IBD Flashcards

1
Q

Two subtypes?

A

Crohn’s disease

Ulcerative colitis

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2
Q

Where do the subtypes affect?

A
UC= only colon 
CD= Any part of GI tract
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3
Q

Possible aetiology?

A

Combo of genetic susceptibility and environmental factors and mucosal immunity

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4
Q

Environmental triggers?

A

Smoking
NSAIDS
Stress
Diet

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5
Q

Mucosal immune system cause?

A

IBD occurs due to an overactive response to luminal antigens eg bacteria

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6
Q

IBD patients have a leaky epithelium. True or false?

A

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
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7
Q

Crohns mediated by?

A

TH1

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8
Q

UC mediated by?

A

TH1/TH2

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9
Q

IBD increases the risk of what GI conditions?

A
  • Developing colon
  • Toxic megacolon in UC
  • Bowel obstruction
  • Sclerosing cholangitis
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10
Q

Systemic manifestations of IBD?

A

Eyes= uveitis, episcleritis, conjunctivitis
Skin= Erythema nodosum, pyoderma gangrenosum
Joints= Arthralgia, ankylosing spondlitis
Liver & biliary tree= Sclerosing cholangitis, fatty liver, chronic hepatitis, cirrhosis, GS

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11
Q

What is most commonly affected in Crohn’s disease?

A

Terminal ileum

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12
Q

Signs and symptoms of CD?

A
  • 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
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13
Q

CD will only present as chronic. True or False?

A

FALSE

Chronic or actute but chronic more common in OSCEs

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14
Q

Risk factors for CD?

A

Fam history

Smoking

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15
Q

Investigations for IBD?

A
  • 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)
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16
Q

What type of inflammation is seen in Crohn’s?

A

Transmural inflammation

Cobble stoning

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17
Q

1st line Management of Crohn’s?

A
  • Lifestyle (quit smoking)

- 1st line= Steroids (prednisalone, short course 6-8 weeks)

18
Q

2nd line management of Crohns?

A

Immunosuppressants

  • Azathioprine
  • methotrexate
19
Q

3rd line management of Crohn’s?

A

Anti-TNF

  • anything ending in -imab
  • TNF is a cytokine involved in loads of pathways- it will promote the apoptosis of T cells
20
Q

Surgery for management of Crohn’s?

A
  • Non curative
  • Emergency or elective
  • Often involves resection of area affected
  • RISK= short gut syndrome, parenteral nutrition
  • Patient may need stoma
21
Q

Complications of Crohn’s?

A
  • Strictures, fistulas & obstruction
  • Periods of flares and remission
  • Malnutrition, SGS
  • Colon cancer
22
Q

What is UC?

A

Chronic remitting inflammatory condition affecting just the colon

23
Q

What can UC be?

A

Proctitis, proctosigmoiditis, left-sided colitis, extensive colitis

24
Q

Macroscopic changes in UC?

A
  • Mucosa looks red & inflammed
  • Very friable (easily bleeds)
  • Continuous appearance
  • Pseudo-polyps
  • Thin wall
25
Q

Risk factors for UC?

A
  • Smoking isn’t one
  • Fam history
  • NSAIDS
  • No appendectomy
26
Q

Symptoms of UC?

A
  • 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
27
Q

Signs of UC?

A
  • Apthous ulcers
  • Finger clubbing
  • Pallor
  • Abdo tenderness in LIF
28
Q

Investigations for UC?

A
  • 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
29
Q

1st line treatment for UC?

A

Topical aminosalicylate

30
Q

2nd line treatment for UC?

A

Oral aminosalicylate

31
Q

3rd line treatment for UC?

A

Add on topical/oral steroid

32
Q

4th line treatment for UC?

A

Biologics (eg anti-TNF like infliximab)

33
Q

How to treat an acute exacerbation of UC?

A

IV steroids

34
Q

What to do when drugs don’t work in UC?

A

Elective colectomy with/without ileostomy or colostomy (stoma)

35
Q

Lifestyle management of UC?

A
Lifestyle
Bone health assessment 
Colonic cancer surveillance 
Mnitor utrition status 
Flu, pneumococcal vaccines
36
Q

Genetic aetiology?

A
  • FH +ve

- NOD2/CARD15-protein for bacterial recognition

37
Q

Why is gut flora crucial?

A

There is evidence of altered bacterial flora in IBD

38
Q

SE of prednisalone?

A

Weight gain
Osteoporosis
Thinning of skin
Hypertension

39
Q

Microscopic changes in UC?

A
  • Inflammation limited to mucosa (superficial)
  • Goblet cells depleted
  • Crypt abscesses
40
Q

What does ANCA stand for?

A

Anti-neutrophil cytoplasmic antibodies