IBD Flashcards

1
Q

What are all the forms of IBD?

A
Crohn's disease
Ulcerative colitis
Microscopic ulcerative colitis
Microscopic lymphatic colitis
Microscopic collagenous colitis
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2
Q

What factors affect likelihood of developing IBD?

A

Genetics
Environmental susceptibility
Immune response

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3
Q

Which environmental factors are risk factors for IBD?

A

Smoking
NSAIDs
Good hygiene
Psychological stress

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4
Q

In what way is intestinal microbiota different in IBD?

A

Reduced diversity of gut flora

Decreased mucosal and chemical barrier

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5
Q

In what way is the immune response different in IBD?

A

Overactive mucosal immunological response

Leaky epithelium increases chance of immune response

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6
Q

Where does CD most commonly affect?

A

Terminal ileum and ascending colon

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7
Q

What is proctitis?

A

UC affecting the rectum alone

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8
Q

What is extensive colitis?

A

UC affecting the whole colon

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9
Q

What is backwash colitis?

A

UC with inflammation of the distal terminal ileum

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10
Q

What are the macroscopic changes in CD?

A

Involved bowel is thickened and often narrowed
Cobblestone appearance
Intra-abdominal fistulae and abscesses may be seen

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11
Q

What are the macroscopic changes in UC?

A

Mucosa is red, inflamed and friable

Severe disease may have extensive ulceration with pseudo-polyps

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12
Q

What are the microscopic changes in CD?

A

Transmural inflammation
Increase in inflammatory cells
Lymphoid hyperplasia
Granulomas in over half

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13
Q

What are the microscopic changes in UC?

A

Superficial inflammation
Chronic inflammatory cell infiltrate in the lamina propria
Crypt abscesses
Goblet cell depletion

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14
Q

What is the term for when it is not possible to distinguish between CD or UC?

A

Indeterminate colitis

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15
Q

What are the extraintestinal manifestations of IBD that can manifest in the eyes?

A

Uveitis
Episcleritis
Conjunctivitis

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16
Q

What are the extraintestinal manifestations of IBD that can manifest in the skin?

A

Erythema nodosum

Pyoderma gangrenosum

17
Q

What are the extraintestinal manifestations of IBD that can manifest in the liver and biliary tree?

A
Sclerosing cholangitis
Fatty liver
Chronic hepatitis
Cirrhosis
Gallstones
18
Q

How does microscopic colitis present?

A

Chronic or fluctuating watery diarrhoea

19
Q

Describe microscopic ulcerative colitis

A

Chronic inflammatory cell infiltrate in the lamina propria
Deformed crypt architecture
Goblet cell depletion

20
Q

Describe microscopic lymphocytic colitis

A

Surface epithelial cell injury
Prominent lymphocytic infiltration in surface epithelium
Increase in lamina propria mononuclear cells

21
Q

Describe microscopic collagenous colitis

A

Thickened sub epithelial collagen later adjacent to basal membrane
Increased infiltration of the lamina propria with lymphocytes and plasma cells
Surface epithelium damage

22
Q

What are the symptoms of CD?

A
Diarrhoea (+/- blood)
Abdominal pain
Weight loss and anorexia
Malaise, lethargy
Nausea and vomiting
Low grade fever
23
Q

What signs of CD can be seen on examination?

A
Weight loss
Signs of malnutrition
Aphthous ulceration
Abdominal tenderness or iliac fossa mass occasionally
Anal fissures or abscesses
24
Q

What blood tests are done in suspected IBD?

A
FBC
CRP/ESR
LFTs
Blood culture if septicaemia suspected
Serology
25
Q

Which stool tests may be done in suspected IBD?

A

Stool culture, including C. diff if diarrhoea
Stool microscopy if travel history
Faecal calprotectin raised in active intestinal disease

26
Q

Which endoscopic and imaging tests are done in suspected CD?

A
Colonoscopy with biopsy
Upper GI endoscopy
Small bowel imaging
Ultrasound scanning
Capsule endoscopy if radiological examination is normal
27
Q

How is disease activity of CD assessed?

A
Hb
White cell count
Inflammatory markers
Serum albumin
Faecal calprotectin or lactoferrin
28
Q

What medication is used to induce remission in a flare up of CD?

A

Steroids
Enteral nutrition
TNF-alpha if resistant to steroids or if disease is more extensive, preferably in combination with immunosuppressants

29
Q

What medication is used to maintain remission of CD?

A

Long-term immunosuppressants, e.g. azathioprine, methotrexate
Anti-TNF (infliximab) for patients who are resistant to immunosuppressants

30
Q

What are the symptoms of UC?

A
Diarrhoea with blood and mucus
Abdominal discomfort
Malaise, lethargy
Anorexia and weight loss
Aphthous ulceration may be seen
31
Q

How is a severe attack of UC defined?

A
Stool frequency >6 per day with blood
Fever
Tachycardia
ESR >30
Anaemia - Hb<100
Albumin <30
32
Q

What is the management for a severe attack of UC?

A
  1. Admit to hospital
  2. Exclude enteric infection
  3. Confirm diagnosis with limited flexible sigmoidoscopy
  4. Assess fluid status
  5. Give prophylactic anti-coagulation
  6. IV hydrocortisone
  7. Monitor
33
Q

What is toxic megacolon?

A

AXR showing thin walled colon with diameter of >6cm
Gas filled and containing mucosal islands
Impending perforation and high mortality

34
Q

What signs of UC can be seen on examination?

A

Abdomen may be slightly distended and tender
Tacycardia and pyrexia indicate severe disease
PR exam reveals the presence of blood

35
Q

What medication is used by most UC patients?

A

Aminosalicyclate

36
Q

What is the order medication is tried in UC?

A

5-ASA (aminosalicyclate)
Steroids
Immunosuppressant
Anti-TNF

37
Q

What are the indications for surgery in UC?

A

In an acute attack: failure of medical treatment, toxic megacolon, haemorrhage, imminent perforation
In chronic disease: incomplete response to medical treatment
Dysplasia on surveillance colonoscopy

38
Q

What is the operation of choice for UC in acute disease?

A

Subtotal colectomy with end ileostomy and preservation of rectum