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Gastrointestinal > Crohn's & UC > Flashcards

Crohn's & UC Flashcards

1
Q

What is the cytokine profile of Crohn’s?

A

Th-1, IFN-gamma

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2
Q

What is the cytokine profile of ulcerative colitis?

A

Th-2, IL5 IL13

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3
Q

In which disease might you find a right iliac fossa mass?

A

Crohn’s

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4
Q

What is the definition of Crohn’s?

A

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

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5
Q

Where does Crohn’s most commonly affect?

A

Most common in the terminal ileum and colon

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6
Q

What might Crohn’s disease present with?

A 
Abdominal pain
Small bowel obstruction
Diarrhoea
Bleeding PR
Anaemia
Weight loss
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7
Q

Which disease is characterised by chronic transmural inflammation?

A

Crohn’s

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8
Q

How is the diagnosis of inflammatory bowel disease made?

A

Endoscopy and mucosal biopsy

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9
Q

Which disease IBD is characterised by skip legions?

A

Crohn’s

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10
Q

Which IBD is characterised by granulomatous inflammation?

A

Crohn’s

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11
Q

What do the ulcers of Crohn’s disease typically look like?

A

Knife-life, fissuring ulcers

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12
Q

What are some of the complications of Crohn’s disease?

A 
Perforation 
Stricture
Malabsorption
Fistula
Anal disease
Bowel obstruction
Malignancy
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13
Q

What is the characteristic appearance of the mucosal remodelling due to fissuring ulcers?

A

Cobblestoning

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14
Q

Where in the colon does ulcerative colitis affect?

A

The rectum, extends proximally

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15
Q

What are some of the symptoms of ulcerative colitis?

A 
Diarrhoea + bleeding
Increased bowel frequency
Urgency
Tenesmus
Incontinence
Night rising
Lower abdo pain (esp. LIF)
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16
Q

What is the Truelove and Witt criteria for severe ulcerative colitis?

A 
>6 bloody stools/24 hour
\+
1 or more of
Fever (>37.8°C)
Tachycardia (>90/min)
Anaemia (Haemoglobin 30mm/hr)
17
Q

Other than the abdomen and anus, where might other signs of IBD manifest?

A

Skin, joints, eyes

18
Q

What is the definition of toxic megacolon when assessing on a plain AXR?

A

Dilatation of colon:
Transverse > 5.5cm
Caecum > 9cm

19
Q

What changes occur in the intestinal mucosa in ulcerative colitis?

A

Crypt distortion and abscess formation

Absence of goblet cells

20
Q

What is the aberrant immune response in Crohn’s?

A

Persistent activation of T-cells and macrophages (failure to switch off)
Excess proinflammatory cytokine production

21
Q

Which two layers is ulcerative colitis confined to?

A

Mucosa and submucosa

22
Q

Which IBD is primary sclerosing cholangitis associated with?

A

UC > Crohn’s

23
Q

What are some examples of peri-anal disease associated with Crohn’s?

A

Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters

24
Q

What do the ulcers of ulcerative colitis look like?

A

Limited to submucosa
Wide/broad based
Superficial horizontal undermining ulcer

25
Q

Which IBD is development of colorectal cancer associated with and why?

A

UC

Chronic inflammation leads to epithelial dysplasia and then carcinoma

26
Q

What are some of the complications of UC?

A

Blood loss
Electrolyte disturbance (hypokalaemia)
Colorectal cancer
Anal fissure

27
Q

Which disease might treatment with 5ASA (mesalazine) be useful in?

A

Ulcerative colitis

28
Q

What is the mechanism of action of 5ASA?

A

Topical effect
Anti-inflammatory properties
Reduces risk of colon cancer

29
Q

What are some of the side effects of 5ASA?

A

Diarrhoea

Idiosyncratic nephritis

30
Q

Which steroids might be used to treat IBD?

A

Prednisolone

Budesonide

31
Q

What are some of the side effects of steroid use?

A 
Weight gain
Diabetes
Hypertension
Neuropsychiatric
Cataracts
Growth failure
Osteoporosis
Acne 
Thinning of skin
32
Q

When is immunosuppression therapy considered?

A

When more potent suppression of inflammation required

33
Q

What are some of the side effects of immunosuppression with azothiaprine?

A

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

34
Q

How long does azothiaprine take to have effect?

A

16 weeks

35
Q

What is the mechanism of anti-TNF therapy?

A

Promotes apoptosis of activated T lymphocytes

36
Q

When, according to NICE guidelines, is anti-TNF therapy indicated in Crohn’s disease?

A

As part of long term strategy, including immune suppression, surgery, supportive therapy
In fistulating disease

37
Q

What is the danger in resection of small bowel to treat Crohn’s?

A

It is not curative

May result in “short-gut” syndrome which requires life long parenteral nutrition

38
Q

What surgical options are there for ulcerative colitis?

A

Permanent ileostomy
or
Restorative proctocoloectomy and pouch

Gastrointestinal (17 decks)

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