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IBD Flashcards

1
Q

What is IBD made up of?

A

Crohn’s disease

Ulcerative Colitis

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2
Q

Define IBD

A

Chronic
Idiopathic
Relapsing and remitting
Inflammatory disorders of the GI tract

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3
Q

Which parts of the body does Crohn’s affect?

A

Anywhere between mouth and anus

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4
Q

Which parts of the body does ulcerative colitis affect?

A

Large intestine only

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5
Q

What should IBD not be confused with?

A

IBS - much less acute and dangerous! much more common!

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6
Q

Where is IBD prevalent in?

A

Increase in Europe and higher latitudes
Argentina
Rise in newly industrialised countries

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7
Q

NOD 2 gene

A

Protein which helps immune cells in body detect invading pathogens

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8
Q

Autophagy

A

Another way to protect against invading pathogens

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9
Q

Purpose of epithelial barrier

A

Separates microbiota in gut from immune system

If not separated = profound inflammatory reaction = destruction of bowel wall, ulcers

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10
Q

Genetic cause of IBD

A

Mutations/changes in 100s of genes which protect body against invading pathogens
e.g. NOD2, autophagy

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11
Q

Environmental factors affecting IBD

A 
Physical activity
Appendectomy - protective in UC
Smoking
Stress
Vitamin D/UV exposure is protective
Hygiene
Diet
Sleep
Medications
Microbiome
Genetic susceptibility
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12
Q

Hygiene Hypothesis

A

Large decline in infectious diseases = TB, hep A, RF etc.

But large increase in immune mediated disorders = RA, asthma, T1D, MS

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13
Q

Smoking link with Crohn’s

A

Accelerates progression of Crohn’s
Less likely to respond to treatment
Cessation Is an effective treatment

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14
Q

Smoking link with UC

A

Onset follow smoking cessation

Nicotine patches as effective as 5ASA (but badly tolerated unless you are a smoker)

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15
Q

Which drugs can initiate a relapse in IBD?

A

NSAIDs
Oral contraceptive pull = Crohns
Opiods (loperamide, codeine) - provoke colonic dilatation in acute severe UC

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16
Q

What diet is good at treating Crohns?

A

Elemental/polymeric liquid diet

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17
Q

Foods badly affecting IBD

A

High animal fat diet
Low fibre intake
Emulsifiers and thickeners
May alter gut microbiome

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18
Q

Link between physical activity and IBD

A

Regular active exercise reduced risk of

  • developing Crohns but not UC
  • relapse of Crohns and possibly UC
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19
Q

What type of people are more likely to get UC?

A 
White people
Men to women equal
20-40 year olds
Second peak >60
Higher rate of monozygotic twins
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20
Q

4 sites of UC

A

Proctitis (rectum)
Proctosigmoiditis
Left sided colitis (all the `way up to splenic flexure)
Pancolitis (all the way around)

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21
Q

In which UC site are different drug administration methods used?

A

Proctitis - suppositories
Left sided colitis - enemas
Whole colon - oral therapy

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22
Q

What anatomy is UC limited to?

A

Colon and rectum only

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23
Q

What is the most common site in UC

A

Almost always rectum with variable proximal extent

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24
Q

Where is there inflammation in UC

A

Lamina propria

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25
How do patients with UC present?
``` Urgent diarrhoea Bloody stools Fatigue (all immune mediated disease) Weight loss Cancer (rare) Extra-intestinal manifestations ```
26
What is the hallmark of UC?
Diarrhoea
27
What extra-manifestations are there in IBD?
``` Mouth - ulcerations Eyes - uveitis Joints - Arthritis/arthropathy/RA Skin - erythema nodosum shins/feet, pyoderma gangrenosum Perianal disease ```
28
What is perianal disease much more common in?
Crohns!! rather than UC
29
What are the signs of UC?
``` tender abdomen - LIF generally mild Pallor tachycardia leukonychia - malnutrition extra-intestinal manifestations ```
30
Ix of UC
``` Bloods - anaemia microcytic - low ferritin - low albumin - raised inflammatory markers = CRP, ESR< thrombocytosis, faecal calprotectin - MC&S - OC&P (parasites) - Plain AXR Endoscopy - gold standard ```
31
What is faecal calprotectin?
Inflammatory marker expressed by immune cells in lining of gut wall particularly neutrophils that you can detect in stool Good way to differentiate between IBS and IBD
32
What are you looking for on an AXR?
Toxic megacolon Pancolitis severe disease shows this Dilation of large intestine
33
UC Histology
Lumen and epithelial layer only affected Always continuous so will not see areas of unaffected bowel in between Crypt architecture distortion/twisted Crypt abscess (neutrophils in crypt)
34
Crohns histology
Affects whole gut wall unlike UC | Not continuous so will see areas of unaffected areas in between 2 sites of affected bowel
35
What is a hallmark of chronic inflammation on histology?
Crypt architecture distortion/twisted
36
Treatment options for UC
``` Steroids 5-Amino salicylic acid Probiotics Azathioprine Methotrexate Anti-TNF Anti-integrins JAK inhibitors Surgery ```
37
Examples of 5-ASA
Sulphasalazine - bone marrow suppression side effect | Mesalazine
38
Which anti TNFs are used for Tx of UC?
Infliximab - infusion Adalimumab - SC Golimumab
39
Example of anti-integrin
Vedolizumab - blocks alpha4beta7 which binds to MADCAM (adhesion molecule in the blood vessels of gut allowing white cells in to gut
40
Example of Jak inhibitor
Tofacitinib
41
Order/protocol of IBD Tx
Vast majority on Mesalazine - oral & topical-> Immunomodulators (azathioprine & 6-mercaptopurine) -> Anti-TNFs, anti-integrins, Jak inhibitors
42
What drugs can get you better quickly in UC?
Corticosteroids - IV hydrocortisone, prednisolone, Cortiment MMX
43
Who is more likely to get Crohn's?
Higher in Caucasian 1;1 male to female 15-30 yrs
44
Symptoms of Crohns
DEPENDS WHERE DISEASE IS - crohns colitis = similar UC symptoms (diarrhoea and urgency) - terminal ileum = pain colicky post prandially - altered bowel habits = diarrhoea, obstruction - PR blood loss - weight loss more likely than UC as hurts every time you eat - fistulae and abscesses as affecting whole wall - oral symptoms - extra intestinal manifestations - fatigue
45
Where is the most common site of Crohns
terminal ileum
46
Signs of Crohns
- mass - scars - stoma - fistula - abscess - malnutrition - oral ulceration
47
Natural cycle of Crohns
- starts of inflammatory - then can get scarring -> structuring/fibrosis/permanent narrowing of bowel - OR can get penetration
48
Ix in Crohns
``` Bloods - anaemic microcytic - low ferritin, folate, B12 - raised inflammatory markers - low albumin Faeces - MC&S - OC&P - faecal calprotectin Plain AXR - loops of small bowel - megacolon Barium Follow Through now rare - strictures - rose thorn ulcers CT be wary of radiation as young patients - terminal ileum thickening - abscess MRI - small bowel - pelvic/perianal sepsis Endoscopy ```
49
Crohns Histology
Non caseating granuloma Regions of unaffected bowel then affected Giant cells granulomas
50
Treatment options for Crohns
Diet Steroids = prednisolone, budesonide (topical) 5 ASA not used now as uneffective (Pentosa) Probiotics not that helpful ABs (cipro, metro allow healing) Immunosuppressants Biologicals - Anti-TNF, anti-integrin, anti-IL 12/23 Surgery
51
Which immunosuppressants are used in Crohns
Azathiopurine | MTX
52
Example of anti-IL 12/23
Ustkeiumab
53
Complications of extra-intestinal features
``` LIVER - primary sclerosing cholangitis Anaemia thrombosis Urinary stones gallstones Osteoporosis Skin, eyes, joints ```
54
How are joints affected?
Saroiliitis Ankylosing spondylitis Large joint arthropathy Small joint arthropathy
55
How is the liver affected?
Primary sclerosing cholangitis - increasing risk of cancer in bile duct and colon - itching and jaundice Fatty Liver Autoimmune hepatitis
56
Colorectal Cancer
Increased risk in IBD >10 years >8 years screening offered - increased risk if extensive colitis, chronic inflammation and sclerosing cholangitis - screening looks for macro and microscopic dysplasia
57
What causes IBS?
``` Diet Psychological Dysbiosis Motility Chronic Pain ```
58
How do you diagnose IBS?
Faecal calprotectin to prove they don't have IBD
59
Who is more likely to have IBS?
Young - teens to 20s | female 2:1
60
Presentation of IBS
``` Relief after defecation With or without bloating No nocturnal symptoms Normal FBC/CRP/coeliac screen/haemetinics/TFTs Normal faecal calprotectin ```
61
Differentials for IBS
Coeliac Disease- everyone should have coeliac screening Bile Salt Malabsorption Parasitic Infection Small Intestinal Bacterial Overgrowth Neuroendocrine tumours - fasting gut hormones Hyperthyroidism Carcinoid syndrome
62
IBS Tx
``` reassurance FODMAP Sparing use of anti-spasmodics CBT if need ABs in some Probiotics Anti-depressants ```

MET3a (38 decks)

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