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BDS2 - GIT system > IBD - Crohn's disease and ulcerative colitis > Flashcards

IBD - Crohn's disease and ulcerative colitis Flashcards

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1
Q

what is IBD

A
  • inflammatory bowel disease

- can be crohn’s disease or ulcerative colitis

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2
Q

what are significant GI malabsorption diseases

A
  • pernicious anaemia
  • coeliac disease
  • Crohn’s disease
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3
Q

what are significant GI diseases in the large bowel

A
  • IBD
  • colonic cancer
  • infections
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4
Q

what is IBD characterised by

A
  • inflammation of the bowel
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5
Q

what is the prevalence of IBD

A
  • quite prevalent
  • incidence is 20x more in Western societies
  • occurs more in white people than black
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6
Q

at what age are patients usually diagnosed with IBD

A
  • 15-25 years old

- could have had it for longer at a low level but it has only become critical at this age

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7
Q

in what gender is Crohn’s disease more common

A

male

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8
Q

in what gender is ulcerative colitis more common

A

female

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9
Q

what is the aetiology of IBD

A
  • bit of a mystery
  • is a change in gut lining and mucosa = trigger for this change is different person to person
  • likely that there is more than one cause = but once you have the disease the pattern of disease is the same
  • there is a whole range of things that can set off change in mucosa
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10
Q

what are the 4 main factors that can cause IBD

A
  • immunological = if immune system is overreactive
  • psychological = perhaps a cause of IBD but definitely a consequence
  • smoking = less risk of IBD
  • genetic = clearly tendencies that run in families
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11
Q

what do granulomas do in crohn’s

A
  • cause granulomatous inflammation

- have granulomas in tissue

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12
Q

how does food intolerance affect Crohn’s disease

A
  • something happens in tissues causing immune stimulation that the body can’t handle
  • if you don’t feed patients it gets better
  • unclear what the food intolerance
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13
Q

how can viral infections/immune activation affect Crohn’s

A
  • passed to people which in the right susceptibility causes problems
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14
Q

what can infection with mycobacteria do for Crohn’s

A
  • causes paratuberculosis
  • causes Johne’s disease = problem cattle get similar to Crohn’s
  • get bacterium that causes Johne’s in farms which then passes milk to the dairy industry which then passes disease to us
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15
Q

what is the link between Johne’s disease and Crohn’s

A
  • incidence of Johne’s in cattle and Crohn’s in people both increased over time with about 10 years between
  • some people think it is passed down from cattle
  • pasteurised milk kills a lot of bacteria but not m.paratuberculosis
  • should have ultra-high-temperature milk all the time as it would kill m.paratuberculosis
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16
Q

what is the changes to the bowel and mucosa in Crohn’s disease

A
  • has lots of bumps
  • areas of oedema caused by granulomas blocking lymphatics so preventing drainage from tissue
  • can affect any part of the bowel
  • get cobblestoning of mucosa
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17
Q

where are Crohn’s disease sites

A
  • anywhere = mouth, oesophagus, stomach, large intestine, small intestine, rectum, anus
  • can be in sections = skip lesions, may not affect whole GIT only certain parts
18
Q

where are ulcerative colitis sites

A
  • only colonic disease
  • starts in rectum and works way back up the colon
  • continuous inflammation = not in sections
  • changes bowel activity
19
Q

what happens in ulcerative colitis

A
  • disease continuous = easier to identify
  • rectum always involved
  • anal fissures = 25%
  • ileum involved = 10%
  • mucosa granulomas and ulcers = only affects top layer of bowel wall (superficial)
  • vascular
  • serosa normal
20
Q

what happens in Crohn’s disease

A
  • discontinuous
  • rectum involved 50%
  • anal fissures 75%
  • ileum involved 30%
  • mucosa cobbled and fissures
  • non vascular
  • serosa inflamed = affects entire thickness of bowel
21
Q

what are the microscopic features of Crohn’s

A
  • transmural
  • oedematous = as granulomas blocking lymphatics
  • granulomas
22
Q

what are the microscopic features of ulcerative colitis

A
  • mucosal
  • vascular
  • mucosal abscesses
23
Q

what does Crohn’s disease look like

A
  • red appearance around mouth
  • inflammation/swelling of bowel wall so lumen is narrower so difficult to pass bowel connects through
  • cobblestone appearance of mucosal surface due to linear ulceration
  • abscess can form on outside of bowel as well as inside as inflammation has gone right through wall = can even extend to adjacent bowel loop which can then form a fistula between the bowel
24
Q

what does ulcerative colitis look like

A
  • superficial problem = affects mucosal layer only, absence of goblet cells, crypt distortion and abscess
  • inflammation never extends to outside = bottom area remains fairly normal
25
Q

what are the different types of ulcerative colitis

A
  • proctitis = involves only rectum
  • proctosigmoiditis = involves the rectum and sigmoid colon
  • distal colitis = involves only left side of the colon
  • pan colitis = involves entire colon
  • backwash ileum = involves distal ileum, fairly unusual
26
Q

what would happen to the patient if you removed the colon in ulcerative colitis

A
  • it would go away as it doesn’t affect the small bowel
27
Q

what are the ulcerative colitis symptoms

A
  • diarrhoea = as water absorption decreased so stool volume is more
  • abdominal pain
  • PR bleeding = get when you have bowel infections, mucosa is fragile so is easily damaged
28
Q

what are Crohn’s disease symptoms

A
  • colonic disease = same as UC
  • small bowel disease = pain form obstruction as tube narrower, malabsorption
  • mouth = orofacial granulomatous
  • patent rarely complains of discomfort until obstruction
29
Q

what is orofacial granulomatosis

A
  • OFG
  • not a single condition
  • granuloma formation blocks lymphatics
  • lip and oral swelling then noted from other causes of increased capillary leakage
  • can be a very localised disease
30
Q

what are the causes of OFG

A
  • food preservative and additives = benzoate’s/sorbate/cinnamon, can benefit from cutting out certain foods
  • some have to identifiable trigger
  • not clear why people get it
31
Q

what are the clinical features of OFG

A
  • lip swelling
  • angular cheilitis
  • cobblestoning
  • gingivitis
  • ulceration
  • microscopic granulomas
32
Q

what is gingivitis

A
  • very red thick gums
  • can be in one part of the mouth or whole area
  • common in 6-12 year olds
33
Q

what is the link between OFG and Crohn’s disease

A
  • younger you get OFG the more likely you are to get Crohn’s disease
34
Q

what are the investigations for IBD

A

same for OFG and Crohn’s disease

  • blood tests = anaemia, CRP, ESR (look for anaemia due to low level bleed)
  • foetal calprotectin = released the bowel cells inflamed, measure in stool, high amount = inflamed bowel
  • endoscopy
  • leukocyte scan
  • barium studies
  • bullet endoscopy = swallow capsule that takes pictures of bowel as it passes through
35
Q

what are IBD complications

A
  • ulcerative colitis develops carcinoma = risk increases with time
  • judgements whether colectomy is justified = attitude to risk, carcinoma surveillance potential
  • risk is less now as we are more aware
36
Q

what is the treatment for IBD

A
  • medical treatment and surgical treatment
37
Q

what is the medical treatment for IBD

A
  • based on removing inflammation
  • systemic steroids = prednisolone
  • local steroids = rectal administered, colorectal disease
  • anti-inflammatory drugs = 5-ASA based drugs = pentasa, mesalazine, sulphasalazine (topical)
  • non-steroid immunosuppressants = azathiopine, methotrexate
  • manufactured antibody drugs = anti TNF-alpha therapy, infliximab, adalimumab
38
Q

what is the problem with using steroids

A
  • can cause other problems
39
Q

what is the surgical treatment for IBD

A
  • colectomy = cures ulcerative colitis
  • for Crohn’s disease you palliate symptoms = remove obstructive bowel segments, drain abscess, close fistula (especially perianal)
  • usually results in a stoma bag = may be reversible in some patients, problem is social issue, can be a big help with bowel disease
40
Q

what are oral issues in IBD

A
  • oral lesions in Crohn’s = OFG
  • oral ulceration = ulcers worse when UC is worse
  • haematinic deficiency caused by malabsorption or intestinal bleeding = if have inflamed bowel gradually work away your iron stores an can get malabsorption

BDS2 - GIT system (5 decks)

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