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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
Q

Truelove and Witt criteria for UC

A 
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
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26
Q

What do you also want to check for in blood in UC?

A

CRP

Albumin (a negative acute phase reactant)

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27
Q

UC stool ditribution in AXR

A

Absent in inflamed colon

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28
Q

AXR findings in UC

A

“Thumb printing” -mucosal oedema

29
Q

Toxic megacolon?

A

Transvers >5.5cm

Caecum >9cm

30
Q

What are psuedopolyps?

A

Psuedopolyps are projecting masses of scar tissue that develop from granulation tissue during the healing phase in repeated cycle of ulceration

31
Q

What is extensive colitis?

A

Beyond the splenic felxure

requires surveillance after 10 years of disease because of colorectal cancer risk

32
Q

Circulation extramanifestation of UC?

A

Phlebitis

33
Q

Biliary tract extramanifestations of UC?

A

Gallstones,

Sclerosing cholangitis

34
Q

Mouth extramanifestations of UC?

A

Apthous ulcers,

Stomatitis

35
Q

Liver extramanifestations of UC?

A

Steatosis

36
Q

What is primary sclerosing cholangitis massively linked to?

A

IBD (UC>Crohn’s)

37
Q

What type of cancer will those suffering from PSC get?

A

Cholangiocarcinoma (15%)

38
Q

Signs of PSC

A

Most aysmptomatic, ITCH, RIGORS

Cholestatic LFTs

39
Q

Most common sites involved in Crohn’s?

A

Terminal ileum, iliocaecal valve and caecum

40
Q

Cobblestone appearance?

A

Crohn’s

41
Q

Is the intestinal wall thickened in Crohn’s?

A

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
Q

Creeping fat

A

Crohn’s! (mesenteric fat frequently extends around the serosal surfaces)

43
Q

What is a crypt abscess?

A

Neutrophils in a

44
Q

Where might you see paneth cell metaplasia in Crohn’s?

A 
Left colon (paneth cells normally absent)
Epithelial metaplasia is also common
Non-caseating granulomas
45
Q

If you have Crohn’s in small intestine, where would you feel cramps?

A

Peri-umbilical region

lower abdomen if large intestine Crohn’s

46
Q

Crohn’s with diarrhoea and blood would suggest which area is affected?

A 
Large intestine
(small intestine just diarrhoea)
47
Q

Weight loss, RIF mass, perianal signs?

A

you got croooooohn’s

48
Q

Where is vitamin B12 absorbed from?

A

Small intestine, so be wary in Crohn’s

49
Q

Ferritin in IBD

A

Levels may be low e.g due to bleeding

50
Q

Small Bowel Assessment

A

Barium follow through
Small bowel MRI
Technetium-labelled white cell scan

51
Q

Side effects of 5ASA

A

diarhoeaa, idiosyncratic nephritis

52
Q

5ASA mechanism of action?

A

Topical effect
Anti-inflammatory
Reduces risk of colon cancer

53
Q

How can you take ASA?

A

Oral (pro-drugs, pH dependent drugs, delayed release)

Topical (suppositories, enema)

54
Q

What is Sulphazaline?

A

Sulphapyridine/ASA

55
Q

What is Balsalazide

A

5ASA/inert carrier

works in colon

56
Q

What is Mezavant

A

5ASA/matrix carrier

57
Q

What is Asacol?

A

pH release ASA

works in colon and ileum

58
Q

Mesalazine?

A

5ASA

59
Q

What is pentasa?

A

Delayed release 5ASA

works in duodenum, jejunum, ileum and colon

60
Q

Corticosteroids used in UC?

A

Prednisolone

Budesonide

61
Q

Neuropyschiatric side effects of Steroids?

A

Cataracts, growth failure

62
Q

Side effects of Aziathioprine?

A

PANCREATITIS, leucopania, hepatitis, lymphoma

63
Q

How would you give infliximab?

A

IV infusion

64
Q

How would you give adalimumab?

A

S/C injection

65
Q

Anti-TNF side effects?

A

Infusion reactions, infection and CANCER :(

cancer:lymphoma, solid tumours

66
Q

When would you give elective surgery for IBD?

A

When there is a failure to respond to medical therapy

When there is dysplasia of the colon mucosa

67
Q

When is emergency surgery for IBD needed?

A

Failure to respond to medical therapy, small bowel obstruction, abscess, fistulae

68
Q

What is proctocolectomy?

A

Surgery to remove the rectum and all/part of the colon

GI (11 decks)

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