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IBD Flashcards

1
Q

what causes IBD?

A

idiopathic autoimmune disease

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2
Q

course of UC?

A

relapsing remitting

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3
Q

pattern of inflammation in UC?

A

continuous inflammation of mucosa and submucosa only
only in large bowel
rectum always affected

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4
Q

what is backwash ileitis ?

A

severe UC where entire colon is affected and inflammation continues up into ileum and small bowel
ileum is oedematous
occurs in 20% of UC patients

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5
Q

how does smoking affect UC?

A

protective

often flares when people stop smoking

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6
Q

who is UC most common in?

A

equal genders

peaks in early 20s and again in 40s/50s

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7
Q

what is seen on endoscopy in UC?

A

granular, hypervascular and mildly oedematous mucosa with loss of vascular pattern

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8
Q

other pathology in UC?

A

lack of fibrosis
neutrophilic infiltration leading to crypt abscess
pseudopolyps
loss of haustrations (lead pipe colon)
can lead to dysplastic changes and adenocarcinoma

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9
Q

what does Proctitis mean in terms of UC?

A

rectum only involved

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10
Q

what does proctosigmoiditis mean in terms of UC?

A

rectum and sigmoid involved

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11
Q

what does left sided colitis mean in terms of UC?

A

involvement up to splenic flexure

40% of UC patients

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12
Q

what does extensive colitis mean in terms of UC?

A

involvement up to hepatic flexure

20% of UC patients

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13
Q

what does panproctocolitis mean in terms of UC?

A

whole colon involved

may get backwash ileitis due to imcompetent iliocaecal valve

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14
Q

what are the cardinal symptoms of UC?

A 
bloody diarrhoea = main symptom
also
- stool mixed with mucus
- tenesmus
- abdo pain
- systemic upset
- extra-intestinal symptoms
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15
Q

what might abdo distension and tenderness in context of UC indicate?

A

toxic megacolon

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16
Q

extra-intestinal symptoms in UC?

A 
enteropathic arthritis
sclerosing cholangitis 
cholangiocarcinoma
erytheme nodosum
pyoderma gangrenosum
uveitis
episcleritis
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17
Q

describe enteropathic arthritis?

A

large joints affected
asymmetrical oligoarthritis
usually knees, ankles, elbows, wrists and sometimes axial (spine, hips etc)

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18
Q

how is UC severity scored?

A

truelove and witt score

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19
Q

mild UC?

A

<4 stools a day
only small amount of blood
no systemic upset

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20
Q

mod UC?

A

4-6 stools per day
varying amounts of blood
no systemic upset

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21
Q

severe UC?

A

> 6 bloody stools/diarrhoea a day

features of systemic upset

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22
Q

what size of transverse colon indicates toxic megacolon?

23
Q

basic investigations in UC?

A

FBC: raised WCC and neutrophils, anaemia
Us&Es: rules out AKI, hypokalaemia and hypobilirubinaemia
raised CRP
blood and stool culture: excludes infective colitis

24
Q

imaging in UC?

A

AXR
thumbprinting (Mucosal thickening of haustra)
lead pipe colon: loss of normal haustra
toxic megacolon

25
other investigations in UC?
``` varium enema (lead pipe colon) CT scan (shows thickening of colon wall) ```
26
what test is diagnostic of UC?
colonoscopy + biopsy (differentiated crohns and UC)
27
how is medical management used to induce remission in acute presentation of UC?
proctitis: topical 5-ASA is first line proctosigmoiditis: topical 5-ASA extensive disease: combined topical and oral 5-ASA (may add oral 5-ASA as well as topical or a short course of steroids in proctitis/proctosigmoiditis if topical not inducing remission in 4 weeks)
28
how is remission maintained with medical management in UC?
5-ASA topical, oral or both | oral azathioprine if 2 exacerbations in 12 months requiring systemic corticosteroid therapy
29
when is surgery indicated in UC?
acute colitis that fails to respond to medical therapy chronic symptomatic colitis on max medical therapy or bad side effects of therapy perforation complications such as neoplasia
30
most common surgery in UC?
proctocolectomy with ilioanal pouch formation (removes colon and rectum and ileum folded into a pouch and reattached to anus - ileal resevoir functions as sort of new anus)
31
when is a proctocolectomy with end ileostomy used in UC?
patient or anus not suitable for restorative procedure due to either advanced age, impaired anal sphincter etc
32
when is sub-total colectomy with ileostomy used? (sigmoid and rectum left in place)
safest procedure to do in an emergency when patient is very unwell rectosigmoid stump can be brought up as a mucus fistula while everything is healing and then reversed and reattached
33
pattern of inflammation in crohns?
chronic inflammatory, non-caseating, granulomatous disease full thickness inflammation (transmural) affects any part of the GI tract so can crop up anywhere but mostly starts in terminal ileum and caecum
34
how is smoking associated with crohns?
risk factor | makes it worse
35
who does crohns usually affect?
peak onset in teens and early 20s (younger than UC)
36
what is fat wrapping?
type of pathology seen in crohns affected bowel looks blue-grey and thickened with spiral surface vessels and encroachment of the mesenteric fat around the bowel (fat from mesentery attached to the bowel creeps up and around the bowel)
37
what causes "cobblestoning" in crohns?
mucosal thickening and fissuring ulceration (mucosa thickens, then fissures form causing deep lines in the thick mucosa = cobblestones)
38
how does stenosis occur in crohns?
extensive fibrosis and smooth muscle hyperplasia
39
describe the transmural inflammation in crohns and what happens in the bowel wall
lymphoid aggregates form in the subserosal tissues forming "crohns rosary" also causes mucosal crypt ulceration and fissuring ulceration
40
complications in crohns disease?
perforation fistula formation abscess formation
41
how does crohns affect the anus?
can cause - superficial ulcers with undermined edges (relatively painless) - rectovaginal fistula (communication between rectum and vagina causing leakage of gas and faeces from vagina) - incontinence as a result of destruction of anal sphincter muscle
42
how can crohns affect the upper GI tract?
oral ulceration dysphagia oesophageal involvement or upper abdo pain gastric outlet obstruction with gastroduodenal involvement
43
how does crohns present?
``` inflammatory features - abdo pain - altered bowel habit (not bloody) - weight loss - fever - failure to thrive in children features of a fistula stenosis symptoms perianal disease (fissures and fistulae) ```
44
features of stenosis?
colicky abdo pain small bowel obstruction weight loss can have food fear as eating can worsen colicky abdo pain as bowel is trying to push food past stricture
45
basic investigations in crohns?
FBC: raised WCC and neutrophils, anaemia Us&Es: hypokalaemia, hypoalbuminaemia, rule out AKI CRP: raised blood and stool culture: excludes infective colitis
46
imaging in crohns?
AXR not really needed as dilation not really a feature in crohns but often done anyway usually go straight to CT which shows inflammatory mass, abscess, perforation etc OGD or colonoscopy used depending on site affected barium enema: can show narrowing or irregularity in small bowel MRI: used in anal disease
47
diagnostic test in crohns?
colonoscopy + biopsy
48
how is remission induced in crohns?
mono-therapy with systemic IV glucocorticoid (prednisolone, hydrocortisone) consider enteral nutrition in kids where concerned about growth retardation may add azathioprine to glucocorticoid to induce remission infliximab used in severe, non-responsive cases
49
how is remission maintained in crohns?
oral azathioprine mono-therapy | methotrexate if azathioprine allergic due to TPMT enzyme deficiency
50
principles of surgery in crohns?
remove as little bowel as possible | surgery done to deal with complications, not cure
51
indications for surgery in crohns?
perforation, haemorrhage, severe colitis, obstruction abscess or fistula steroid dependency, dysplasia/cancer failure of medical treatment
52
what surgeries are used in crohns?
segmental resection (just single bit of disease taken out and ends reattached) colectomy with iliorectal anastomosis subtotal colectomy with iliostomy ileocaecal resection
53
how can IBD and IBS be differentiated?
IBS is relieved by passing stool IBD causes tenesmus - doesnt feel like youve emptied bowels, always feel a need to pass more so not relieved by passing stool

Year 4 (83 decks)

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