IBD Flashcards
Stem: A lady known to have ulcerative colitis and on surveillance colonoscopy is found to have a lesion less than 1 cm in sigmoid colon.
Stem: A lady known to have ulcerative colitis and on surveillance colonoscopy is found to have a lesion less than 1 cm in sigmoid colon.
Q1: What is ulcerative colitis?
Chr. Inflam dis involving the wall of part of the colon and ch.ch by inflamm. Process limited to mucosa and nearly always involves the rectum
Q2: What is its etiology? What’s the commonest site? What’s meant by Backwash ileitis?
Idiopathic and suggestive theories ( genetic – Immunologic – Environmental )
Rectum (Crohn’s – > Ileum)
After involving all the colon it may affect terminal ileum with no skip lesions
Q3: Which treatment would you offer this lady? Why?
Proctocolectomy with ileal pouch
Total colectomy as all parts of colon are affected (as dysplasia can be colon cancer)
–If there is liver mets, how will this affect TNM staging?
Yes, M1
Q4: What is the microscopic features of ulcerative colitis? How does it differ from Crohn’s?
- Crypt abcesses. – pseudopolyps
- In crohn’s it’s granulomatous inflammation non caseating
Q5: What are the prominent clinical features of ulcerative colitis? What are the complications?
Crampy Abd pain, diarrhea, loss of wt., tenesmus, malnutrition
Extra-intestinal – > aphthos ulcer , iritis , pyod. Gang / eryth nodusm
Compl; Malign transformation Toxic megacolon , , obstruction , malabsorption Fistula, Abcess
What would you see on colonoscopy in UC, Crohn’s?
UC; diffuse mucosal involve, pseudoplop , ulceration , diffuse edema
Crohn’s; Cobble stone lesion / Strictures / skip lesions / Aphthos ulcerations
Q7: Why are patients with Crohn’s are more susceptible to renal stones?
Malabsorbtion of fat – bind to Ca – oxalate will not bind to Ca leading to hyperoxaluria and renal stones
Q6: Why does the patient have diarrhea? The patient underwent terminal ileal resection but still has dirrahea, why?
Malabsorption / infection / Incr. motality
– Malabsorption/ recurrence of disease / short bowel syndrome (Less than 100 cm)
Q8: Beside the GIT, what are the other systems affected by IBD?
Erythma Nodosa / Pyoderma gang / Iritis / episcelritis / Aphthous ulcer / Sclerosing cholangitis / arthritis
Q9: How would you investigate a patient with suspected ulcerative colitis?
Lab; Routine, FIT, Fecal calprotectin ,C-ANCA, P-ANCA abs, Stool C&S
Flared; flex Sigmoidoscopy with biopsy NOT Flared; Colonscopy
X-ray / Ct / Barium enema ( Lead pipes app. UC / Follow through Crohn’s)
Q10: What are the vitamins deficiencies to be expected in IBD?
Vit B12
AKED
Q14: What’s TNF? What’s its rule in inflammatory bowel disease?
Tumor necrosis Fx it’s a cytokine involved in syst. Inflammation
its role; Activate macrophage and neutrophils – Cofactor in T cell activation -tumor killing effect – can induce apoptosis (IN GENERAL)
IBD; direct epithelia to increase tight junctions permeability which increase the flux of luminal bacterial components which activates innate and adaptive immune responses
Q13: How would you treat a patient with Crohn’s disease? What are the indications of surgery?
“MAINLY MEDICAL”
-Conserve; Low alcohol , Fat and smoking Low fiber diets
- Medical ttt; Corticosteroids, Mesalazine
in complicated cases; Infliximab
Correction of malabsorption of vitamins
-Surgical involvement in cases of refractory to ttt, Abscess formation, fistula and toxic megacolon and intestinal obst. And fulminant acute attack.
Q11: Does this patient needs endoscopic surveillance? Why?
Yes, As risk of malignancy will increases 1% every yr after 10 yrs of onset and he’s potential to develop cancer.
Q15: Which drugs antagonize TNF?
Infliximab / Adalimumab / certolizumab
