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GI and Surgery > IBD > Flashcards

IBD Flashcards

1
Q

What is the most common extra-intestinal manifestation of IBD?

A

Arthritis

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2
Q

What extra-intestinal skin changes can be seen in IBD?

A

Erythema nodosum and pyoderma gangrenosum.

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3
Q

What is a major complication of UC?

A

Toxic mega colon.

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4
Q

Uveitis is strongly associated with CD or UC?

A

UC

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5
Q

Which hepatobiliary pathology is associated with UC?

A

Primary sclerosing cholangitis (PSC).

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6
Q

Which classification system can be used to assess the severity of UC?

A

Truelove & Witts’ (classifies into mild, moderate and severe).

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7
Q

What is the MOA of thiopurines (azathioprine and mercaptopurine)?

A

Purine synthesis inhibition in lymphocytes leading to immunosuppression.
Must check TPMT enzyme activity before use.

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8
Q

What is the MOA of methotrexate?

A

Inhibits dihydrofolate reductase, having both immunomodulatory and anti-inflammatory properties.

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9
Q

What is the MOA of infliximab and adalimumab?

A

TNF alpha inhibitor.

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10
Q

Patients with CD and UC have an increased risk of which cancer?

A

Colorectal cancer.

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11
Q

What are the differences between CD and UC?

A

CD: affects entire GI tract, skip lesions, transmural inflammation, smoking is a risk factor.
UC: affects rectum and colon, continuous inflammation, superficial mucosa affected, smoking is protective.

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12
Q

Which part of the GI tract is most commonly affected in CD?

A

Terminal ileum.

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13
Q

What is the aetiology of IBD?

A

Abnormal immune response to normal intestinal microflora within a genetically susceptible individual. Th1 response —> proinflammatory cytokines e.g. INF alpha.

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14
Q

What are the histological features of CD?

A

Cobblestone appearance, rose thorn ulcers, lymph node hyperplasia, narrowing of lumen, thickening of intestinal wall, skip lesions, non-caseating granulomas.

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15
Q

What are the histological features of UC?

A

Inflammatory polyps, crypt abscesses, goblet cell depletion, superficial inflammation and ulcers.

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16
Q

UC that affects only the rectum is known as…

A

Proctitis

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17
Q

Name 2 other variations of UC

A

Left-sided colitis, pancolitis.

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18
Q

What are the clinical features of CD?

A

Diarrhoea (+/- blood), abdominal pain, weight loss, fever, fatigue, perianal disease, aphthous stomatitis.

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19
Q

What are the clinical features of UC?

A

Bloody diarrhoea, rectal bleeding, abdominal pain, increased frequency/urgency, fatigue, fever.

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20
Q

What is perianal disease?

A

Skin tags, fissures, fistulae, abscesses —> rectal bleeding.

21
Q

Name the marker of intestinal inflammation

A

Faecal calprotectin.

22
Q

How can IBD definitively be diagnosed?

A

Endoscopy and biopsy.

23
Q

Describe the management plan for inducing remission in CD

A

First line: glucocorticoids e.g. oral prednisolone.
Aminosalicylates.
Add on therapy: steroid + other drugs e.g. azathioprine, mercaptopurine, methotrexate.
Biological agents: adalimumab, infliximab.

24
Q

Describe the management plan for maintaining remission in CD

A

First line: azathioprine, mercaptopurine.
Methotrexate.
Infliximab, adalimumab.

25
Q

What are the surgical treatment options for CD?

A

Surgical resection of distal ileum or ileocaecal resection.
Hemicolectomy.
Colectomy (with ileostomy or ileo-rectal anastomosis).
Proctocolectomy.

26
Q

Describe the management plan for inducing remission in mild-moderate UC

A

First line: aminosalicylates e.g. mesalazine oral or rectal.
Glucocorticoids e.g. prednisolone.
Tofacitinib (JAK inhibitor).

27
Q

Describe the management plan for inducing remission in acute severe UC

A

First line: IV hydrocortisone.
IV ciclosporin.
Infliximab.

28
Q

What is the MOA of ciclosporin?

A

Inhibits T cell activation and differentiation.

29
Q

Describe the management plan for maintaining remission in UC

A

Aminosalicylates.
Azathioprine or mercaptopurine.

30
Q

What is the name of the surgery to remove the colon and rectum in UC?

A

Proctocolectomy

31
Q

What happens after a proctocolectomy?

A

Patient left with either an ileostomy or ileo-anal anastomosis (J-pouch).

32
Q

What is a J-pouch?

A

It attaches to anus and collects stools prior to defecation.

33
Q

Why is an ileostomy spouted?

A

Prevents skin irritation from small bowel contents produced by stoma.

34
Q

Describe classification of UC severity

A

Mild: < 4 stools/day, small amount of blood.
Moderate: 4-6 stools/day, varying amounts of blood, no systemic upset.
Severe: > 6 stools/day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers).

35
Q

If a mild-moderate flare of UC doesn’t respond to topical aminosalicylates, what is the next step?

A

Add oral aminosalicylates

36
Q

What is a key haematological adverse effect of aminosalicylates?

A

Agranulocytosis

37
Q

Pancreatitis is a side effect of which aminosalicylate?

A

Mesalazine

38
Q

Heinz body anaemia is associated with which drug?

A

Sulphasalazine

39
Q

Inflammation of bowel limited to mucosa and submucosa is characteristic of…

A

UC

40
Q

A 22 year old man is investigated for weight loss and diarrhoea. A rectal biopsy is taken and reported as follows:
‘Deep inflammatory infiltrate from mucosa to muscularis externa. Numerous granulomata noted.’
What is the most likely diagnosis?

A

CD.

41
Q

What is the treatment for complex perianal fistulas in patients with CD?

A

Draining seton

42
Q

What is the management of haemorrhoids and anal fissures?

A

Lidocaine gel (analgesia), increased dietary fibre, increased oral fluids and laxatives.

43
Q

Topical glyceryl trinitrate can be used to treat…

A

Anal fissures - relaxes sphincter muscles, improving blood flow to area, enabling healing. Also provided analgesia.

44
Q

Why is CD associated with gallstones?

A

Bile salts aren’t absorbed due to inflammation of terminal ileum.

45
Q

What is the management for a peri-anal abscess?

A

Incision and drainage.

46
Q

A severe flare in UC should be treated with…

A

IV steroids

47
Q

If a mild-moderate flare of UC does not respond to topical or oral aminosalicylates, what should be tried next?

A

Oral corticosteroids

48
Q

In patients with severe colitis what method of endoscopy is preferred?

A

Flexible sigmoidoscopy - colonoscopy should be avoided due to the risk of perforation.

GI and Surgery (14 decks)

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