Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal > IBD > Flashcards

IBD Flashcards

1
Q

what is IBD?

A

Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the different types of IBD?

A
  • crohn’s disease and ulcerative colitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the definition of Chron’s Disease?

A

chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus
(most common in the terminal ileum and the colon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

who is more likely to get Crohn’s Disease?

A
  • young patients

- more common in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the presentation of Crohn’s Disease?

A
  • abdominal pain
  • small bowel obstruction
  • diarrhoea
  • bleeding PR
  • anaemia
  • weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are changes in histology?

A

granuloma formation, lamina propria plasma cells and lymphocytes, neutrophillic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the pathology of Crohn’s Disease?

A
  • segmental disease
  • ileal and/or colonic chronic active mucosal inflammation
  • transmural inflammation
  • deep knife-like fissuring ulcers
  • granulomas, 50%, non-caseating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the malabsorption complications of Crohn’s Disease?

A
  • malabsorption
  • -iatrogenic (short bowel syndrome)
  • -hypoproteinemia, vitamin deficiency
  • -gallstones (interrupted enterohepatic ciruclation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the fitula complications of Crohn’s Disease?

A
  • vesicocolic
  • enterocolic
  • gastrocolic
  • recto vaginal
  • tuboovarian abscess
  • bind loop syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the anal disease complications of Crohn’s Disease?

A
  • sinuses
  • fissures
  • skin tags
  • abscesses
  • perineum fall apart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what intractable disease complications are of Crohn’s Disease?

A
  • failure to tolerate or respond to medial therapy
  • continuous diarhoea or pian
  • may require surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

give examples of environmental triggers f Crohn’s Disease

A
  • smoking
  • NSAIDs
  • infectious agents
  • vasculitis
  • sterile environment theory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the immune response involved in Crohn’s disease?

A
  • persistent activation of T cells and macrophages

- excess proinflammatory cytokine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the definition of ulcerative colitis?

A
  • chronic inflammatory disorder confined to colon and rectum

- mucosal and submucosal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

who is more likely to get ulcerative colitis?

A
  • young patients

- males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

where is ulcerative colitis?

A

colon and rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the clinical presentation of ulcerative colitis??

A

diarrhoea, mucus and blood PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the changes in histology for ulcerative colitis

A
  • massive influx of inflammatory cells
  • basal lymphoplasmacytic infiltrate with irregular shaped branching crypts
  • acute cryptitis
  • absecesses
  • excess fibrin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

management of ulcerative colitis/

A
  • does not respond to medical therapy

- subtotal colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

where is inflammation confined to in ulcerative colitis?

A

mucosa and submucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

give a pathological summary of ulcerative colitis

A
  • continuous, diffuse disease
  • rectal involvement
  • superficial ulceration and inflammation
  • chronic active colitis
    • cryptitis
    • crypt abscess
  • no granulomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

intractable disease complications of ulcerative colitis

A
  • continuous diarrhoea
  • flares may be due to intercurrent infection by enteric bacteria or CMV
  • total colectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the toxic megacolon complications of ulcerative colitis?

A
  • acute or acute on chronic fulinmant colitis
  • colon swells up to massive size
  • will rupture unless removed
  • emergency colectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how can complications of ulcerative colitis lead to colorectal carcinoma?

A
  • chronic inflammation leads to epithelial dysplasia and the carcinoma
  • risk increased if
    • pancolitis
    • disease longer than 10 years
  • requires surveillance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

give a summary of complications of ulcerative colitis

A
  • blood loss
  • electrolyte disturbance
  • anal fissures
  • eyes: uveitis
  • liver: primary sclerosing cholangitis
  • joints: arthritis
    skin, erythema ?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

why do you get ulcerative colitis?

A
  • genetic defects
  • aberrant immune response
  • environmental factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

describe the immune response of ulcerative colitis

A
  • persistent activation of T-cells and macrophages
  • autoantibodies present
  • excess proinflammatory cytokine production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

explain the pathogenesis of ID

A

the genetic predisposition + mucosal immune system + environmental triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the IBD gene?

A

NOD2/CARD15 (IBD-1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what chromosome is the disease susceptibility gene located?

A

16q12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does the gene encode?

A

a protein involved in bacterial recognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

describe the innate immunity involved in IBD

A
  • tight junctions regulate epithelial permeability
  • hydrophobic mucus protects the epithelial cell layer
  • defensins (catatonic anti-microbial peptides) can be activated
  • NOD2 contributes to normal mucosal defences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

describe the adaptive immunity involved in IBD

A
  • T lymphocytes are critical to the orchestration of adaptive mucosal immunity
  • ## normal conditions are characterised by a balance between effector and regulatory T cell responses
34
Q

what happens if there is an overreactive effector T-cell response?

A

inflammation/disease

35
Q

what happens if there is an absence of regulatory T cells?

A

uncontrolled inflammation/aggressive disease

36
Q

what T helper cells mediate Crohn’s disease?

A

Th1

37
Q

what T helper cells mediate ulcerative colitis?

A

mixed Th1/Th2 and NKTC

38
Q

what are the main symptoms of UC?

A
  • diarrhoea and bleeding
  • increased bowel frequency
  • urgency
  • tenesmus
  • lower abdo pain (esp LIF)
39
Q

how would you determine the severity of UC?

A 
- Truelove and Witt criteria 
>6 bloody stools/24 hours
\+ 1 or more of 
   fever 
   tachycardia
   anaemia
   elevated ESR
40
Q

what tests would you do for UC?

A
  • bloods (CRP, albumin)
  • plain AXR
  • endoscopy
  • histology
41
Q

why would you do a plain AXR in UC?

A
  • to see stool distribution, mucosal oedema/thumb printing or toxic megacolon
42
Q

why would you do an endoscopy in UC?

A
  • to define extent
  • confluent inflammation
  • loss of vessel pattern
  • granular mucosa
  • contact bleeding
43
Q

what are histological signs of UC?

A
  • crypt distortion

- absence of goblet cells

44
Q

what are some extra-intestinal manifestations of UC?

A
  • skin
  • joints
  • eyes
  • deranged LFTs
  • oxalate renal stones
45
Q

what is Primary Sclerosing Cholangitis (PSC)?

A

chronic inflammation of biliary tree

46
Q

what are signs of PSC?

A
  • most asymptomatic OR itch, rigors
  • cholestatic LFTs
  • 15% get cholangiocarcinoma
47
Q

what is cholestasis?

A

a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts

48
Q

describe the distribution of Crohn’s disease

A
  • can affect any region of GI tract
  • skip lesions
  • transmural inflammation
49
Q

what are signs and symptoms of peri-anal disease?

A
  • recurrent abscess formation
  • pain
  • fistula with persistent leakage
  • damaged sphincters
50
Q

what are the disease phenotypes of Crohn’s disease?

A
  • stenosis
  • inflammation
  • fistula
51
Q

what are symptoms of Crohn’s disease in the small intestine?

A
  • abdominal cramps (peri-umbilical)

- diarrhoea, weight loss

52
Q

what are symptoms of Crohn’s disease in the colon?

A
  • abdominal cramps (lower abdomen)
  • diarrhoea with blood
  • weight loss
53
Q

what are symptoms of Crohn’s disease in the mouth?

A
  • painful ulcers
  • swollen lips
  • angular chielitis
54
Q

what are symptoms of Crohn’s disease in the anus?

A
  • peri-anal pain

- absecess

55
Q

what blood tests would you do for Crohn’s disease?

A

CRP, albumin, platelets, B12, ferritin

56
Q

what are endoscopic signs of Crohn’s disease?

A

cobblestoning, thickened walls, fissures

57
Q

what are endoscopic signs of ulcerative colitis?

A
  • ulceration
  • loss of haustra
  • crypt distortion
  • pseudopolyps
58
Q

what are some of the aims of IBD therapy?

A
  • control inflammation and heal mucosa

- restore normal bowel movement

59
Q

what is the lifestyle advice for therapy?

A
  • smoking aggravates Crohn’s

- diet not implicated in pathoogenesis but can induce symptoms

60
Q

what drug types would you give to a patient with ulcerative colitis?

A
  • 5ASA (mesalazine)
  • steroids
  • immunosuppressants
  • anti-TNF therapy
61
Q

what drug types would you give a patient with Crohn’s disease?

A
  • steroids
  • immuosuppressants
  • anti-TNF therapy
62
Q

what is the mechanism of action of 5ASA?

A
  • anti-inflammatory

- reduces risk of colon cancer

63
Q

what are side effects of 5ASA?

A
  • diarrhoea

- idiosyncratic nephritis

64
Q

what are the pros and cons of oral 5ASA?

A
  • prodrugs
  • pH dependent release
  • dealyed release
65
Q

what are the pro and cons of topical 5ASA?

A
  • suppositories coat <20cm but have better mucosal adherence than enemas
  • enemas. reflex contraction aids proximal spread of foam or liquid enemas
  • <10% enemas remain in the rectum
66
Q

give some examples of 5ASA drugs

A
  • sulphasalazine
  • balsalazide
  • mezavant
  • asacol salofalk
  • pentasa
67
Q

describe mechanism of corticosteroids

A
  • systemic anti-inflammatory properties
  • eg prednisolone, budesonide
  • to induce remission
  • short course of high dose initially then reduce over 6-8 weeks
68
Q

what are the musculoskeletal side effects of steroids?

A

avascular necrosis

osteoporosis

69
Q

what are the cutaneous side effects of steroids?

A
  • acne

- thinning of skin

70
Q

what are the metabolic side effects of steroids?

A
  • weight gain
  • diabetes
  • hypertension
71
Q

give examples of immunosuppressive drugs used in the maintenance therapy of Crohn’s

A
  • azathioprine/mercaptopurine

- methotrexate

72
Q

what is the mechanism of action of Azathioprine?

A
  • slow onset
  • TPMT activity contributes to toxicity
  • avoid co-prescription of allopurinol
  • regular blood monitoring required
73
Q

what are side effects of Azathioprine?

A
  • pancreatitis
  • leucopaenia
  • hepatitis
74
Q

what is Tumour Necrosis Factor alpha?

A

proinflammatory cytokine

75
Q

name antibodies to TNF

A
  • chimeric (infliximab)

- humanised (adalimumab)

76
Q

how is infliximab administered?

A

IV infusion

77
Q

how is adalimumab administered?

A

S/C injection

78
Q

what is the mechanism of action of anti-TNF therapy?

A
  • promote apoptosis of activated T-lymphocytes
79
Q

when would you use ant-TNF therapy?

A

as part of long term strategy, including immune suppression, surgery (Crohn’s), supportive therapy

80
Q

why would you perform an elective operation for Crohn’s disease?

A
  • resection
  • strictuoplasty
  • fistulas
  • anal disease
81
Q

why would you perform an elective operation for UC?

A
  • proctocolectomy with end ileostomy

- proctocolectomy with ileorectal anastomosis

Gastrointestinal (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions