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Year 2 > IBD > Flashcards

IBD Flashcards

1
Q

Name two IBDs

A
  1. Ulcerative Colitis (effects only the COLON)

2. Crohn’s disease (any part of GI tract mouth - anus)

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2
Q

What ethnic group are most vulnerable to IBD

A

Jewish people

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3
Q

When does IBD occur

A
  1. Mucosal immune system exerts an inappropriate response to luminal antigens such as bacteria which may enter the mucosa via leaky epithelium
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4
Q

What is Ulcerative Colitis

A

Relapsing and remitting inflammatory disorder of COLONIC MUCOSA

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5
Q

What is ulcerative colitis od the rectum called

A

Proctitis

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6
Q

What is left-sided colitis

A

Rectum AND left colon

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7
Q

What is pan colitis

A

Ulcerative colitis that effects the ENTIRE COLON (up to ileocaecal valve)

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8
Q

Does ulcerative colitis effect ileocaecal valve

A

Never effects proximal to the ileocaecal valve

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9
Q

Where is ulcerative colitis most common

A

N. Europe
UK
N. A

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10
Q

Is Crohn’s or Colitis more common

A

Coeliac’s

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11
Q

What gender do ulcerative colitis effect

A

Males + females equally

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12
Q

What kind of habits can increase chances of colitis

A

SMOKERS and EX SMOKERS

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13
Q

Chances of ulcerative colitis with first degree relative having the disease

A

1 in 6

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14
Q

What surgery seems to protect people from ulcerative colitis

A

Appendicectomy before age 20

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15
Q

Risk factors of ulcerative colitis

A
  1. Family History
  2. NSAIDs
  3. Chronic stress + depression triggers flares
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16
Q

What differentiates Ulcerative Colitis from Crohn’s

A
  1. Restricted mucosal disease
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17
Q

What part of the colon does ulcerative colitis effect

A

Begins in the rectum and extends (only up to the ileocaecal valve)

Circumferential and continuous inflammation (NO SKIP LESIONS)

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18
Q

Appearance of mucosa in ulcerative colitis

A

Reddened and inflamed + bleeds easily

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19
Q

What structures are seen in severe ulcerative colitis

A

Ulcers and pseudo-polyps

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20
Q

Extent of spread of inflammation in ulcerative colitis

A
  1. Inflammation stays in mucosal layer
  2. No Granulomata
  3. Increased crypt abscesses
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21
Q

What happens to goblet cells in colitis

A

Depleted goblet cells

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22
Q

Clinical presentations in severe ulcerative colitis

A
  1. Runs a course of remissions and exacerbations
  2. Restricted pain in lower left quadrant
  3. Episodic or chronic diarrhoea with blood or mucus
  4. Cramps
  5. Bowel frequency linked to severity
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23
Q

Symptoms seen in acute UC

A

Fever
Tachycardia
Tender distended abdomen

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24
Q

In acute attacks of UC what is seen

A
  1. Bloody diarrhoea at night

Incontinence

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25
Q

What are extra-intestinal signs of Ulcerative Colitis

A
  1. Clubbing
  2. Aphthous oral ulcers
  3. Erythema nodusum
  4. Amyloidosis
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26
Q

What is erythema nodusum

A

Red round lumps below skin surface

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27
Q

Complications of Ulcerative Colitis

A

LIVER:

  1. fatty change
  2. Chronic pericholangitis
  3. Sclerosing cholangitis

COLON:

  1. Blood loss
  2. Perforation
  3. Toxic dilatation
  4. Colorectal cancer

Skin:
Erythema nodusum
Pyoderma gangrenous (painful ulcers on the skin )

Joints:
Ankylosing spondylitis
Arthritis

EYES:
Iritis
Uveitis
Episcleritis

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28
Q

Differential diagnosis of UC

A

Other causes of diarrhoea (salmonella, giardia intestinal and rotavirus)

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29
Q

Blood tests in UC

A
  1. WCC and planets raise din severe attacks
  2. Iron deficiency anaemia
  3. ESR and CRP raised
  4. Liver biochemistry abnormal
  5. Hypoalbuminaemia
  6. pANCA (Anti-neutrophilic cytoplasmic antibody) = positive

NEGATIVE in crown’s

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30
Q

Other than blood tests, how else do we diagnose UC

A
  1. Stool samples
  2. Faecal cal protein
  3. Colonoscopy (GOLD STANDARD) with mucosal biopsy
  4. AXR
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31
Q

Why are stool samples taken for UC

A

Exclude C.diff and campylobacter

32
Q

What does the presence of faecal cal protein suggest

A

IBD (not specific)

33
Q

Role of colonoscopy with mucosal biopsy for UC

A
  1. Allows assessment of disease activity and extent

2. Can see inflammatory infiltrate, goblet cell depletion, crypt abscesses and mucosal ulcers

34
Q

What would an AXR show for UC

A
  1. Exclude colonic dilatation in acute severe attacks
35
Q

When is an AXR used for UC

A

If too severe for colonoscopy

36
Q

How is UC treated

A

INDUCE REMISSION

1. Aminosalicylate (5-ASA)

37
Q

Where is 5-ASA absorbed

A

Small intestines

38
Q

What 5-ASA is prescribed for UC

A

Sulfasalazine
MESALAZINE
OLSALAZINE

39
Q

What is given for proctitis (mild UC)

A

Rectal 5-ASA

40
Q

What is the first line treatment for left-sided colitis

A

Oral 5-ASA

41
Q

If someone with UC does not response to 5-ASA what is prescribed instead

A

ORAL PREDNISOLON (glucocorticoid)

42
Q

What is given in severe UC

A

ORAL PREDNISOLONE

43
Q

In severe systemic involvement of UC, what is given (liver, skin and eye involvement)

A
  1. HYDROCORTISONE
  2. CICLOSPORIN
  3. INFLIXIMAB
44
Q

How do we maintain remission

A

5-ASA: most patients require maintenance treatment

AZATHIOPRINE - for those who relapse if 5-ASA does not work

45
Q

When is surgery done for UC

A
  1. Indicated for severe colitis that fails to respond to treatment
46
Q

What two surges are done for UC

A
  1. Colectomy (colon removed) or ileoanal anastomosis (rectum fused to ileum)
47
Q

What is the terminal ileum used for following ileoanal anastomosis

A

Reservoir pouch to store faeces

48
Q

What is panproctocolectomy with ileostomy

A

Whole colon and rectum are removed and ileum is brought out to abdominal wall as a stoma

49
Q

What is Crohn’s disease

A

A chronic inflammatory GI disease characterised by transmural (goes deep into mucosa) granulomatous inflammation affecting any part of the gut from mouth to anus (especially in terminal ileum and proximal colon)

50
Q

Difference between Crohn’s disease and UC

A
  1. Skip lesions found in CD (unaffected bowel between areas of active disease)
51
Q

Where is prevalence for Crohn’s highest

A
  1. N. Europe
  2. UK
  3. North America
52
Q

What gender does Crohn’s effect more

A

Females

53
Q

What risk factors are there for corhn’s

A
  1. Smoking
  2. 1 in 5 chance if first-degree relative
  3. NSAIDs
  4. Family History
  5. Chronic stress and depression triggers flares
  6. Good hygiene (those who live in poor hygiene families have lower risk of developing CD)
  7. Appendicectomy may increase risk of CD development
54
Q

Where does Crohn’s typically effect

A

Terminal ileum and proximal colon

55
Q

What happens to the wall of the bowel in Corhn’s

A

Thickened and narrowed

Cobblestone appearance of mucosa due to ulcers and fissures

56
Q

What layers of the bowel does inflammation extend into

A

ALL LAYERS of the bowel

57
Q

What happens to cells in Crohn’s

A
  1. Increase in chronic inflammatory cells
  2. Lymphoid hyperplasia
  3. Granulomas (non-caseating epithelia cell aggregates with langerhand’ giant cells)
  4. Goblet cells present
  5. Less crypt abscesses than UC
58
Q

Clinical presentation of Corhn’s

A
  1. Diarrhoea with urgency (need to go 5-6 times in 45 mins), bleeding and pain
  2. Abdo pain (mimicks appendicitis - right iliac fossa pain)
  3. Weight loss
  4. Malaise
  5. Lethargy
  6. Anorexia
  7. Abdo tenderness
  8. Perianal abscess
  9. Anal strictures
  10. Extra intestinal signs: aphthous oral ulcerations, clubbing, skin, joint and eye problems
59
Q

Complications of Crohn’s

A
  1. Perforation and BLEEDING - major
  2. Fistula formation
  3. Anal: skin tags, fissures, fistula
  4. Malabsorption
  5. Small bowel obstruction
  6. Toxic dilatation of colon
  7. Colorectal cancer
  8. venous thrombosis
  9. Amyloidosis
60
Q

Differential diagnosis of Crohn’s

A
  1. Alternative causes of diarrhoea should be excluded (Salmonella, Giardia intestinal and rotavirus)
  2. Chronic diarrhoea
61
Q

Physical examination of Crohn’s

A
  1. Tenderness of right iliac fossa

2. Anal examination

62
Q

Blood tests in Crohn’s

A
  1. Anaemia is common due to malabsorption and iron/folate deficiency
  2. B12 anaemia is unusual
  3. Raised ESR and CRP
  4. Raised WBC and platelets
  5. Hypoalbuminaemia present in severe disease as part of acute phase response to inflammation associated with raised CRp
  6. Liver biochemistry may be abnormal
  7. Negative pANCA
63
Q

Other than blood tests what other diagnostic features of crohn’s are there

A
  1. Stool sample (exclude C.difficile and campylobacter)
  2. Faecal cal protein (indicates IBD not specific)
  3. Colonoscopy (confirms spot lesions and granulomatous transmural inflammation)
  4. Upper GI endoscopy (exclude oesophageal and gasproduodenal disease)
64
Q

How is Crohn’s treated

A
  1. Smoking cessation

2. Anaemia due to iron/B12 or folate deficiency (replacement)

65
Q

How is mild attacks of crown’s traded

A

Controlled-release corticosteroids (BUDESONIDE)

66
Q

How is moderate to severe tacks of crohn’s treated

A

Glucocorticoids (ORAL PREDNISOLONE)

67
Q

When do we reduce the dosage of ORAL PREDNISOLONE

A

Every 2-4 weeks if symptoms resolve

68
Q

How is severe attacks of Crohn’s treated

A
  1. IV HYDROCORTISONE
  2. Treat rectal disease (HYDROCORTISONE per rectum)
  3. Antibiotics (IV METRONIDAZOLE) for perianal disease (inflammation at or near the anus) and abscesses
  4. ORAL PREDNISOLONE if IV METRONIDAZOLE is working
69
Q

how do we treat Corhn’s disease if there is no improvement

A

Switch to anti-TNF antibodies (INFLIXIMAB or ADALIMUMAB)

70
Q

How do INFLIXIMAB and ADALIMUMAB function

A

Reduce disease activity by countering neutrophil accumulation and granuloma formation and activating complement

Causes cytotoxicity to CD4 cells clearing cells which drive the immune response

71
Q

Main drugs that keep crohn’s in remission

A
  1. AZATHIOPRINE
  2. METHOTREXATE (if intolerant to AZATHIOPRINE)
  3. Anti-TNF antibodies (reduces remission if resistant to corticosteroids, immunosuppression then maintains it)
72
Q

Main surgical intervention for crohn’s

A

Temporary Ileostomy = Allows time for affected areas to rest

73
Q

Worst case scenario surgical intervention for Crohn’s

A
  1. Resection (results in short bowel syndrome so diarrhoea and malabsorption)
74
Q

Parts of the colon affect din Coeliac’s, UC and Crohn’s

A
  1. Duodenum
  2. Colon
  3. ASS to mouth
75
Q

Wat condition has no skip lesions

A

UC

Year 2 (155 decks)

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