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MBChB3 > IBD > Flashcards

IBD Flashcards

1
Q

What are the contributing factors of IBD?

A
  • environmental factors (eg. Antibiotics, intestinal inf.)
  • genetic predisposition
  • gut microbiota
  • host immune response
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2
Q

Describe the presentation of infective colitis

A
  • short history of diarrhoea +/- vomiting
  • abrupt onset +/- resolution of symptoms
  • systemic upset
  • fever
  • travel + unwell contacts
  • immunocompromised
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3
Q

What is the investigation and management of infective colitis?

A

Investigation:
- stool culture (x4)
- CDT

Management:
- conservative if immunocompetent (even if bacterial gastroenteritis confirmed)

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4
Q

Describe the presentation of ischaemic colitis

A
  • increased risk in elderly, CV disease, HF
  • abrupt onset pain + bloody diarrhoea
  • +/- systemic inflammatory response syndrome (SIRS)
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5
Q

Describe the investigation findings and treatment of ischaemic colitis

A
  • CT may show segmental colitis in watershed areas (areas receiving dual supply from distal branches of their arteries)
  • splenic flexure + rectosigmoid junction
  • treatment is usually conservative
  • IV fluids +/- antibiotics (if unstable)
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6
Q

When should you decide to admit a patient with suspected UC?

A

If they are producing >6 stools a day + signs of systemic upset

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7
Q

What imaging is useful in colitis?

A
  • abdominal X-ray
  • assess disease extent + severity
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8
Q

Define megacolon + toxic megacolon

A
  • megacolon: transverse diameter of colon >5.5cm or caecum >9cm
  • toxic megacolon: megacolon + signs of systemic toxicity (EMERGENCY - risk of perforation)
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9
Q

What is an X-ray sign of bowel inflammation?

A

Thumb-printing

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10
Q

What are the 4 layers of the bowel?

A
  • mucosa
  • sub-mucosa
  • muscularis
  • sub-serosa
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11
Q

Describe the pathology of CIBD

A

Acute changes:
- acute inflammation
- ulceration
- loss of goblet cells
- crypt abscess formation (neutrophil aggregation)

Chronic changes:
- architectural changes
- paneth cell metaplasia (increased plasma cells and lymphocytes)
- chronic inflammatory infiltrates in lamina propria
- neuronal hyperplasia
- fibrosis

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12
Q

Describe the prescribed treatment of UC

A
  • mesalazine
  • 4.8g (in flare ups)
  • 2.4g daily maintenance (decreases metaplasia and polyp formation)
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13
Q

At what point would you consider a treatment escalation from mesalazine in UC?

A
  • severe relapse/frequent relapses of disease which require 2 or more corticosteroid courses within 12 month period
  • azathioprine/mercaptopurine (immunosuppressants)
  • biologics (anti-IL/TNF)/surgery
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14
Q

When treating a patient in hospital for UC when can you decide that steroid treatment is not working efficiently?

A

If on day 3 of treatment:
- stool frequency >8
- or CRP >45
* colectomy needed (consider surgery or medical treatment with infliximab/cyclosporin)

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15
Q

List the complications of UC

A

Local: haemorrhage, toxic dilation of colon

Systemic: skin (erythema nodosum, pyoderma gangrenosum), liver (sclerosing cholangitis), eyes (iritis, uveitis), ankylosing spondylitis, malignancy (esp. colorectal cancer)

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16
Q

When is endoscopic surveillance for colorectal cancer commenced in UC patients?

A

After 10 years of disease (where the risk of colorectal cancer increases)

17
Q

What factors in a history/investigations does a Crohn’s disease diagnosis become more likely?

A
  • family history
  • evidence of malabsorption
  • weight loss
18
Q

What is Crohn’s disease?

A
  • chronic inflammatory condition affecting anywhere from mouth to anus
  • 2x more common in smoking
  • peak incidence 15-25y
19
Q

What are the symptoms of Crohn’s disease?

A
  • abdo pain (central)
  • diarrhoea (watery)
  • weight loss
  • fistulae (communication between internal adjacent structures), abscesses, oropharyngeal/gastroduodenal involvement
  • eye symptoms (episcleritis, uveitis)
  • joints (sacroilitis, inflammatory athropathy)
  • skin (erythema nodosum)
20
Q

Contrast Crohn’s disease vs UC

A
  • Crohn’s can affect the small and large bowel, UC just affects large bowel
  • Crohn’s is patchy inflammation giving macroscopic ‘skip lesions’, UC is confluent and diffuse inflammation
  • Crohn’s is a transmural, deeply ulcerating inflammation, UC inflammation is confined to the mucosa
  • Crohn’s has granulomas presence, UC does not
21
Q

What is the medical treatment of Crohn’s?

A
  • azathioprine or 6-mercaptopurine
  • methotrexate (not routinely used due to side effects + teratogenicity)
  • infliximab/adalimumab (anti-TNF biologics)
  • vedolizumab/ustekinumab anti-cytokine)
22
Q

What are the risk factors for severity/need for surgery in Crohn’s patients?

A
  • young onset
  • smoking
  • perianal disease
  • stricturing small bowel disease

MBChB3 (100 decks)

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