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Phase 2a Revision > GI > Flashcards

GI Flashcards

1
Q

What is IBD

A

Inflammatory Bowel Disease, defines Crohn’s disease and Ulcerative Colitis (UC)

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2
Q

What are the features of crohns

A 
N - no mucus or blood
E - entire GI tract
S- skip lesions
T - terminal ileum most affected
T - transmural (full thickness) inflammation
S - smoking is a risk factor
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3
Q

what are the potential risk factors for Crohns disease

A
  • smoking
  • genetic
  • recurrent URTIs
  • NSAIDs
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4
Q

Presenting symptoms for Crohns

A
  • diarrhoea
  • abdominal pain
  • passing blood
  • weight loss
  • malaise
  • anorexia
  • fever
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5
Q

what are the extra-intestinal manifestations of crohns

A
  • Clubbing, erythema nodosum, pyoderma gangrenosum.
  • Conjunctivitis, episcleritis, iritis.
  • Large joint arthritis, sacroiliitis, ankylosing spondylitis.
  • Fatty liver, primary sclerosing cholangitis (rare), cholangiocarcinoma (rare).
  • Granulomata may occur in the skin, epiglottis, mouth, vocal cords, liver, nodes, mesentery, peritoneum, bones, joints, muscle or kidney.
  • Renal stones.
  • Osteomalacia.
  • Malnutrition.
  • Amyloidosis
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6
Q

How does crohns typically present

A

periods of acute exasperation followed by periods or remission or less severe disease

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7
Q

what initial Ix would be done for Crohns

A
  • FBC
  • CRP
  • U&Es
  • LFTs
  • stool culture and microscopy
  • faecal calprotectin
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8
Q

what can the CRP Ix show in Crohns

A

useful to determine a pts risk of relapse (High CRP is indicative of active disease or bacterial complication)

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9
Q

what further Ix can be done to diagnose Crohns

A
  • endoscopy with biopsy
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10
Q

what are the possible complications of Crohns disease

A
  • fistulas
  • strictures
  • abscesses
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11
Q

What Ix are done to look for the complications of Crohns disease

A
  • CT/MRI

- US

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12
Q

What are the differential diagnosis’ for Crohns

A
  • Infectious gastroenteritis.
  • Tuberculosis.
  • Ulcerative colitis.
  • Actinomycosis.
  • Carcinoid.
  • Amyloidosis.
  • Intestinal lymphoma.
  • Behçet’s disease.
  • Bowel carcinoma.
  • Ischaemic colitis.
  • Radiation or drug-induced colitis (eg, NSAIDs).
  • Diverticulitis.
  • Coeliac disease.
  • Irritable bowel syndrome[11].
  • Acute ileitis may mimic acute appendicitis.
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13
Q

what staging system is used to assess the severity of Crohns

A

Crohn’s Disease Activity Index (CDAI)

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14
Q

What condition is it essential to rule out if the faecal calprotectin comes back positive in pts >50yrs

A

colorectal adenoma or colorectal carcinoma

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15
Q

when should you consider admission for a pt with crohns

A
  • severe abdo pain
  • severe diarrhoea
  • bowel obstruction
  • pt is systemically unwell
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16
Q

What is the typical tx used to induce a remission in Crohns

A

mono-therapy with a glucocorticosteriod

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17
Q

name a glucocorticosteriod

A
  • prednisolone
  • methylprednisolone
  • intravenous hydrocortisone
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18
Q

what alternative can be given to induce remission in Crohns if glucocorticosteriods are contra-indicated

A

budesonide

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19
Q

when are glucocorticosteroid contraindicated

A
  • hypersensitivity
  • live/live-attenuated vaccines (if using immunosuppressive dosages)
  • systemic fungal infection
  • osteoporosis
  • DM/uncontrolled hyperglycaemia
  • adrenocortical atrophy
  • Cushings syndrome
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20
Q

What is budesonide

A

corticosteriod

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21
Q

when would you consider add-on tx in Crohns

A
  • 2 or more exacerbation’s in 12mths

- glucocorticosteriod dose can’t be tapered

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22
Q

what medication would you add on to tx when inducing a remission of Crohns

A
  • azathioprine
  • mercaptopurine
  • methotrexate
  • Infliximab
  • Adalimumab
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23
Q

Why are Infliximab and Adalimumab used in the tx in Crohns

A

they block the action of the cytokine tumour necrosis factor alpha (TNF-α), which mediates inflammation in Crohn’s disease

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24
Q

when are Infliximab and Adalimumab recommended in the tx of Crohns

A
  • severe active disease that has not responded to conventional therapy
  • when conventional tx cannot be used due to contra-indications/intolerance
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25
Q

define SEVERE active Crohns disease

A
  • very poor general health
  • one or more symptoms
    - weight loss,
    - fever,
    - severe abdominal pain
    - frequent (3-4 or more) diarrhoeal stools daily
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26
Q

what is the first line tx for maintaining remission in Crohns

A
  • azathioprine

- mercaptopurine

27
Q

what other medication can be given for maintaining remission in Crohns

A
  • methotrexate
  • infliximab
  • adalimumab
28
Q

what life style change is vital in the management of Crohns

A

smoking cessation

29
Q

when can surgery be used in the tx of crohns

A
  • if the disease only affects the distal ileum

- strictures and fistulas

30
Q

what are some of the complications of Crohns

A
  • bowel CA
  • strictures/fistulas/rupture
  • osteoporosis (due to steroid use)
  • renal disease & gallstones
  • iron, B12, folate deficiency
  • delayed growth + puberty in children
31
Q

What are the features of UC

A

UP CLOSE

U - use aminosalicylates
P - primary sclerosing cholangitis
C -continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa
S - smoking is protective
E - excrete blood and mucus
32
Q

What are the typical presenting symptoms of UC

A
  • bloody diarrhoea
  • colicky abdo pain
  • urgency
  • tenesmus (a feeling of incomplete defecation with an inability or difficulty to empty the bowel at defecation)
33
Q

What are the extra-intestinal presentations of UC

A
  • Erythema nodosum.
  • Aphthous ulcers.
  • Episcleritis.
  • Acute arthropathy affecting the large joints
  • Pyoderma gangrenosum.
  • Anterior uveitis
  • Sacroiliitis.
  • Ankylosing spondylitis.
  • Primary sclerosing cholangitis
34
Q

Differential dx of UC

A
  • Crohns
  • infective colitis
  • IBS
  • Ischaemic colitis
  • Radiation colitis
  • Bowel trauma
  • Colorectal cancer
  • Diverticulitis
  • Polyposis syndromes
  • Colonic polyps
35
Q

Ix for UC

A
  • FBC
  • U&E
  • LFT
  • ESR/CRP
  • Iron, folate and B12
  • faecal calprotectin
  • stool sample ?c.diff
36
Q

What imaging is done to Ix UC

A
  • abdo XR ?colonic dilation
  • endoscopy + biopsies
  • colonoscopy (used to assess the extent of the disease
37
Q

which serology markers are associated with Crohns and UC

A 
Crohns = ASCA
UC = p-ANCA
38
Q

What are the different levels of severity with UC

A

mild
moderate
severe

39
Q

Define Mild UC

A
  • fewer than four stools daily,
  • no more than small amounts of blood in stools,
  • no anaemia,
  • pulse rate not above 90,
  • no fever
  • normal ESR and CRP.
40
Q

Define Moderate UC

A
  • four to six stools a day with more blood in stools than for mild disease
  • No anaemia,
  • pulse rate not above 90,
  • no fever
  • normal ESR and CRP
41
Q

Define Severe UC

A
  • six or more stools per day
  • visible blood in stools
  • at least one feature of systemic upset (temperature above 37.8°C, pulse rate greater than 90, anaemia, ESR above 30)
42
Q

When should a pt with UC be admitted to hospital

A
  • severe UC
  • ## moderate UC that doesn’t respond to steroid tx within 2 wks
43
Q

What first line tx is used to induce remission in mild-mod UC

A

aminosalicylates

44
Q

name an aminosalicylate

A

mesalazine

45
Q

what is the second line tx for inducing remission in UC

A

corticosteriods (eg. prednisolone)

46
Q

what is the first line tx for inducing remission in severe UC

A

IV corticosteriods (eg.hydrocortison)

47
Q

what is the second line tx for inducing remission in severe UC

A

IV ciclosporin

48
Q

What tx is used to maintain remission of UC

A
  • aminosalicylates
  • azathioprine
  • mercaptopurine
49
Q

what non-pharmacological tx can be used for UC

A
  • surgery

pts are left with an ileostomy or “J-pouch”

50
Q

Complications of UC

A
  • colorectal CA

- osteoporosis (steriod tx)

51
Q

What is IBS

A

a chronic functional bowel disorder (no underlying pathology)

52
Q

how is IBS often diagnosed

A

diagnosis of exclusion

53
Q

symptoms of IBS

A
  • diarrhoea
  • constipation
  • fluctuating bowel habit
  • abdo pain
  • bloating
54
Q

what Ix are done in ?IBS to rule out other pathologies

A
  • FBC, ESR, CRP
  • faecal calprotectin
  • anti-TTG antibodies
55
Q

what conditions should be rules out if ?IBS

A
  • IBD
  • bowel cancer
  • coeliac
  • anaemia
  • diverticulitis
  • gastritis
56
Q

what symptom is most suggestive of IBS

A

abdo pain/discomfort which is relieved when opening bowels or associated with a change in bowel habit

57
Q

Mx of IBS

A

lifestyle advice

  • adequate fluid intake
  • regular small meals
  • reduced processed foods
  • limit caffeine and alcohol
  • FODMAP
  • trial of probiotic supplements (4wks)
  • reduce stress
58
Q

first line medication for IBS

A
  • loperamide for diarrhoea
  • laxatives for constipation (avoid lactulose)
  • antispasmodics
59
Q

name an antispasmodic

A

hyoscine butylbromide (Buscopan)

60
Q

second line medication for IBS

A

TCA (amitriptyline 5-10mg)

61
Q

third line medication for IBS

A

SSRIs

62
Q

what alternative therapy can be used to treat IBS

A

CBT

63
Q

what Ix can be used to investigate IBS

A

food/symptom diary

64
Q

which laxative is best for tx of IBS

A

linaclotide

Phase 2a Revision (13 decks)

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