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JazGI > IBD - inflammatory bowel disease > Flashcards

IBD - inflammatory bowel disease Flashcards

1
Q

IBD associated with sudden flare ups and remissions

A

Crohn’s

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2
Q

IBD with skip lesions and anywhere from mouth to anus affected

A

Crohn’s

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3
Q

IBD that is transmural

A

Crohn’s

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4
Q

IBD that is associated with granulomas of macrophages and T cells and causes villi shortening

A

Crohn’s

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5
Q

IBD associated with smoking

A

Crohn’s

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6
Q

IBD prevented by smoking

A

UC

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7
Q

IBD more associated with blood and mucus in diarrhoea

A

UC

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8
Q

IBD with abdominal mass more common

A

Crohn’s

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9
Q

IBD with a gradual onset of weeks of symptoms

A

UC

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10
Q

IBD that is continuous from rectum -> colon

A

UC

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11
Q

IBD associated with shortened and branched crypts with plasma cell infiltrates

A

UC

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12
Q

IBD that affects only mucosa and submucosa usually

A

UC

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13
Q

Extra-intestinal symptoms of IBD more common in _

A

UC

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14
Q

Extra-intestinal symptoms of IBD =

A 
non-rheumatic arthritis
aphthous ulceration
pyoderma gangrenosum
uveitis/episcleritis
IDA
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15
Q

IBD with stronger genetic component

A

Crohn’s

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16
Q

Obesity’s effect on gut microbiome =

A

less diversity an increases proteobacteria

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17
Q

Bacteria ___ can infiltrate normally sterile mucus layer in IBD if there is ___ => extra ___

A

bound to IgA

inflam=> extra inflam

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18
Q

NOD2/CARD15(IBD-1) on chromosome ___ are mutated in 10-20% of ___
encodes protein involved in ____

A

16q12
Crohn’s
bacterial recognition and presenting to T cells

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19
Q

UC is __ mediated with ___ and causes too few colonic bacteria to be present

A

Th1/2 with NKTC

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20
Q

Crohn’s is __ mediated and so can’t control ___

A

Th1

can’t control bacterial numbers

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21
Q

Severity markers of UC (Truelove and Witt) =

A

more than 6 bloody stools in 24hrs and 1 or more of fever/ tachycardia/anaemia/increased ESR

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22
Q

which IBD:
on endoscopy is a clear transition zone
pseudopolyps

A

UC

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23
Q

Histology of UC =

A

enlarged and distorted crypts, abscence of goblet cells, abscesses that only affect mucosa

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24
Q

Cobblestonemucosa = which IBD

A

Crohn’s

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25
Q

IBD associated with PSC =

A

UC

26
Q

Peak incidence of UC is at ages

A

20-30yo

27
Q

Commonest ages of Crohn’s presenting =

A

90% present 10-40yo

28
Q

Most commonly Crohn’s affects the

A

RHS colon and distal ileum

29
Q

Stenosis in Chron’s may be __/__

A

fibrotic or inflammatory

30
Q

knife-like fissures =

A

Crohn’s

31
Q

Histology of Crohn’s -

A 
thicker mucosa
knife like fissures
chronic active colits w non-casseating granuloma
increased inflam cells in lamina propria
crypt branching
32
Q

Complications of Crohn’s

A 
greater omentum wraps around
strictures
gallstones
fistulas
perianal disease
33
Q

Extra-intestinal symptoms/signs are rare in which IBD

A

Crohn’s

34
Q

Which IBD is more ac=ssociateed with colorectal cancer

A

UC

35
Q

IBD that causes a thin wall

A

UC

36
Q

Crohn’s 3 steps of treatment

A

steroids>immunosuppression> anti-TNF therapy

37
Q

UC 4 steps of treatment =

A

5-ASA>steroids>immunosuppression>anti-TNF therapy

38
Q

___ is effective in UC but not in treating Crohn’s

A

5-ASA

39
Q

examples of 5-ASA drug names:

routes =

A

sulfasalazine, balsalazide, mezavant = prodrugs
asacol = pH release
pentasa = delayed release all PO
can get suppositories and enemas

40
Q

Compare suppositories and enemas of 5-ASA for UC

A 
suppository = morning, coats less than 20cm but better mucosal adherence
enema = night, reflex contraction aids proximal spread
41
Q

for acute flare of UC give 5-ASA in ___ approach

A

top and tail

PO + enema/suppository

42
Q

Steroids used in UC and Crohn’s eg.s
used for flare ups so start ___ and ___ over 6-8wks
dont ____ as could get Addison’s crisis

A

budesonide, prednisolone
high dose, taper down
DON’T stop immediately

43
Q

Immunosuppression eg.s used in IBD
In Crohn’s used as ___
In UC used as ___

A

azathioprine/mecaptopurine(6-MP), methotrexate
Crohn’s = maintenance therapy
UC = steroid sparing agents

44
Q

IS in IBD mechanism of action =

A

purine analogues and interfere with DNA synthesis

45
Q

If hetero/homozygous for low ___ then giving mercaptopurine(6-MP) in IBD could be toxic as 6MP not converted to ___ which balances out toxic effects of 6-TGN which is formed by ___ breakdown of 6-MP

A

TPMT
6-MMP
HPRT

46
Q

Don’t prescribe ___ with IS for IBD because it inhibits xanthine oxidase which ___

A

allopurinol

breaks down 6-MP to 6-TU for clearance

47
Q

IS for IBD has a slow/rapid onset so __

A

slow - 16wks

start when start steroids then when they end IS should take over

48
Q

TNFα is a ____

functions =

A

pro-inflam cytokine
causes Th0 to differentiate
modulates MadCAM-1 on vessel walls which pull T cells to site of inflam

49
Q

eg. of anti TNFs used in IBD

mechanism

A

IV infliximab
S/C adalimumab
block TNFα and increase apop of activated T cells

50
Q

anti TNFs have a slow/rapid onset

give on day 0 then __ then __ then every ___ after that

A

rapid
wk 2
wk6
every 6-8wks to maintain

51
Q

if give then can reactivate tb

must never have had tb to be put on them

A

anti-TNF therapy

for IBD/ rheumatoid arthritis

52
Q

one side effect =may develop HACA

A

infliximab (antiTNF therapy)

53
Q

biosimilars to infliximab that are cheaper =

A

inflectra and remsima

54
Q

Which IBD:
If operate rarely see again
also doesn’t cure ___ symptoms

A

UC

extra-intestinal

55
Q

in toxic megacolon most likely part to perforate is __ because ___

A

caecum as it is most thin walled

56
Q

2 methods of panproctocolectomy

A

with ileostomy

leave sphincter and make J/S pouch with at least 30cm of bowel

57
Q

surgery for IBD is if -

A

no response to drugs, obstruction, abscess, fistulae = emergency
no response to drugs, dysplasia of mucosa = elective

58
Q

If operate on this IBD is likely to come back within 10 yrs

A

Crohn’s

59
Q

Peri-anal fistulae are more common in which IBD

A

Crohn’s

60
Q

Surgery that can be done for strictures

A

stricturoplasty - cut longitudinally and stitch horizontally to widen = non-functioning any more

61
Q

for terminal ileal disease in Crohn’s the surgery done =

A

R hemicolectomy

62
Q

Fistula are common in which ibd

A

Crohns

JazGI (26 decks)

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