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Year 4 > IBD > Flashcards

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?

A

> 6cm

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
Q

other investigations in UC?

A 
varium enema (lead pipe colon)
CT scan (shows thickening of colon wall)
26
Q

what test is diagnostic of UC?

A

colonoscopy + biopsy (differentiated crohns and UC)

27
Q

how is medical management used to induce remission in acute presentation of UC?

A

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
Q

how is remission maintained with medical management in UC?

A

5-ASA topical, oral or both

oral azathioprine if 2 exacerbations in 12 months requiring systemic corticosteroid therapy

29
Q

when is surgery indicated in UC?

A

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
Q

most common surgery in UC?

A

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
Q

when is a proctocolectomy with end ileostomy used in UC?

A

patient or anus not suitable for restorative procedure due to either advanced age, impaired anal sphincter etc

32
Q

when is sub-total colectomy with ileostomy used? (sigmoid and rectum left in place)

A

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
Q

pattern of inflammation in crohns?

A

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
Q

how is smoking associated with crohns?

A

risk factor

makes it worse

35
Q

who does crohns usually affect?

A

peak onset in teens and early 20s (younger than UC)

36
Q

what is fat wrapping?

A

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
Q

what causes “cobblestoning” in crohns?

A

mucosal thickening and fissuring ulceration (mucosa thickens, then fissures form causing deep lines in the thick mucosa = cobblestones)

38
Q

how does stenosis occur in crohns?

A

extensive fibrosis and smooth muscle hyperplasia

39
Q

describe the transmural inflammation in crohns and what happens in the bowel wall

A

lymphoid aggregates form in the subserosal tissues forming “crohns rosary”
also causes mucosal crypt ulceration and fissuring ulceration

40
Q

complications in crohns disease?

A

perforation
fistula formation
abscess formation

41
Q

how does crohns affect the anus?

A

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
Q

how can crohns affect the upper GI tract?

A

oral ulceration
dysphagia
oesophageal involvement or upper abdo pain
gastric outlet obstruction with gastroduodenal involvement

43
Q

how does crohns present?

A 
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
Q

features of stenosis?

A

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
Q

basic investigations in crohns?

A

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

46
Q

imaging in crohns?

A

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
Q

diagnostic test in crohns?

A

colonoscopy + biopsy

48
Q

how is remission induced in crohns?

A

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
Q

how is remission maintained in crohns?

A

oral azathioprine mono-therapy

methotrexate if azathioprine allergic due to TPMT enzyme deficiency

50
Q

principles of surgery in crohns?

A

remove as little bowel as possible

surgery done to deal with complications, not cure

51
Q

indications for surgery in crohns?

A

perforation, haemorrhage, severe colitis, obstruction
abscess or fistula
steroid dependency, dysplasia/cancer
failure of medical treatment

52
Q

what surgeries are used in crohns?

A

segmental resection (just single bit of disease taken out and ends reattached)
colectomy with iliorectal anastomosis
subtotal colectomy with iliostomy
ileocaecal resection

53
Q

how can IBD and IBS be differentiated?

A

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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