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IBD + IBS Flashcards

1
Q

What is the definition of Chron’s Disease?

A

Chronic inflammatory and ulcerative disease with skip lesions and transmural inflammation

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2
Q

What type of inflammatory inflitrate is found in CD?

A

Non-caseating granulomas

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3
Q

Where in the GI tract is CD most common? Can it occur anywhere in the GI tract?

A

Terminal ileum and colon

Can occur anywhere in GI tract

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4
Q

In what type of IBD would you find knife like fissures?

A

CD

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5
Q

Name two environmental triggers for CD

A

Smoking (big big one)

NSAIDS

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6
Q

What genetic factor is associated with CD?

A

NOD2

CARD15

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7
Q

Name 4 symptoms of CD

A
  • Anaemia (commonly Fe deficient)
  • Diarrhoea (rarely with blood and mucus)
  • Abdominal pain (visceral)
  • Weight loss and reduced growth in children (malabsoprion)
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8
Q

What investigations should be done for IBD?

A

Biopsy to stage disease
Colonscopy
Blood tests
Stool sample - faecal calprotectin

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9
Q

How can CD be managed through lifestyle?

A

Increase fruit and fibre

Smoking cessation

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10
Q

What drugs can be offered in CD?

A
  1. Steroids for managing flareups e.g. budesonide/prednisilone
  2. Immunosuppresnats - azathrioprine, methotrexate
  3. Anti-TNF - “-imab” - infliximab
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11
Q

When would surgery be offered in CD and is a patient likely to have many surgeries throughout their lifetime?

A 
Symptomatic after treatment
Peri-anal disease
Complications 
Carcinoma
Many surgeries
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12
Q

What type of IBD is more likely to present orally and give 3 examples of how it may present

A

CD

  • Swollen Lips
  • Linear ulceration
  • Cobble-stoning of mucosa
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13
Q

Name 5 complications of IBD (many more)

A
  • Peri-anal disease
  • Malnutrition
  • Fistulas
  • Obstruction
  • Perforation
  • Toxic megacolon
  • Sclerosing cholangitis (IMPORTANT)
  • Colorectal cancer
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14
Q

What kind of inflammatory response is in CD and UC?

A

Linked to T cells CD - TH1

UC - TH1 and TH2

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15
Q

Where does inflammation start in UC?

A

Rectum and works back - (never affects small bowel)

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16
Q

What criteria is used to measure the severity of UC? What are the criteria on this?

A 
Truelove and Witt
Bowel movements
<4 - mild
4-6 - moderate
6+ - severe
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17
Q

What is the main symptom of UC?

A

Diarrhoea with blood and mucus

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18
Q

What would be seen in examination of UC in a PR exam that would be different from CD?

A

Blood and mucus will very likely be present in UC

Blood is much rarely in CD

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19
Q

What is the method of drug management in UC?

A
  1. Mesalazine - 5-ASA (aminosalicyates) - remission

2. Steroids - prednisilone/Budesonide - flareups

20
Q

What is the name of the anti-TNF drug?

A

Infliximab

21
Q

What is the name for the removal of the colon?

A

Colectomy

22
Q

What type of IBD is cured through surgery?

A

UC

23
Q

What kind of surgery would a patient with CD get?

A

Many surgeries dependant on location of disease e.g. hemi-colectomies

24
Q

What is the classical sign of mucosal inflammation/oedema on AXR?

A

Thumbprinting

25
Q

What type of IBD is associated with toxic megacolon? What is toxic megacolon?

A

UC - presistent inflammation causes loss of muscle tone of the colon -> distension

26
Q

What is one of the main indications for surgery in CD?

A

Fistula formation

27
Q

What is the handy pneumonic to remember characteristics of UC and CD?

A 
Crohns = NESTS
N - no blood/mucus
E - entire GI tract
S - skip lesions
T - transmural/ terminal ileum 
S - smoking increases (don't want the nest to catch fire)

UC = up close

U - use aminosalicylates 
P - primary sclerosing cholangitis (commonly tested)
C - continuous inflam
L - limited to colon and rectum 
O - only superfical mucosa
S - smoking is protective
E - excrete blood and mucus
28
Q

What is IBS?

A

Functional bowel disorder in which abdo pain assoc. with defecation in ABSENCE OF STRUCTAL PATHOLOGY

29
Q

Whats important for history of IBS?

A

SOCRATES
Impact on daily activties
Diet/exercise/mental well-being

30
Q

Investigations for IBS?

A

Rule out IBD - negative faceal calprotectin
Rule out coeliac - negative anti-TTG antibodies

Regular - FBC, CRP, malabsorption

31
Q

When can someone be diagonosed with IBS?

A

Doesn’t have IBD (negative faceal calprotectin) and coeliac (negative anti-tTg antibodies)

> 6mnths of abdo pain w/ improvement on defecation
Change in stool appearance/frequency

32
Q

Bowel symptoms with other systemic conditions e.g. uveitis/ erythema nodosum - what should you think of?

A

IBD

33
Q

Why do you test for B12 and ferritin in bloods?

A

Ferritin - iron levels

Test for malabsorption

34
Q

How would Crohns present endoscopically?

A

Cobble-stoning (lumps in lumen) and skip lesions

35
Q

What is short gut syndrome?

A

If keep removing areas of bowel = malabsorption

36
Q

How will UC appear on endoscopcy?

A

Red and inflamed
Friable - easy to bleed (due to angiogenesis)
Pseudo-polyps (buzzword)

37
Q

Differnce in area of pain felt in UC and CD?

A

RIF - CD (most likely to be found in terminal ileum)

LIF - UC (restricted to colon and rectum)

38
Q

What clinical presentations are important to note in UC?

A

Finger clubbing
Apthous ulcers
Pallor

39
Q

Surgery for UC?

A

Panproctocolectomy - removal of rectum and colon and anal canal = ileostomy
OR
Protcololectomy = removal of rectum and colon = formation of J-pouch (ileo-anal anastomosis) -> more bowel movements than before

40
Q

A patient with Crohns comes in for a review and says she is still having trouble with her symptoms. She was put on steroids when she was first diagnosed 8 weeks ago. What would be the next line of treatment?

A

Immunosuppresants e.g. azathioprine, methotrexate

41
Q

What test can be used on stool which is very accurate for IBD?

A

Faceal calprotectin - released by inflamed intestines

42
Q

A patient with IBS would have what kind of bowel movements?

A

Change between diarrohea and constipation

43
Q

Altered gut flora can be found in what disease?

A

IBD

44
Q

Why does IBD occur?

A

An overactive immunological response to luminal antigens e.g. bacteria

45
Q

What is the most common extra-intestinal disease in both UC and CD

A

Arthritis

46
Q

What is the most important side effect of mesalazine?

A

agranulocytosis

GI (26 decks)

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