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Stage 2 Year 2 > IBD, Coeliac + Peptic Ulcers > Flashcards

IBD, Coeliac + Peptic Ulcers Flashcards

1
Q

What is UC?

A

Inflammation of the large colon

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2
Q

What causes UC?

A

Autoimmune - T cells destroy the mucosa and submucosa of large bowel (superficial inflammation)

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3
Q

How does UC progress?

A

Starts in the rectum and progressively goes up the colon linearly
- Proctitis to left-sided colitis to pancolitis

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4
Q

What disease is UC associated with?

A

Primary sclerosing cholangitis

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5
Q

What are symptoms of a UC flare?

A
  • Diarrhoea
  • Urgency
  • Blood in stool
  • LLQ pain
  • Weight loss
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6
Q

How do you diagnose UC?

A

Lower GI endoscopy (colonsocopy)

  • Flexible sigmoidoscopy in acute stage to assess and biopsy
  • Full colonoscopy when stable to define disease extent
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7
Q

What would you see on other investigations for UC?

A
  • Raised CRP/ESR
  • Anaemia (bc bleeding)
  • Raised faecal calprotectin
  • P-ANCA
  • Low albumin
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8
Q

How do you treat UC?

A
  • Aminosalicylates (mesalazine)
  • Steroids/immunosuppressants (azathioprine, methotrexate)
  • Biologics (infliximab - anti-TNF)
  • Colectomy (curative)
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9
Q

What is Crohn’s disease?

A

Immune related disease that affects all layers of the whole GI tract in patches (rather than continuously)

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10
Q

What are symptoms of Crohn’s?

A
  • Abdominal pain
  • Diarrhoea
  • Weight loss
  • N&V
  • Dysphagia
  • Systemic - fatigue, fever, malaise, anorexia
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11
Q

What conditions are associated with Crohn’s?

A
  • Oral ulcers
  • Anal abscesses
  • Stricture (narrowing of bowel - normally small bowel)
  • Fistulas
  • Erythema nodosum (red tender patches on shin)
  • Pyoderma gangrinosum
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12
Q

What are the 3 types of disease distribution in Crohn’s?

A

1) Terminal ileum (causes less B12 to be absorbed)
2) Colonic
3) Ileo-colonic

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13
Q

How do you diagnose Crohn’s?

A

Endoscopy ± MRI small bowel

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14
Q

What would you see on other investigations for Crohn’s?

A
  • Anaemia, B12, folate

- Faecal calprotectin

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15
Q

How do you treat Crohn’s?

A
  • Steroids - prednisolone
  • Abx - ciprofloxacin, metronidazole (short term)
  • Immunosuppressants (azathioprine)
  • Sulfasalazine
  • Biologics (anti-TNF)
  • Surgery
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16
Q

After what does Crohn’s often present?

A

Gastroenteritis

17
Q

What would you see on histology in UC?

A

Crypt abscesses and mucosal inflammation

18
Q

What would you see on histology in Crohn’s?

A

Granulomas and transmural inflammation

19
Q

What is the deal with smoking in IBD?

A

UC - smoking protective

Crohn’s - smoking detrimental

20
Q

What causes toxic megacolon in UC?

A

Nerve plexuses exposed to gastric contents so become damaged - colon doesn’t keep tone so just dilates (doesn’t happen in Crohn’s bc of patchy distribution)

21
Q

What is coeliac disease?

A

Autoimmune disease where T cells react to gliadin (part of gluten) causing inflammation and destruction of duodenal lining - FH link

22
Q

What are symptoms of coeliac disease?

A
  • Bloating
  • Abdominal pain/cramping
  • Diarrhoea/steatorrhoea
  • Failure to thrive
  • Anaemia (low iron and B12)/osteoporosis (osteomalacia) due to malabsorption and diarrhoea
  • Muscle weakness
  • Amenorrhoea and infertility
  • Angular stomatitis
23
Q

What skin condition is associated with coeliac disease?

A

Dermatitis herpetiformis (often on abdomen)

24
Q

How do you diagnose coeliac disease?

A

Duodenal biopsy ± OGD

25
Q

What do you see on duodenal biopsy in coeliac disease?

A
  • Villous atrophy
  • Crypt hyperplasia
  • Immune cell infiltration
26
Q

What antibodies might you see in coeliac disease?

A
  • Anti-TTG (tissue transglutaminase) - most important for diagnosis
  • Anti-gliadin
  • Anti-endomysial
27
Q

What is the treatment for coeliac disease?

A

GFD

28
Q

Where do peptic ulcers occur?

A

Stomach or duodenum

29
Q

What are common causes of peptic ulcers?

A

NSAIDs and H pylori

30
Q

How do you diagnose H pylori?

A

Urease breath test

31
Q

What is a big risk factor for peptic ulcers?

A

Smoking

32
Q

What are symptoms of peptic ulcers?

A
  • Epigastric pain
  • Bloating
  • Can lead to bleeding - haematemesis or malaena
33
Q

How do you treat H pylori?

A

Triple therapy

  • Amoxicillin
  • Omeprazole
  • Clarithromycin/metronidazole
34
Q

How do you treat peptic ulcers?

A
  • Stop NSAIDs and smoking

- Treat H pylori

35
Q

What diseases is coeliac associated with?

A

Thyroid, T1D, RA

36
Q

What genes are present in coeliac?

A

HLA-DQ2 or DQ9

37
Q

What classification is used in coeliac?

A

Marsh classification

38
Q

When does coeliac disease peak?

A

Childhood and 50s-60s

Stage 2 Year 2 (13 decks)

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