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GASTROENTEROLOGY SCE > IBD > Flashcards

IBD Flashcards

1
Q

Histology in CD

A

Goal
Transmural
Asymmetrical
Granulomatous

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2
Q
  1. How many UC Pt flare each yr
  2. How many patients with pancolitis eventually have a colectomy?
  3. What is the CRC incidence at 20yrs in UC?
  4. What is the colorectal cancer incidence at 40years
  5. What is the relative risk reduction for CRC with 5ASA?
A
  1. 50%
  2. 25%
  3. 8%
  4. 16%
  5. 50%
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3
Q

When is a 5 year screening colonoscopy required for UC screening?

A

Extensive colitis with no macro/microscopic activity
Left sided colitis
Crowns colitis affecting <50% colon
Pouch surveillance post-colectomy

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4
Q

When is a 3 year screening colonoscopy required for UC screening?

A

Extensive colitis with mild micro and macroscopic activity
Pseudo-polyp
Post inflammatory polyp
CRC in 1st degrees relative >50yrs

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5
Q

When is annual screening colonoscopy required for UC screening?

A

Extensive colitis and severe micro/macroscopic changes
Hx stricture/dysplasia declining surgery in last 5yrs
CRC in relative <50yrs
PSC
Pouch with dysplasia
Severely inflamed pouch

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6
Q

Describe diversion colitis
What Rx is given
What is the definitive Rx

A

Deficiency of short chain fatty acids
Unabsorbed carbs enter colon are metabolised by bacteria to SCFA to provide nutrition for colonic mucosa
Rx - SCFA enema, steroid enema, mesalazine
Surgery to restore faecal flow

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7
Q

Describe type 1 peripheral arthropathy

A

Affects <5 joints, acute, self-limiting

Occurs alongside intestinal inflammation

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8
Q

Describe type 2 peripheral arthropathy

A

> 5 joints
Prolonged course, independent of gut inflammation
Associated with uveitis only

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9
Q

Classically what is the B12 and folate in SBBO

A

B12 low

Folate HIGH

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10
Q

What is the criteria for a severe attack based on True Love and Witt criteria

A

Tachycardia >90
Temperature >37.8
Hb <10.5
ESR>30

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11
Q

In what situations can’t you give ciclosporin

A

Uncontrolled HTN
Renal impairment
My <0.5
Cholesterol <3

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12
Q

What can we use VSL#3 for?

A

Proctitis

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13
Q

What is the General role of CT colonoscopy

A

Tumour or polyp detection

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14
Q

Describe the histology in UC

A 
Severe crypt architecture distortion
Reduced crypt density
Collins surface appearance
Severe mucin depletion
Diffuse, transmural lamina propria cell increase
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15
Q

Describe histology in Crohn’s

A

Epithelial granuloma
Discontinuous inflammation
Crypt distortion
Focal cryptitis

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16
Q

Which medication used to treat UC reduces sperm count and motility?

A

Sulfasalazine

Reversible infertility

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17
Q

IBD and pregnancy:

  1. do you continue maintenance medications?
  2. Are congenital defects reported in infliximab?
  3. Infliximab is found in breast milk? Y/N
  4. 1st line management of N+V in pregnancy
  5. Which antibiotic used in CD should be avoided in pregnancy
  6. 1st line constipation treatment
A
  1. Yes
  2. No
  3. No
  4. Ginger and P6 acupuncture
  5. Metronidazole
  6. Fibre supplements
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18
Q

Which medications are safe in pregnancy and IBD

A

Sulfasalazine
Mesalazine
Azathiprine
Infliximab (undetectable)

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19
Q

Which antibiotics are not safe in pregnancy and IBD?

A

Metronidazole

Cilrofloxacin

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20
Q

After prednisolone hoe long should you delay breastfeeding for

A

4 hours

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21
Q

What strongly predicts the presence of a peri-anal abscess?

A

Peri-anal pain

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22
Q

Treating fistulating disease

A

Map fistula - MRI
Assess current disease activity
EUA is gold standard - can then give therapeutic treatment if required
(Equivalent is ano-rectal USS

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23
Q

Describe the different types of simple fistulas

A

Superficial perianal

Inter-sphincteric perianal or duo-vaginal

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24
Q

Describe the types of complex fistula

A 
Trans-sphincteric = enterocutaneous
Supra-sphincteric = enters-enteric
Extra-sphincteric = entero-enteric, enterovesical, rectovaginal
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25
Q

What is the benefit of colonic release budesonide

A

As effective as prednisolone in mild-moderate left sided disease (UC).

But high first pass metabolism and fewer side effects

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26
Q

What to tell pt when counselling for thiopurines

A 
Slow onset
Avoid sun
Risk of cancer (<1% at 10 yrs)
Avoid allopurinol
Rise in MCV
Monitor bloods 2-4/52 for 2/22 then every 3months
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27
Q

Treatment of complex fistula

A

Drain abscess and seton suture
ABX and thiopurine first line
Anti-TNF 2nd line

Emerging therapy - topical IFX, stem cells, fistula plug, hyperbaric O2

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28
Q

There is evidence for VSL#3 in pouchitis, what main bacteria does it contain?

A

Strep. Thermophilus
Bifidobscterium species
Lactobacillus

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29
Q

Which genes show the greatest association with CD

A

NDD2

CARD15

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30
Q

What is the chance of offspring developing IBD if both parents have IBD

A

30%

If only one parent = 9% CD and 6% UC

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31
Q

Which cytokines does Th1 produce?

A

IL1 and IL6 and TNG

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32
Q

Th17 produces…

A

IL-17 and IL22

They are proinflammatory cytokines

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33
Q

What increases risk of immunogenicity in IFX

A

Mono therapy

Episodic IFX therapy

34
Q

Describe IFX and antibody production and how we manage this

A

Low IFX and positive antibody = switch drug (92% clinical response)

Low IFX and negative antibody = increase drug dose

35
Q

What is considered gold standard for diagnosing small bowel IBD

A

Capsule endoscopy

36
Q

Describe the Vienna classification

A

Age - A1<40, A2>40
Location - L1 TI, L2 colonic, L3 ileocolonic, L4 upper GI tract
Behaviour - B1 non-structuring, non-penetrating, B2 structuring, B3 penetrating, intra-abdominal or peri-anal fistula/ulcer

37
Q

Management of peristomal pyoderma gangrenosa

A

Topical corticosteroids

Pustules and rapidly ulcerates
Serpinginous painful, bluish ulcer

38
Q

Describe sweets syndrome

A

Acute onset febrile illness
Pathergy at immunisation site
Skin Bx shows diffuse polynuclear neutrophilic infiltration in upper dermis

Treat with topical/oral steroids

39
Q

Is episcleritis painful

A

NO it is painless

40
Q

What proportion of patients have a significantly low TPMT level

A

0.3% (1 in 300).

This increases the risk of leucopenia - can consider dose reduction

41
Q

MOA of sulfasalazine

A

Depends on cleavage of 5ASA dinners by colonic bacteria.

It is linked to 5ASA by an AZO bond. This bond is split by colonic bacteria to release 5ASA

42
Q

What is FCP

A

Protein complex of s100 family
Present in neutrophils and macrophages
Biomarker of inflammation
Correlates well with mucosal inflammation

43
Q

HBI - what score indicates remission and severe flare

A

<5 remission
>5 is a relapse
>16 = severe disease

44
Q

What test should be performed in asymptomatic iron deficiency in patients with quiescent UC

A

Possibly colon cancer

Do colonoscopy

45
Q

What is the prevalence of colon cancer in patients with a positive FOB test

A

8%

46
Q

Antigen exposure leads to activation of CD4 cells which produce TH1 and TH2 cells.

Which cytokines are produced by TH1 cells

A

IL1, IL2, IL6, IL12, IFN, TNF-alpha

47
Q

Antigen exposure leads to activation of CD4 cells which produce TH1 and TH2 cells and TH17

Which cytokines are produced by TH2 cells

A

IL4, IL5, IL13

48
Q

Antigen exposure leads to activation of CD4 cells which produce TH1 and TH2 cells and TH17

Which cytokines are produced by TH17

A

IL17, IL6, IL22

49
Q

Which cytokines are anti-inflammatory

A

TGF

IL4

IL10 - levels found to be low in IBD

50
Q

Which EIM of IBD run a course alongside IBD flare

A

EN
Episcleritis (painless)
Type 1 peripheral arthritis
Oral ulcers

51
Q

Which EIM is associated with type 2 arthritis

A

Uveitis

52
Q

What proportion of IBD patients are under hospital follow up

A

30%

53
Q

What proportion of patients with IBD have UC

A

66%

54
Q

What is the lifetime risk of surgery in:

  1. Crohn’s
  2. UC
A
  1. 70%

2. 30%

55
Q

What congenital defects are associated with infliximab

A

VACTERL

56
Q

In pregnancy, increasing daily recommended dose of folic acid is required when taking which IBD medication

A

Sulfasalazine

Increase by further 2mg

57
Q

There is evidence for what treatment in pouchitis

A

VSL3

58
Q

Which EIM of IBD has RCT evidence for infliximab use

A

Pyoderma gangrenosum

59
Q

1st line treatment for perianal fistula

A

ABX

Azathioprine

Then consider anti-TNF if above doesn’t work

60
Q

In a patient with mild-moderate colonic disease, what treatment can be offered

A

Increase 5ASA

Addition of enemas

Prednisolone

BUDESONIDE MR - as effective as prednisolone with less side effects and high first pass metabolism

61
Q

What bacteria are present in VSL3

A

Strep thermophilus
Bifidobacterium species
Lactobacillus

62
Q

If both parents have IBD what is the chance of offspring developing disease

A

30% by age 30years

63
Q

If one parent has IBD what is the chance of developing the disease

A

9% CD

6% UC

64
Q

IBD is more common in black people compared to white? T or F

A

false

65
Q

What is the incidence of CD in UK population

A

5-10/100,000

66
Q

What is the incidence of UC in the U.K population

A

10-20/100,000

67
Q

Th17 produces which pro-inflammatory cytokines

A

IL17

IL22

68
Q

Th1 cells produce which pro-inflammatory cytokines

A

IL1, IL-2, IL-6, TNF-alpha

69
Q

Th2 cells produce which proinflammatory cytokines

A

IL4, IL10, TGF

70
Q

What percentage of patients with toxic colon perforate?

A

35%

71
Q

Treatment of peristomal pyoderma gangrenosum

A

Topical steroids

Po steroids

Painful serpinginous ulcer, bluish

72
Q

Treatment of erythema nodosum

A

Treat flare of underlying IBD - PO steroids

Can also give PO K-iodine, NDAIDS

73
Q

What proportion of those who are homozygous (wild type) for TPMT have high/normal levels

A

90%

74
Q

Those who are heterozygous for TPMT have …………. levels of TPMT

A

LOW

10%

75
Q

What does the mechanism of sulphasalazine depend on…

A

Cleavage of 5-ASA diners by colonic bacteria

5ASA bound by an AZO bond. This bond is split by colonic bacteria to release 5ASA

76
Q

HBI score that defines remission

A

<5

77
Q

HBI score that defines severe disease

A

> 16

78
Q

What percentage of those with positive FOB test are then identified to have CRC on investigation

A

8%

79
Q

What is the most useful test for assessing/monitoring toxicity with azathioprine use

A

FBC - WBCs

80
Q

Excess of what metabolite can cause toxicity in azathioprine use

A

6-TGN

6-thioguanine nucleotide

81
Q

1st line treatment of aphthous ulcers

A

Topical steroid (hydrocortisone lozenges)

But ensure there is no need to treat IBD flare e.g. With PO steroids

GASTROENTEROLOGY SCE (11 decks)

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