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Year 3 Gastro > IBD > Flashcards

IBD Flashcards

1
Q

Describe the basic anatomy of the Lower GI tract?

A 
Appendix
Caecum
Ascending Colon
Transverse Colon
Descending Colon
Sigmoid Colon
Rectum 
Anus
Small bowel
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2
Q

What is the parasympathetic supply to the lower GI tract?

A

Ascending colon and most of transverse colon innervated by vagus nerve

More distal innervated by pelvic nerves

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3
Q

What is the sympathetic innervation of the GI tract?

A

lower thoracic and upper lumbar spinal cord

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4
Q

What is the purpose of the illiocaecal valve?

A

Gives access to the terminal illeum

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5
Q

What provides the blood supply to the lower GI tract? (Arterial)

A

Small bowel - SMA

Colon - branches of SMA and IMA (mainly left side)

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6
Q

What provides the blood supply to the lower GI tract? (Venous)

A

SMV
IMV
Both join the portal vein and eventually the inferior vena cava

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7
Q

What are the 4 layers of the gut?

A

Mucosa: Epithelium, Lamina propia and muscularis mucosae

Submucosa

Muscularis: Circular and Lpongituidinal

Serosa: Nerve supply

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8
Q

What are the nerve plexuses in the gut?

A

Myenteric plexus

Submucosal plexus

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9
Q

What is the main features of the mucosa?

A

Glands that produce mucin that lubricates the bowel making the passing of faeces easier

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10
Q

What is the nerve supply to the external anal sphincter?

A

somatic motor fibres in the pudendal nerves

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11
Q

What is the function of the afferent sensory neurons?

A

Detect pressure

Send signals to empty

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12
Q

Where is the myenteric plexus gangila?

A

Concentrated below the teniae coli?

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13
Q

What are the inflammatory bowel disorders?

A

Inflammatory bowel disease

Micrscopic colitis (normal looking mucosa, but histological abnormalities on biopsy)

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14
Q

What are some infective bowel disorders?

A

C Diff

Ecoli

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15
Q

What are some structural bowel disorders?

A

Diverticular disease
Haemorrhoids
Fissures

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16
Q

What are some functional bowel disorders?

A

Irritable bowel syndrome

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17
Q

What are some neoplastic bowel disorder?

A

Colonic polyps

Colon cancer

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18
Q

What are some other causes of bowel disorders?

A

Neurological
Metabolic
Vascular

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19
Q

How many people in Europe and America are affected by IBD?

A

1.5 million people in America and 2.2 million in Europe

Particularly high in the northern hemisphere

But more recently studies in Asia and the Middle East have shown increasing incidence world wide

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20
Q

Who does IBD often affect?

A

Often young people

Lifelong chronic disease

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21
Q

What is the toll of IBD?

A 
Burden of therapy for patients
Hospitalisation
Surgery
Health-related quality of life
Economic productivity
Social functioning
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22
Q

What does IBD comprise?

A

Ulcerative Colitis

Crohn’s disease

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23
Q

What are the features of Ulcerative Colitis?

A 
Inflammatory disorder limited to the colonic mucosa
Superficial
Continuous
Always involves the rectum
Only large bowel
M = F
NO granulomas
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24
Q

What are the features of Crohn’s disease?

A

Can affect any part of the gastrointestinal tract
Patchy chronic transmural granulomatous inflammation
Tendency to form fistula or strictures
Affects deeper structures
Small and Large bowel
F>M (1.5:1)

25
What is UC involving only the rectum?
Proctitis
26
What is UC involving the rectum and sigmoid?
Proctosigmoiditis
27
What is UC involving the rectum, sigmoid and descending?
Distal colitis
28
What is UC involving the rectum, sigmoid, descending and transverse?
Extensive Colitis
29
What is UC involving the whole large bowel?
Pancolitis
30
What are the symptoms of Colitis?
Bleeding Mucus Urgency Diarrhoea
31
What are the perianal symptoms of perianal disease? (Crohn's)
Anal pain Leakage Difficulty passing stool
32
What are the symptoms of small bowel disease?
``` Abdominal pain Weight loss Tiredness/lethargy (Caused by reduces absorption) Diarrhoea Abdominal mass ```
33
What are the extra-intestinal manifestations of IBD?
Arthritis Axial – Ankylosing Spondylitis Peripheral Skin Erythema nodosum Pyoderma gangrenosum Eyes Anterior uveitis Episcleritis/Iritis Liver Primary Sclerosing Cholangitis (PSC) Autoimmune hepatitis
34
What causes IBD?
In genetically susceptible patients They respond inappropriately to git microbiota Imbalance between healthy and pathological microbiota Causing inflammation
35
What are the three factors of IBD aetiology?
Luminal microbes (environmental factors) Genetic susceptibility Immune respnse
36
Using GWAs, which genes were found to be involved with IBD?
NOD2 HLA ATG Il23R 30+ genes now known
37
What are the environmental factors?
Poor diet results to alteration of the microbiota
38
What is dysbiosis?
Unhealthy gut microbiota
39
Who are less likely to have IBD?
Physically active | Those who have and appendectomies do not get UC
40
What worsens crohn's disease?
Smoking Diagnosed earlier Worsens symptoms Oddly protective of UC
41
What are the main management goals with IBD?
Induce clinical remission Maintain clinical remission Improve patient quality of life
42
What are the other management goals?
Heal mucosa Decrease hospitalisation/ surgery & overall cost Minimise disease and therapy related complications
43
What treatments are used for IBD?
Steroids 5 ASA Immune suppressants Azathioprine Methotreaxate Biologic therapy Others –diet, FMT, antibiotics, probiotics, novel agents
44
How do steroids work?
Diffuse and bind in nucleus to Glucocorticoid Responsive Elements (GRE). GRE interact with specific DNA sequences Increase anti-inflammatory gene products Block pro-inflammatory genes Used short term and to induce healing in hospital settings Significant side effects long term Can be delivered IV, Orally or Rectally
45
How does 5 Amino-Salycylic-Acids work?
Inhibition of pro-inflammatory cytokines (IL-1 and TNF-a ) Inhibition of the lipo-oxygenase pathway i.e. prostaglandin and leukotrienes Scavenging of free radicals Inhibition of NF-kB/ TLR via PPAR-gamma induction (perioxisome proliferator activated receptor-gamma) Some immunosuppresive activity – inhibiting T cell proliferation, activation and differentiation Impairs neutrophil chemotaxis and activation Orally or rectal
46
What are the sides effects of 5 ASA?
Intolerance Diarrhoea Renal impairment Headache Malaise Pancreatitis Pneumonitis
47
What immunomodulator is used in IBD?
Azathioprine
48
How does Azathroprine work?
6-TG interferes with adenine and guanine ribonucleotide production. Results in reduced number of B and T lymphocytes, immunoglobulins and interleukins. Reduces inflammation via suppressing immune system Another pathway potentially results in apoptosis of T cells
49
What are the side effects of Azathioprine?
``` Allergic reaction Infection Pancreatitis Bone marrow surpression GI gisturbances Hepatotoxicity ```
50
What is checked before giving immunosurpressants?
``` Thiopurine Methyltransferase (TPMT) Hep B/C HIV Chicken pox Vaccinations TB Frequent bloods on starting Maintenance bloods ```
51
How does methotrexate work?
Mechanism not clear Interferes with DNA synthesis & cell reproduction Increased adenosine levels (anti-inflammatory) Increased apoptosis of peripheral T cells ``` Takes 3 months to work Need history re liver abnormalities Monitor LFTs, FBC Advise NO pregnancy Folic acid supplements (reduces side effects) WEEKLY DOSE ```
52
What biologic drugs are used?
Anti-TNFα – infliximab, adalimumab Anti- α4β7 Vedolizumab Anti-IL12/IL23 Ustekinumab More and more on the way
53
What are the side effects of methotrexate?
``` Rash Nausea, mucositis, Diarrohea Bone marrow suppression Hypersensitivity pneumonitis ↑’ed liver enzymes Hepatic fibrosis/cirrhosis Known abortifacient No documented ↑ed risk of lymphoma or skin cancer ```
54
Give examples of how biologics are used in hospital?
IV infliximab in hospital – less frequent Induction 0,2,6 weeks Maintenance 8 weekly s/c adalimumab (humira) 160/80/ 40mg EOW At home – more frequent s/c Golimumab
55
What are the side effects of biologics?
``` Opportunistic infections Infusion or site reactions Infusion reactions Neutropenia Infections Demyelinating disease Heart failure (HF) Cutaneous reactions, including psoriasis Malignancy Induction of autoimmunity ```
56
What combination therapy is used in IBD?
AZA/ 6MP and aTNF act synergistically Combination is superior in inducing and maintaining response and remission Reduces the rate of antibody formation
57
What other considerations can be made when managing IBD?
``` Dietary therapy Liquid therapy diet Increased use in children As effective as steroids Use in small bowel Crohns disease Weeks ``` Antibiotics No hard evidence Good for sepsis Faecal Microbiota Transplantation (FMT) Lots research into the role of the microbiome Novel agents
58
What is used to induce remission in Crohn's?
Glucocorticoids only

Year 3 Gastro (39 decks)

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