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IBD Flashcards

1
Q

What are crypts of lieberkuhn?

A

A gland found in the epithelial lining of the small intestine and colon

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2
Q

How do IBD and Crohn’s differ in clinical presentation?

A

Abdominal pain and perianal disease (Crohn’s)

Diarrhoea and bleeding (Ulcerative Colitis)

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3
Q

What is the greatest established risk factor for disease development?

A

Positive family history (>80%) (early onset may have strong genetic links)

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4
Q

Mutated allele associated with Crohn’s?

A

NOD2/CARD15 (IBD1)

  • gene located on chromosome 16q12
  • homozygous have greater risk than heterozygous (both increased risk)
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5
Q

What does NOD2/CARD15 do?

A

Encodes a protein involved in bacterial recognition

-contributes to mucosal defence

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6
Q

Are antibiotics effective in the treatment of perianal Crohn’s disease?

A

Yes

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7
Q

What type do cell junctions regulate epithelial permeability?

A

Tight Junctions

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8
Q

What protects the epithelial layer?

A

Hydrophobic mucus

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9
Q

Name the cationic anti-microbial peptides that can be activated in response to bacterial components

A

Defensins

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10
Q

T cells involved in Crohn’s disease

A

Th1

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11
Q

T cells involved in UC

A

Mixed Th1/Th2 (NKTC)

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12
Q

What is the antimicrobial activity like in Crohn’s?

A

Reduced

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13
Q

Effect of smoking on Crohn’s and UC

A

Smoking aggravates Crohn’s but is protective against UC

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14
Q

NSAIDs and IBD?

A

NSAIDS increase risk

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15
Q

Peak incident age for UC?

A

20’s-30’s

Crohn’s = 90% onset before age 40

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16
Q

What kind of ulcers in UC?

A

Broad based

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17
Q

What are pseudopolyps? (found in UC)

A

Islands of regenerating mucosa which bulge into the lumen. Medscape says that these appear in Crohn’s aswell

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18
Q

Is mural thickening present in UC?

A

No it is absent

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19
Q

Which is transmural, UC or Crohn’s?

A

Crohn’s

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20
Q

Loss of haustra in?

A

UC

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21
Q

What is proctitis?

A

Inflammation of the anus and the lining of the rectum

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22
Q

Pancolitis?

A

Severe UC, spread throughout the whole large intestine

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23
Q

Where is lower abdominal pain most common in UC?

A

Left iliac fossa

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24
Q

Extra manifestations of UC common where?

A

Skin, eyes and joints
You may also get deranged LFTS
You may also get oxalate renal stones (calcium oxalate)

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25
Truelove and Witt criteria for UC
``` 6 or more bloody stools in the past 24 hours and 1 or more of: Fever Tachycardia Anemia (Hb30mm/hr) Sever colitis = 30% risk of colectomy ```
26
What do you also want to check for in blood in UC?
CRP | Albumin (a negative acute phase reactant)
27
UC stool ditribution in AXR
Absent in inflamed colon
28
AXR findings in UC
"Thumb printing" -mucosal oedema
29
Toxic megacolon?
Transvers >5.5cm | Caecum >9cm
30
What are psuedopolyps?
Psuedopolyps are projecting masses of scar tissue that develop from granulation tissue during the healing phase in repeated cycle of ulceration
31
What is extensive colitis?
Beyond the splenic felxure | requires surveillance after 10 years of disease because of colorectal cancer risk
32
Circulation extramanifestation of UC?
Phlebitis
33
Biliary tract extramanifestations of UC?
Gallstones, | Sclerosing cholangitis
34
Mouth extramanifestations of UC?
Apthous ulcers, | Stomatitis
35
Liver extramanifestations of UC?
Steatosis
36
What is primary sclerosing cholangitis massively linked to?
IBD (UC>Crohn's)
37
What type of cancer will those suffering from PSC get?
Cholangiocarcinoma (15%)
38
Signs of PSC
Most aysmptomatic, ITCH, RIGORS | Cholestatic LFTs
39
Most common sites involved in Crohn's?
Terminal ileum, iliocaecal valve and caecum
40
Cobblestone appearance?
Crohn's
41
Is the intestinal wall thickened in Crohn's?
yah Thickened as a consequence of transmural edema, inflammation, submucosal fibrosis, and hypertrophy of the muscularis propria, all of which contribute to stricture formation
42
Creeping fat
Crohn's! (mesenteric fat frequently extends around the serosal surfaces)
43
What is a crypt abscess?
Neutrophils in a
44
Where might you see paneth cell metaplasia in Crohn's?
``` Left colon (paneth cells normally absent) Epithelial metaplasia is also common Non-caseating granulomas ```
45
If you have Crohn's in small intestine, where would you feel cramps?
Peri-umbilical region | lower abdomen if large intestine Crohn's
46
Crohn's with diarrhoea and blood would suggest which area is affected?
``` Large intestine (small intestine just diarrhoea) ```
47
Weight loss, RIF mass, perianal signs?
you got croooooohn's
48
Where is vitamin B12 absorbed from?
Small intestine, so be wary in Crohn's
49
Ferritin in IBD
Levels may be low e.g due to bleeding
50
Small Bowel Assessment
Barium follow through Small bowel MRI Technetium-labelled white cell scan
51
Side effects of 5ASA
diarhoeaa, idiosyncratic nephritis
52
5ASA mechanism of action?
Topical effect Anti-inflammatory Reduces risk of colon cancer
53
How can you take ASA?
Oral (pro-drugs, pH dependent drugs, delayed release) | Topical (suppositories, enema)
54
What is Sulphazaline?
Sulphapyridine/ASA
55
What is Balsalazide
5ASA/inert carrier | works in colon
56
What is Mezavant
5ASA/matrix carrier
57
What is Asacol?
pH release ASA | works in colon and ileum
58
Mesalazine?
5ASA
59
What is pentasa?
Delayed release 5ASA | works in duodenum, jejunum, ileum and colon
60
Corticosteroids used in UC?
Prednisolone | Budesonide
61
Neuropyschiatric side effects of Steroids?
Cataracts, growth failure
62
Side effects of Aziathioprine?
PANCREATITIS, leucopania, hepatitis, lymphoma
63
How would you give infliximab?
IV infusion
64
How would you give adalimumab?
S/C injection
65
Anti-TNF side effects?
Infusion reactions, infection and CANCER :( | cancer:lymphoma, solid tumours
66
When would you give elective surgery for IBD?
When there is a failure to respond to medical therapy | When there is dysplasia of the colon mucosa
67
When is emergency surgery for IBD needed?
Failure to respond to medical therapy, small bowel obstruction, abscess, fistulae
68
What is proctocolectomy?
Surgery to remove the rectum and all/part of the colon

GI (11 decks)

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