IBD Flashcards

1
Q

why are TPMT levels checked before azothioprine?

A

some people have a defective enzyme which can lead to azothiorpine causing bone marrow toxicity in them as it is not being properly metabolised

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2
Q

what is the investigation of choice for a suspected perianal fistula?

A

MRI is the investigation of choice for suspected perianal fistulae - can be used to determine if there (is an abscess and if the fistula is simple (low fistula) or complex (high fistula that passes through or above muscle layers)

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3
Q

what are complications of crohs?

A
  • small bowel cancer (standard incidence ratio = 40)
  • colorectal cancer (standard incidence ratio = 2, i.e. less than the risk associated with ulcerative colitis)
  • osteoporosis
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4
Q

which drug used to treat UC and RA causes haemolytic anaemia?

A

sulfasalezine

  • cause haemolytic anaemia with Heinz bodies.
  • blood tests show low haemoglobin, increased reticulocytes and the peripheral smear shows multiple Heinz bodies, confirming the diagnosis.
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5
Q

what is left Lower quadrant pain more typical of?

A

UC

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6
Q

which causes more weight loss?

A

chrons- due to loss of absorption by the small intestines

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7
Q

in which is bloody stool more common?

A

UC

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8
Q

which affects the RLQ?

A

crohns

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9
Q

what are features of UC?

A

always involves rectum

  • confined to colon
  • continuous
  • superficial
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10
Q

what are features of crohs?

A
  • transmural (causing fistulation and luminal stenosis)
  • discontinuous (skip lesions - rose thorn ulcers)
  • mouth to anus (terminal ileum most common)
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11
Q

which is more likely to cause bowel obstruction?

A

crohns

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12
Q

what is the difference in extra intestinal features present in CD vs UC?

A

Arthritis is the most common extra-intestinal feature in both CD and UC

  • Episcleritis is more common in CD
  • Primary sclerosing cholangitis is much more common in UC
  • Uveitis is more common in UC
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13
Q

in which is gallstones more common?

A

CD
secondary to reduced bile acid reabsorption

Oxalate renal stones*

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14
Q

what is the difference in histology between the two?

A

CD:
increased goblet cells
granulomas

UC:
neutrophils migrate through the walls of glands to form crypt abscesses

depletion of goblet cells and mucin from gland epithelium

granulomas are infrequent

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15
Q

how does CD appear on endoscopy?

A

cobblestone appearance

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16
Q

how does CD appear on enema?

A

strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

17
Q

how does UC appear on enema?

A
  • loss of haustrations
  • superficial ulceration, ‘pseudopolyps’
  • long standing disease: colon is narrow and short -‘drainpipe colon’
18
Q

how are the classes of severity for UC classified?

A

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

19
Q

what is the management for severe colitis?

A

should be treated in hospital
intravenous steroids are usually given first-line

intravenous ciclosporin may be used if steroid are contraindicated

if it still doesn’t work patient may need to have surgery

20
Q

which site is most affected in UC?

A

rectum