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IBD Flashcards

1
Q

What is the definition of crohn’s disease?

A

Chronic inflammation and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

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2
Q

Where does crohn’s disease most commonnly affect?

A

In the terminal ileum and colon

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3
Q

What age group does crohn’s disease target?

A

Young patients
50% are 20-30 years old at diagnosis
90% are 10-40

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4
Q

How does crohn’s disease present?

A 
Abdominal pain 
Small bowel obstruction 
Diarrhoea
Bleeding PR
Anaemia 
Weight loss 
Painful ulcers, swollen lipds, angular chielitis
Peri-anal pain, abscess
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5
Q

What does crohn’s affected bowel look like on an endoscopy?

A

Cobble-stone appearance

Patchy segmental disease with skin areas (lesions) anywhere in the GI tract

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6
Q

What does crohn’s disease look like histologically?

A 
Chronic inflammation in lamina propria
Crypts are irregular shape 
Crypt abscesses 
Granulomas, non-causeating
Giant cells
Transumural inflammation
Deep, knife-like fissuring ulcers
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7
Q

What are some common complications of crohn’s disease?

A 
Stricturing of the bowel 
Bowel obstruction requiring surgery 
Fistulas 
Malabsorbtion 
Gallstones 
Anal disease 
Amyloidosis
Toxic megacolon
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8
Q

What is microcytic anaemia?

A

Presence of small, often hypochromic, red blood cells is caused by an iron deficiency

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9
Q

What is macrocytic anaemia?

A

Red blood cells are larger than their normal volume - caused by vitamin B12 and folate deficiency

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10
Q

What are the environmental trggiers for crohn’s disease?

A

Smoking increases risk
Infectious agents
Vasculitis
Sterile environment theory

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11
Q

Is there is genetic link to crohn’s disease?

A

Yes - NOD2 on chromosome 16

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12
Q

What is the definition of UC?

A

Chronic inflammatory disoreder confined to the colon and rectum
Mucosal and submucosal inflammation

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13
Q

Who does UC affect?

A

Young patients

Peak in 3rd decade

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14
Q

What are the common sites of UC?

A

Confined to the colon and rectum

Nearly always involves the rectum

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15
Q

What is the presentation of UC?

A 
Bloody diarrhoea
Increased bowel frequency 
Urgency
Tenesmus
Incontinence
Night rising
Lower abdo pain
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16
Q

What is the endoscopic apprearance of UC?

A

Red inflamed rectum - diffusely ulcerated
Diffuse continous disease almost always involving the rectum
Pseudopolyps

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17
Q

What are the histological features of UC?

A

Diffuse mucosal chronic active colitis: massive influx of inflammatory cells
No barrier - infiltrate of inflammatory cells in the submucosa destroying the crypts
Acute cryptitis
Crypt abscesses
Sever ulceration with fibrinopurulent exudate

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18
Q

What are the complications of UC?

A

Intractable disease
Toxic megacolon
Colorectal carcinoma
Blood loss`

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19
Q

What are the extra-GI manifestations of UC?

A

Eyes: uveitis
Liver: primary sclerosing cholangitis
Joints: arthritis, ankolysing spodylitis
Skin: Pyoderma gangrenosum, erythemia nodusum

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20
Q

Is there a genetic link for UC?

A

Yes - NOD-2 on chromosome 16

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21
Q

What is the normal innate immunity of the gut?

A

Tight junctions regulate epithelial permability
Hydrophobic mucous protects epithelial cell layer
Defensins can be activated constitiively or in resposne to bacterial components
NOD2 contributes to normal mucosal defences

22
Q

How does the adaptive immunity play a role in IBD?

A

Crohn’s - Th1 mediated

UC - Mixed Th1/Th2 mediated disease

23
Q

Is there less antimicrobial activity in crohn’s or ulcerative colitis?

A

Crohn’s

24
Q

What determines severe ulcerative colitis?

A

More than 6 blood stools in 24 hours and one of:

Fever, tachycardia, anaemia, elevated CRP

25
Q

How is the increased risk of colorectal cancer determined?

A

Severity of inflammation
Duratino of disease
Disease extent (extensive colitis is beyone the splenic flexure)

26
Q

What is peri-anal disease?

A

Recurrent abscess formation in the anus

Can lead to a fistula with persistent leakage, damaged sphincters

27
Q

What are the theraputic strategies for IBD?

A

Lifestyle advice
Drugs
Surgery

28
Q

What lifestyle can be given for crohn’s?

A

Smoking aggravates crohn’s and causes a wose disease outcome and a more rapif recurrence post-surgery
Diet not implicated in pathogenesis but can infleunce symptoms

29
Q

What are the therapy drug options for UC?

A

5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy

30
Q

What are the therapy drug options for crohn’s disease?

A

Steroids
Immunosuppressants
Anti-TNF therapy

31
Q

How does 5ASA work?

A

Topical effect
Anti-inflammatory properties
Reduces risk of colon cancer
Side effects: diarrhoea, idiosyncratic nephritis

32
Q

How is 5-ASA given orally?

A

Prodrugs
pH dependent release
Delayed release

33
Q

How is 5-ASA given topically?

A

Suppositories

Enemas

34
Q

What are some examples of 5-ASA drugs?

A 
Sulphalazine
Mesalazine
Asacol
Pentasa 
Balsalazide
Mezavant
35
Q

What 5-ASA drug releases in all parts of the gut?

A

Pentasa - duodenum, jejunum, ileum and colon

36
Q

What 5-ASA drug releases in the ileum and colon?

A

Asacol

37
Q

What are steriods used for in crohn’s disease?

A

Systemic anti-inflammatory properties
Induces remission
Short course - high dose initially, reducing over 6-8 weeks

38
Q

What are examples of corticosteroids?

A

Prednisolone

Budenoside

39
Q

What are the muscloskeletal side effects of steroids?

A

Oestoporosis

Alvascualr necrosis

40
Q

What are the metabolic side effects of steroids?

A

Weight gain
Diabetes
Hypertension

41
Q

What are the cutaenous side effects of steroids?

A

Acne

Thin skin

42
Q

What are the neurosychiartic side effects of steroids?

A

Cataracts

Growth failure

43
Q

What should be used when a more potent suppression of inflammation is required?

A

UC: steroid-sparing agents

Crohn’s: maintenance therapy - azathorpine, methotrexate

44
Q

What are the side effects of azathoprine?

A 
Pancreatitis
Leucopaenia
Hepatits
Small risk of lymphoma, skin cancer 
Regualr blood monitorig required
45
Q

What are examples of anti-TNF therapies?

A

Infliximab

Adalimumab

46
Q

What does anti-TNF therapy do?

A

Promotes apoptosis of activated T-lymphocytes

Blcoks TNF-alpha a proinflammatory cytokine

47
Q

When should anti-TNF therapy be used?

A

As part of long term strategy, including immune suppression, surgery (crohn’s) and supportive therapy
Refractory or fistulising disease

48
Q

When is surgery required in IBD?

A

Emergency - failure to respond to medical therapy, small bowel obstruction, abscess, fistulae
Elective: failure to respond to medical therapy, dysplasia of colon mucosae

49
Q

What can repeated resection of the small intestine result in?

A

Short gut syndrome and requirement of lifelong total parentral nutrition

50
Q

What can be done to treat peri-anal abscesses?

A

External drainage close to anal spincter

51
Q

Can surgery for Uc be curative?

A

Yes, permanent ileostomy or restorative protocolectomy and pouch

52
Q

What is the therapy pyramid for IBD?

A 
Smoking cessation 
5-ASA (UC)
Steroids
Immunosuppression 
Anti-TNF

GI (42 decks)

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