Gastro - Lower GI tract Flashcards
What is ulcerative colitis?
Inflammatory disorder to the colonic mucosa:
- Continuous
- Superficial
- Always involves rectum
- Isnt always painful
What is Chron’s disease?
Patchy chronic transmural granulomatous inflammation:
- Can affect any part of the GI tract
- Tendency to form fistula or strictures
- More prevalent in females
- Deeper inflammation - much more painful
What are the symptoms of colitis?
- Bleeding
- Mucus
- Diarrhoea
- Urgency to excrete
What are the symptoms of perianal inflammation?
- Anal pain
- Leakage
- Difficulty passing stool
What are the symptoms of small bowel disease?
- Abdominal pain
- Weight loss
- Tiredness/lethargy
- Diarrhoea
- Abdominal mass
What are the extra-intestinal manifestations of inflammatory bowel disease?
Arthiritis:
- Axial
- Peripheral
Skin:
- Erythema nodosum
- Pyoderma gangrenosum
Eyes:
- Anterior uveitis
- Episceritis/Iritis
Liver:
- Primary sclerosing cholangitis
- Autoimmune hepatitis
What is thought to cause inflammatory bowel disease?
When there is an imbalance between the healthy and pathological microbiota in the gut, which leads to the immune system reacting inappropriately which induces inflammation
What does dysbiosis mean?
An unhealthy gut microbiota
What are the goals in the management of IBD?
- Induce clinical remission
- Maintain clinical remission
- Improve patient quality of life
AND
- Heal mucosa
- Decrease hospitilisation
- Minimise disease and therapy related complication
What medications are used for patients with IBD?
- Steroids
- 5 ASA (Amino salicylic acids)
- Immunosuppresants
How do steroids work to help IBD?
They diffuse and bind in nucleus to Glucocorticoid responsive elements (GRE):
- GRE interact with specific DNA sequences
- Increases anti-inflammatory gene products
- Block pro-inflammatory genes
How do ASA’s work to help IBD?
- They inhibit pro-inflammatory cytokines (IL-1 AND TNF- alpha)
- Inhibition of the lipo-oxygenase pathway
- Scavenging of free radicals
How does the immunomodulator azathioprine work?
- AZA is a precursor to 6-TG
- 6-TG interferes with adenine and guanine ribonucleotide production
- Results in reduced number of B and T lymphocytes, immunoglobulins and interleukins - suppresses immune system
- Another pathway potentially results in the apoptosis of T cells
Why are AZA and TNF-alpha given together?
They have a synergistic relationship
