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w141 irritable bowel disease > IBD pathology > Flashcards

IBD pathology Flashcards

1
Q

Name 3 genetic causes of IBD?

A
  • Cystic fibrosis
  • Familial adenomatous polyposis (FAP)
  • Lynch syndrome (like FAP but slower in development)
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2
Q

Name 3 congenital causes of IBD?

A
  • Cystic Fibrosis→ mucoviscidosis. A defect in chloride channel protein means a failure to secrete sodium and water.these viscid secretions cause –Meconium ileus in infants, Pancreatic atrophy, Biliary cirrhosis of liver
  • Hirschprungs disease → Ganglion cells migrate into gut from neural crest. Congenital megacolon with severe constipation.
  • Meckles diverticulum → Disease of 2’s. 2% of population, within 2 feet of ileo caecal valve, 2 inches long. it is a remnant of vitello-intestinal duct linking embryonic gut with yolk sac
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3
Q

Name 4 ways that the gut can be infected resulting in diarrhoeal illness?

A
  • Pre-formed toxins in food → Staphylococcal
  • Surface adherence of organisms - damage to brush border and toxin production → cholera and E.coli.
  • Invasion of gut wall – cell damage, ulceration, bleeding → Shigella, rota viruses, entero-invasive E. Coli, Salmonella, Clostridium difficile
  • Systemic infection in blood stream → typhoid and in nerves - polio
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4
Q

Name2 protazoa that cause IBD?

A

Giardia lamblia and Entamoeba histolytica

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5
Q

Name 5 Metazoa that cause IBD?

A
  • Roundworms
  • Hookworms
  • Tapeworms
  • Pinworms (threadworms)
  • Whipworms
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6
Q

Name 2 vascular causes of IBD?

A
  • Acute Infarction - black bowel, severe abdominal pain, loss of peristalsis, distended bowel, systemic acidosis, perforation and peritonitis
  • Chronic ischaemia – bloody diarrhoea, healing by scarring may lead to strictures
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7
Q

Name 3 Immune related diseases that cause IBD?

A

Coeliacs disease, Crohns disease and Ulcerative colitis.

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8
Q

What is Coeliacs disease?

A
  • Sensitivity to gluten
  • When tested → Serum Tissue Trans Glutaminase positive
  • Villous atrophy and compensatory crypt hyperplasia with intra-epithelial lymphocytes.
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9
Q

What is Crohns disease?

A

Crohns disease is granulomatous, may affect any part of the GI tract from mouth to anus, tends to be discontinuous (skip lesions) and affects whole thickness of bowel wall

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10
Q

what happens in Coeliacs disease?

A 
Loss of villi causes malabsorption
Malabsorbtion!!!
•Defective fat absorption – steatorrhoea
•Deficiencies of vitamins A, D and K
•Folic acid and iron deficiency
•Bone disease, anaemia
•Long term risk of adenocarcinoma and T cell lymphoma
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11
Q

What is Ulcerative Colitis?

A

Ulcerative colitis affects colon and rectum

is continuous, affects mucosa, and shows crypt distortion

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12
Q

What are the key findings in Crohns disease?

A
  • Mouth to anus
  • Skip lesions
  • Granulomas
  • Full thickness
  • Little crypt distortion
  • Little mucin depletion
  • Peri anal disease
  • Strictures and fistulas
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13
Q

What are the key findings in Ulcerative colitis?

A
  • Rectum/colon
  • Continuous
  • No granulomas
  • Mucosa
  • Crypt distortion
  • Mucin depletion
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14
Q

What non bowel symptoms are both Crohns and Ulcerative colitis associated with?

A
  • Arthritis
  • Skin rashes
  • Uveitis
  • Liver disease
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15
Q

Name 2 mechanical cause IBD?

A

Volvulus - twisting of the sigmoid colon

Diverticular disease

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16
Q

Name a drug cause Of IBD?

A

NSAIDs

17
Q

what is the first line treatment of mild Ulcerative colitis?

A

Aminosalicylates

  • Oral sulfasalazine is first line
  • Oral prednisalone is second line

If Distal colitis → Mesalazine

18
Q

What is the mechanism of action for aminosalicylates, what do they do?

A 
•Anti-inflammatory
•Inhibit synthesis of inflammatory mediators:
→Prostaglandins
→Thromboxane
→Platelet-activating factor
•Scavenger of oxygen-radicals
19
Q

What is the aminosalicylate of choice, and what are 3 other aminosalicylates?

A

Mesalazine is 5-ASA of choice.

others include : sulfasalazine, basalazide, olsalazine

20
Q

What is the escalation of treatment for UC?

A
  • For Mild UC, 5-ASA +/- steroids to promote remission induction.
  • For moderate UC, Oral prednisolone + 5-ASA
  • For sever UC Hydrocortisone. With improvement transfer to prednisolone and 5-ASA. Rescue therapy Ciclosporin or infliximab.
  • Surgery- colectomy
21
Q

What is the escalation of treatment for Crohns disease?

A
  • Treat with hydrocortisone

* then either azathioprine or infliximab

22
Q

What are Mono clonal antibodies?

A

They target specific immunological & inflammatory pathways → TNF alpha inhibition.

23
Q

2 examples of monoclonal antibodies used in the treatment of IBD?

A

Infliximab and adalimumab

24
Q

Name 2 immunosuppressant drugs?

A

Ciclosporin and methotrexate.

25
Q

How do Immuno-suppresant drugs work?

A

Immunosuppressant drugs reduces the activity of the immune system by interfering with the activity and growth of T cells.

26
Q

What are thiopurines and when are they used?

A

Cytotoxic, to be used when steroid therapy is not tolerated or or for steroid sparing effect.

27
Q

What are 3 clinical findings in crohns disease?

A

inflamed bowel, malabsorbtion of Vit. B12 and bacterial overgrowth.

28
Q

what are the 3 oral cortico steroids that can be given in IBD?

A

Beclamethasone
Prednisolone
budesonide

29
Q

What are the classifications of Ulcerative colitis?

A
  • Mild: <4 motions/day, small rectal bleeding, apyrexial
  • Moderate: 4-6 motions/day, moderate rectal bleeding, temp 37.1-37.8
  • Severe: >6 motions/day, Large rectal bleeding, Temp >37.8
30
Q

What is the treatment of moderate UC?

A

Oral prednisolone first line

31
Q

What is the treatment of severe UC?

A

IV hydrocortisone

32
Q

What is the treatment for Mild Crohns disease?

A

Oral prednisolone

33
Q

What is the treatment for severe Crohns disease?

A

IV hydrocortisone

w141 irritable bowel disease (1 decks)

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