Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3- Surgery > GI - IBD Pathology and Presentation > Flashcards

GI - IBD Pathology and Presentation Flashcards

1
Q

Outline the pathological (macroscopic) differences between UC and Crohn’s

A

-Location: (UC) Rectum + colon +- backwash ileitis vs (Crohns) Mouth to anus, espcially terminal ileum
-Distribution: contiguous vs skip lesions
Strictures: no vs yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the pathological (microscopic) differences between UC and Crohn’s

A
  • Inflammation: muscosal vs transmural
  • Ulceration: shallow and broad vs deep cobblestone mucosa
  • Fibrosis: none vs marked
  • Granulomas: none vs present
  • Pseudopolyps: marked vs minimal
  • Fistulae: none vs present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe a UC presentation

A
  • Systemic: fever, malaise, anorexia, wt loss (in active disease)
  • Abdominal: diarrhoea. blood and mucus (PR), abdo discomfort, tenesmus and faecal urgency
  • Signs Abdominal: fever, tender and distended abdo
  • Signs extra abdominal: Skin (clubbing, erythema nodosum, pyoedema), Eyes (iritis, conjunctivitis, episcleritis, scleritis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe UC complications

A
  • Toxic megacolon (diameter of >6cm, risk of perforation)
  • Bleeding
  • Malignancy (10% for evert 10 years)
  • Cholangiocarcinoma
  • Strictures leading to obstruction
  • Venous thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe a Crohn’s presentation

A
  • Systemic: fever, malaise, anoresia, wt loss (in active disease)
  • Abdominal: diarrhoea (usually not bloody), abdo pain
  • Abdominal signs: abdo tendernes, RIF mass, perianal abscesses, fistulae, tags, anal and rectal strictures
  • Extra abdo signs: arthritis (non deforming and asymmetrical), sacro-iliitis, gallstones/fatty liver, amyloidosis and oxalate renal stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications in Crohn’s

A
  • Fistulae: Entero-colonic (diarrhea), entero-vesical (freqeuncy/UTI), entero-vaginal, perianal
  • Strictures: obstruction
  • Abscesses (abdominal or anorectal)
  • Malabsorption: fat (steatorrhea/gallstones), B12 (megalobastic anaemia), Vit D (osteomalacia), protein (oedema)
  • Toxic megacolon and Ca can occur but < than UC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

UC: prevalence:

A
  • Most common form of IBD

- Most prev among Caucasian pop, 15-25ya and 55-65ya

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

UC: differentials

A
  • Crohn’s (primary Dx)
  • Chronic infections (schisto, giardia, TB)
  • mesenteric ischaemia
  • radiation colitis
  • Malignancy
  • IBS
  • Coeliac disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

UC: investigations - bloods and samples

A
  • Bloods: FBC, U&Es, CRP, LFT and clotting - examine for anaemia, low albumin, raised CRP and WCC
  • Faecal calprotectin test: in patients with recent onset lower GI problems
  • Stool sample: exclude campy, shigella, salmonella, c diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

UC: investigations - imaging and others

A
  • Colonoscopy with biopsy: provides definitive Dx - characteristic findings are continuous inflammation with ulcers, visible pseudopolyps
  • Can do flexi-sig
  • Acute exacerbations: AXR helps determine whether there is toxic megacolon/bowel performation
  • Chronic UC cases may show lead-pipe colon,
  • Ba/gastrograffin enema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UC: Mx- acute severe UC

A
  • Resus: Admin, IV, NBM
  • Hydrocortisone: IV 100mg QDS + PR
  • Transfuse if required
  • Thromboprophylaxis: LMWH
  • Monitoring: bloods (FBC, ESR, CRP, U&E), vitals + stool chart, AXR
  • avoid anti-motility drugs (loperamide) in acute attacks - can precipitate toxic megacolon
  • ABX do not seem to benefit - not routinely recommended, may be used if megacolon, perforation or undertain Dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

UC: Acute complications

A
  • Performation
  • Bleeding
  • Toxic MC
  • VTE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

UC: stepwise treatment approach

A
  • Mild-mod (proctitis): Step 1 (topical mesalazine or sulfazalaxine), step 2 (add oral pred + oral tacrolimus)
  • Mild to mod (extensive inflammation): Step 1 (high oral dose mesalazine or sulfazalazine) + step 2 as above
  • Severe: Step 1 (IV corticosteroids and assess the need for surgery) + Step 2 (add infliximab if no short term response)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UC: maintaining remission

A
  • Can be maintained with immunomodulators (mesalazine/sulfasalazine)
  • Pts at increased risk of colorectal malignancy t/f: colonoscopuc surveillance offered for pts with 10+ ya Hx of UC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

UC: further Mx

A
  • IBD nurse specialists/pt support groups
  • Enteral nutritional support: considered in young pts with growth concerns
  • ABX: only offered with obvious concurrent disease (ciprofloxacin/metronidazole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UC: surgical Mx

A
  • 30% UC pts will need surgery
  • Indication for acute surgical TRX: toxic MC, perforation, massive haemorrhage, failure to respond to medical Rx
  • Indications for elective surgery: chronic symptoms, carcinoma/high grade dysplasia
  • Proceduces: sub-total colectomy (preservation of rectum) OR total proctocolectomy (curative - pt needs ileostomy)
17
Q

Crohn’s: prevalence and risk factors

A
  • 150/100 000 in uk
  • peak age between 15-30
  • remitting/relapsing course
  • Risk factors (same as UC): family Hx, smoking, white european descent (esp Ashkenzi Jews). appendicectomy (increases risk of developing CD after surgery
18
Q

Crohn’s: Ix - bloods and stool

A
  • FBC, LFT, CRP/ESR, haematinics (Fe, B12, folate), blood cultures
  • Stool: exclude campy, shigella, salmonella and c diff
19
Q

Crohn’s: Ix - imaging and others

A
  • A/CXR: obstriction/performation
  • Faecal caprotectin: raised in IBD but normal in IBS
  • Colonoscopy with biopsy: gold standard (avoid during active flare) - can do flexi sig
  • Barium swallow: less common - can show strictures
  • CT: done in severe flare - shows obstruction, perf, collection, distuale
  • pelvic MRI: shows perianal disease
20
Q

Crohn’s: Mx - severe attack

A
  • Resus: admit, NBM, IV hydration
  • hydrocostisone: IV/PR
  • thrombopro: LMWH
  • Dietician review: elemental diet or parenteral nutrition
  • Monitoring: I/O chart
  • Pt improves: switch to oral TRX (oral pred 40mg/d)
  • No improvement: methotrexate +/- infliximab and surgical talk
21
Q

Crohn’s: Mx - inducing remission

A
  • Resus as above
  • High fibre diet/vitamine supplements
  • corticosteroid therapy in ascending order (pred, methotrexate, infliximab)
22
Q

Crohn’s: Mx - maintaining remission

A
  • Azathroprine/ mercaptopurine: monotherapy to maintain remission
  • Increased risk of colorectal malignancy t/c olonoscopic surveillance offered
23
Q

Crohn’s: Mx - surgery

A
  • Never curative in Crohn’s- should be conservative
  • Emergency: failure to respond to medical Rx, intestinal obstruction/perf/massive haemorrhage
  • Elective: abscess/fistula, perianal disease, chronic ill health, carcinoma
  • Most common is ileocaecal resection with primary anastomosis btw ileum and ascending colon
24
Q

Crohn’s: Mx - further Mx

A
  • IBD nurse specialist/support groups
  • Enteral nutrition in young pts (growth concerns)
  • ABX only offered in cases of concurrent infection (ciprofloxacin/metronidasole)

Year 3- Surgery (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions