administration : IV or oral

Only beneficial As a rescue therapy in severe UC (no effect in Crohn’s)

45
Q

Give 4 side effects of calcineurin inhibitors

A 
minor tremor
paraesthesia
hirutism
major seizures if low cholesterol or magnesium
renal
46
Q

List 2 Biological Therapies that can be used in treatment of IBDs

A

1) Infliximab and Adalimumab

2) Etanercept

47
Q

What is TNF-α

A

TNF-α is a chemical messenger (cytokine) and a key player in the inflammatory process involved in IBD.

48
Q

What is the mode of action of Infliximab and Adalimumab?

A

Infliximab and Adalimumab are monoclonal antibodys targeting tumour necrosis factor α (TNF-α).

Infliximab works by binding to TNF-α and preventing it from binding to receptors involved in the inflammatory process

49
Q

What is the mode of action Etanercept?

A

Etanercept is a recombinant human TNF receptor fusion protein

It inhibits the binding of TNF to its cell surface receptor

GI (Semester 4) (19 decks)

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