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Study notes - Respiratory > *IBD 1 - Lecture 1 > Flashcards

*IBD 1 - Lecture 1 Flashcards

1
Q

What is the name of the overlap condition between Crohn’s disease and ulcerative colitis?

A

Indeterminate colitis

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2
Q

How does Crohn’s disease tend to present? (2)

How does ulcerative colitis tend to present? (2)

A

Crohn’s:
-abdo pain
peri-anal disease

UC:

  • diarrhoea
  • bleeding
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3
Q

What are the 3 overlapping factors why people tend to develop IBD?

A

Genetic predisposition
Mucosal immune system problem
Environmental triggers

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4
Q

What is the best established risk factor for IBD development?

A

Positive family history

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5
Q

What mutations lead to a higher risk of developing Crohns disease?

A

Mutation in NOD2 (on chromosome 16) - also called CARD15 or IBD-1
Encodes a protein involved in bacterial recognition

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6
Q

Amount of bacteria present in Crohn’s?

Amount of bacteria present in UC?

A 
Crohn's = too much
UC = too little
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7
Q

What are 4 pieces of evidence regarding the role of gut flora in IBD?

A
  • gut flora is indispensable to the development of animal models of colitis
  • antibiotics effective in the treatment of peri-anal Crohn’s disease
  • diverting faecal stream helps Crohn’s
  • altered bacterial flora in colons with UC
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8
Q

What are the 4 theories of IBD pathogenesis?

A

Pathogenic bacteria
Abnormal microbial composition
Defective host containment of commensal bacteria
Defective host immunoregulation

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9
Q

Which IBD does smoking aggregate and which does it protect against?

A

Aggravates Crohns and protects against UC

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10
Q

Which pain relief should you not take when you have IBD?

A

NSAIDs

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11
Q

What is ulcerative colitis?

A

Inflammation of the colon of unknown aetiology

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12
Q

Peak age incidence?

A

20 - 30s

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13
Q

What type of course does UC follow?

A

A relapsing corse

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14
Q

What part of the gut does UC affect?

A

Affects rectum extending proximally to the caecum

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15
Q

What are the names of the 3 different UC extents and what part of the bowel does each affect?

A

Proctitis = just rectum
Left sided colitis = to splenic flexure
Pan-colitis = to ileocaecal valve

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16
Q

What is the natural history of UC 1 year after diagnosis?

A 
10% = colectomy
52% = active disease
38% = remission
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17
Q

UC symtoms?

A 
Diarrhoea + bleeding (main)
increased bowel frequency
urgency
tenesmus
incontinence
night rising
lower abdominal pain (esp. LIF)
(practice can cause constipation due to inflammation in the rectum preventing them from passing stool)
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18
Q

What is the Truelove and Witt criteria for severe ulcerative colitis?
What does meeting this criteria mean in terms of clinical outcomes?

A 
passing greater than 6 bloody stool in a 24 hour period
1 or more of:
fever (greater than 37.8)
Tachycardia
Anaemia
elevated ESR/ CRP

30% risk of colectomy

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19
Q

Further assessment of UC?

A

Bloods (CRP and albumin (a negative acute phase reactant which decreases in sepsis or inflammation)
Plain AXR
Endoscopy
Histology

20
Q

What are you looking for on a plain AXR in a UC patient? (3)

A 
Stool distribution (none in inflamed colon)
Mucosal oedema = thumbprining
Toxic megacolon
21
Q

What is toxic megacolon? Widths?

A

an acute toxic colitis with dilatation of the colon
Transverse greater than 5.5cm
Caecum greater than 9cm

22
Q

What would be seen in endoscopy of a patient with UC? (5)

A 
Confluent inflammation/ ulceration extending proximally from anal margin to "transition zone"
Loss of vessel pattern
Loss of hausfrau
Granular mucosa
Contact bleeding
Pseudopolyps sometimes
(endoscopy used to define extent)
23
Q

Histology:
what layers of the colon does ulcerative colitis affect?
What cells are absent in histology of UC?
What happens to the crypts in UC?

A

Mucosal layer only
Goblet cells are absent
Crypts can become distorted and enlarged and accesses can form

24
Q

Long term complication of UC?

A

Increased risk of colorectal cancer

25
Q

What is the risk of developing colorectal cancer from UC determined by?

A

Severity of inflammation
Duration of disease
Disease extent
(patients who have extensive colitis (to beyond splenic flexure) for over 10 years should have regular colonoscopy)

26
Q

Extra-intestinal manifestations of IBD?

A

Skin (erythema nodosum)
Joints (spondylitis, sarcolitis, peripheral arthritis)
Eyes (uveitis)
deranged LFTS (steatosis of liver, gallstones, sclerosing cholangitis)
Renal stones

27
Q

Primary sclerosing cholangitis?

Symptoms?

A

Progressive cholestasis with bile duct inflammation and fibrosing stricture formation
80% of patients with this have associated IBD (UC more common cause than Crohns)
Most asymptomatic or itch and rigours
Median time to death or liver transplant is 10 years
15% get cholangiocarcinoma

28
Q

Mean age of diagnosis of Crohns disease?

A

27 (90% onset before age of 40)

29
Q

Where along the gut does IBD affect?

A

Can affect any region pf the GI tract from the most to naus

30
Q

Does Crohns occur as skip lesions or does it affect the GI tract continually?

A

Skip lesions

31
Q

How deep into the GI tract does crohns affect histologically?

A

Transmural inflammation

32
Q

How does peri-anal Crohns disease present? (4)

A

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

33
Q

What % of crohns patient require surgery within 8-10 years?

A

75%

34
Q

Why do we try to minimise resection in Crohns disease?

A

It is non-curative (having short bowel causes major malabsorption problems)

35
Q

What are the 3 disease phenotypes of Crohns disease?

A

Stenosis (50%) - need to establish whether this is fibrotic or inflammatory
Inflammation (30%)
Fistula (20%)

36
Q

What determine the Crohns disease symptoms?

A

Site of disease

37
Q

Symptoms of Crohns disease of the small intestine?

A 
Abdominal cramps (peri-umbilical)
Diarrhoea, weight loss
38
Q

Symptoms of Crohn’s disease of the colon?

A

Abdominal cramps (lower abdomen)
Diarrhoea with blood
Wt loss

39
Q

Symptoms of Crohn’s disease of the mouth?

A

Painful ulcers
Swollen lips
angular chielitis

40
Q

Symptoms of Crohn’s disease of the anus?

A

Peri-anal pain

Abscess

41
Q

Further assessment of Crohns disease?

A 
Clinical exam (evidence of wt loss, RIF mass, peri-anal signs)
Bloods (CRP, albumin, platelets, B12 (if affecting t. ileum), ferritin)
Stage disease extent using endoscopy
42
Q

Where is vitamin B12 absorbed?

A

Ileum

43
Q

What may you seen on endoscopy of a patient with Crohn’s disease?

A

Cobblestonning
Fissures
Ulceration

44
Q

What creates the “cobble-stoning” seen in crohns disease?

A

Longitudinal and circumferential fissures and ulcers separate islands of mucosa, giving it an appearance reminiscent of cobblestones.

45
Q

What would histology of crohns disease look like?

A

Patchy

Granuloma (30-50%)

46
Q

What can be used to assess the small bowel for Crohns disease? (3)

A

Barium follow-through
Small bowel MRI
Technetium-labelled white cell scan?

Study notes - Respiratory (29 decks)

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