GI: IBD Flashcards
What are the two types of IBD?
Crohn’s disease
Ulcerative Colitis
Which interacting co-factors result in IBD?
Genetics
Environment
Host immune response
Which type of IBD has a greater associated genetic link?
Crohn’s
Mutations in which gene predisposes IBD?
NOD2 gene on chromosome 16
How does smoking affect the two types of IBD?
Aggravates Crohn’s
Protective effect in UC
Which cells mediate Crohn’s disease?
TH1 cells
Which cells mediate UC?
TH1 + TH2 cells
At what age does IBD typically present?
Teens- twenties
Which part of the GI tract is affected in Crohn’s disease?
ANY!
Most common in the terminal ileum and colon
Which part of the GI tract is affected in UC?
Inflammation begins in the rectum and extends proximally. Affects the colon only
What are the 2 main differences between the inflammation in Crohn’s and UC?
Crohns- discontinuous ‘skip lesion’ + transmural
UC- Continuous + confined to the mucosa
What would a mucosal biopsy of a Crohn’s patient show?
Deep ulcers and fissures
Cobblestoned mucosal appearance
What would a mucosal biopsy of a UC patient show?
Red mucosa which bleeds easily
Pseudopolyps + ulcers in severe disease
Which form of IBD is associated with granulomas?
Crohn’s disease
Which form of IBD is associated with crypt abscesses?
Ulcerative Colitis
How does UC typically present?
Diarrhoea which often contains blood and mucus
How many bloody stools per day indicates mild UC?
Less than 4
How many bloody stools indicates severe UC?
Greater than 6
How does Crohn’s disease affecting the ileum present?
Abdominal pain + weight loss
How does Crohn’s disease affecting the colon present?
Diarrhoea, bleeding, pain on defecation
What features are associated with perianal disease due to Crohn’s?
Anal tags
fissures
fistulae
abscess formation
What blood test results might be expected in a patient with acute Crohn’s disease?
Increased platelet count
Increased ESR
Increased CRP
Which investigations undertaken to diagnose IBD?
Sigmoidoscopy + biopsy
Colonoscopy + biopsy
Which drugs are given for mild-moderate UC?
First line: Oral 5-ASA, e.g. mesalazine
Second line if response poor: Oral prednisolone
Which drug is given for severe UC?
Oral prednisolone
Which drugs are given for severe UC with systemic features?
Hydrocortisone
Infliximab (anti-TNF)
Ciclosporin
Which drugs are given to maintain remission in UC?
5-ASA
Azathioprine (immunosuppressant)
Which drug is given in mild Crohn’s only?
Oral 5-ASA
Which drug is given in moderate-severe Crohn’s?
Oral prednisolone
Which drugs are given to maintain remission in Crohn’s?
Azathioprine
Infliximab
Which drug is given in severe perianal disease?
Metronidazole
How do 5-ASA drugs work? What are the side effects?
Anti-inflammatory
Diarrhoea
How do corticosteroids work? What are the side effects?
Anti-inflammatory
Weight gain, hypertension, osteoporosis, growth failure in children
What are the side effects of immunosuppressant drugs such as Azathioprine?
Bone marrow suppression
Pancreatitis
Hepatitis
Allergic reaction
Which drug should azathioprine never be taken with?
Allopurinol (used to treat gout)
How do Anti-tNF drugs work? What are the side effects?
Promote apoptosis of activated T lymphocytes
Increased risk of infection and cancer
When is surgery for IBD indicated?
Failure to respond to medications
Complications, e.g. obstruction, abscess/fistulae (crohn’s)
Dysplasia of colon mucosa (cancer)
