IBD Flashcards
Inflammatory bowel disease mainly comprises of two idiopathic chronic inflammatory diseases - what are they?
crohn’s disease and ulcerative colitis (UC)
what 3 things predispose IDB
Genes, impaired mucosal immunity, environmental triggers
what gene impacts IBD and which disease is more affected
crohn’s more affected, NOD2 on chromosome 16
smoking worsens which disease
crohn’s
Both diseases are TH1 mediated, but which one also has TH2
UC
what is UC
mucosal and submucosal inflammation of the rectum, extending proximally with no skip legions
what age group is normally affected by UC
20’s-30’s
what are the symptoms of UC
diarrhoea + blood,
increased bowel frequency and urgency, incontinence, night rising, LIF pain
what are the symptoms of severe UC
6> bloody stool per day plus one of: tachycardia, anaemia, elevated ESR, fever
what are the microscopic investigations of UC
endoscopy and biopsy: neutrophils NO granulomas, crypt abscesses, superficial in mucosa and submucosa
what would you see on an AXR for UC
thumbprinting
what is crohn’s disease
chronic inflammation and ulceration of GI tract, most common in terminal ileum and colon, skip legions, is transmural
what are symptoms of crohn’s disease
abdominal pain, small bowel obstruction, diarrhoea + blood, weight loss, ulcers, abscesses
what are the investigations of crohn’s
colonoscopy mucosal biopsy: granulomas (50%), knife-like fissues, bloods, stools, QFIT
what are the complications of crohn’s
malabsorption, short bowel syndrome, fistulas
what are the complications of UC
toxic megacolon, colorectal cancer, fistulas
what is toxic megacolon
loss of muscle tone due to chronic inflammation - can be fatal
what blood could be done for UC
CRP and albumin
what can extra-intestinal symptoms of IBD can develop
joints, eyes, skin and primary sclerosing cholangitis (inflammation of biliary tree)
what are the therapy options for UC in order
5-ASA, steroids, immunosuppressants and anti TNFa
what are the therapy options chrons in order
steroids, immunosuppressants and anti TNFa
what is 5-ASA and give an example
anti-inflammatory, mesalazine
what 2 ways can 5ASA be taken
orally or topically
what type is pH dependent release
orally
what 2 ways can topical be administered and the advantages of both
enema = goes more proximal towards sigmoid. suppositories = better mucosal adherence but don't travel as far
give an example of a steroid and how it is taken
prednisolone - orally/ topically, very short course
give examples of immunosuppressants
azathioprine or methotrexate
give examples of anti TNFa and what it does
infliximab, adalimumab. apoptosis of activates T lymphocytes.
when should anti TNFa not be used
TB
what are the emergency procedures for IBD
subtotal colectomy in UC (leaves rectum) and resection in crohn’s
what are indications for elective surgery in UC
medically unresponsive, malignancy, child growth retardation
what are the 3 types of elective UC proctocolectomy
end ileostomy, pouch, ileorectal anastomosis
what is end ileostomy proctocolectomy
small intestine feeds into soma bag
what is a pouch proctocolectomy
loop intestine to create reservoir, ‘normally’ functionin rectum - can become impotent especially in women
what set of criteria can assess severity of IBD
Trueman and witt’s
what surgery is more curative
UC, stomas often remove symptoms and improve QoL
what is the purpose of crohn’s disease surgery
temporary symptom relief, often need further surgeries where bowel is removed
