IBD Flashcards
Two subtypes?
Crohn’s disease
Ulcerative colitis
Where do the subtypes affect?
UC= only colon CD= Any part of GI tract
Possible aetiology?
Combo of genetic susceptibility and environmental factors and mucosal immunity
Environmental triggers?
Smoking
NSAIDS
Stress
Diet
Mucosal immune system cause?
IBD occurs due to an overactive response to luminal antigens eg bacteria
IBD patients have a leaky epithelium. True or false?
True
Increased chance of detection of antigens by immune cells
Antigen will be presented to the other T cells = inflammation in the mucosa
- An absence of regulatory T cells
- Overactive effector T cell response
Crohns mediated by?
TH1
UC mediated by?
TH1/TH2
IBD increases the risk of what GI conditions?
- Developing colon
- Toxic megacolon in UC
- Bowel obstruction
- Sclerosing cholangitis
Systemic manifestations of IBD?
Eyes= uveitis, episcleritis, conjunctivitis
Skin= Erythema nodosum, pyoderma gangrenosum
Joints= Arthralgia, ankylosing spondlitis
Liver & biliary tree= Sclerosing cholangitis, fatty liver, chronic hepatitis, cirrhosis, GS
What is most commonly affected in Crohn’s disease?
Terminal ileum
Signs and symptoms of CD?
- Abdo pain
- Diarrhoea (less common blood or mucous)
- Wt loss/ reduced growth
- Fatigue
- Malaise
- Fever
- Mouth ulcers
- Angular stomitis
- Peri-anal disease (later disease development) abscesses, fistulas, strictures
CD will only present as chronic. True or False?
FALSE
Chronic or actute but chronic more common in OSCEs
Risk factors for CD?
Fam history
Smoking
Investigations for IBD?
- Wt loss?
- RIF mass
- Peri-anal signs
- Bloods= CRP, ESR, ferritin, B12
- Endoscopy= OGD/Colonoscopy (cobble stoning, skip lesions=C)
- Biopsy for diagnosis- pathcy, granuloma, loss of villi
- Bowel imaging= MRI, CT (To look for fistulas, strictures)
What type of inflammation is seen in Crohn’s?
Transmural inflammation
Cobble stoning
1st line Management of Crohn’s?
- Lifestyle (quit smoking)
- 1st line= Steroids (prednisalone, short course 6-8 weeks)
2nd line management of Crohns?
Immunosuppressants
- Azathioprine
- methotrexate
3rd line management of Crohn’s?
Anti-TNF
- anything ending in -imab
- TNF is a cytokine involved in loads of pathways- it will promote the apoptosis of T cells
Surgery for management of Crohn’s?
- Non curative
- Emergency or elective
- Often involves resection of area affected
- RISK= short gut syndrome, parenteral nutrition
- Patient may need stoma
Complications of Crohn’s?
- Strictures, fistulas & obstruction
- Periods of flares and remission
- Malnutrition, SGS
- Colon cancer
What is UC?
Chronic remitting inflammatory condition affecting just the colon
What can UC be?
Proctitis, proctosigmoiditis, left-sided colitis, extensive colitis
Macroscopic changes in UC?
- Mucosa looks red & inflammed
- Very friable (easily bleeds)
- Continuous appearance
- Pseudo-polyps
- Thin wall
Risk factors for UC?
- Smoking isn’t one
- Fam history
- NSAIDS
- No appendectomy
Symptoms of UC?
- History of bloody diarrhoea (>6 wks rectal bleeding)
- Faecal urgency
- Tenesmus (incomplete empty feel)
- Abdo pain (LIF)
- Pain before defecation, relieved once stool passed)
- Non-specific symptoms= malaise, fatigue, fever, anorexia, anaemia
Signs of UC?
- Apthous ulcers
- Finger clubbing
- Pallor
- Abdo tenderness in LIF
Investigations for UC?
- p-ANCA +ve
- FBC- anaemia, high platelets
- CRP= raised
- LFTs- may be deranged
- U&E’s- may be deranged
- Coeliac serology
- Stool culture (excludes infection)
- Faecal calprotectin (raised suggests active inflam)
- Colonoscopy = diagnostic
1st line treatment for UC?
Topical aminosalicylate
2nd line treatment for UC?
Oral aminosalicylate
3rd line treatment for UC?
Add on topical/oral steroid
4th line treatment for UC?
Biologics (eg anti-TNF like infliximab)
How to treat an acute exacerbation of UC?
IV steroids
What to do when drugs don’t work in UC?
Elective colectomy with/without ileostomy or colostomy (stoma)
Lifestyle management of UC?
Lifestyle Bone health assessment Colonic cancer surveillance Mnitor utrition status Flu, pneumococcal vaccines
Genetic aetiology?
- FH +ve
- NOD2/CARD15-protein for bacterial recognition
Why is gut flora crucial?
There is evidence of altered bacterial flora in IBD
SE of prednisalone?
Weight gain
Osteoporosis
Thinning of skin
Hypertension
Microscopic changes in UC?
- Inflammation limited to mucosa (superficial)
- Goblet cells depleted
- Crypt abscesses
What does ANCA stand for?
Anti-neutrophil cytoplasmic antibodies
