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ICC2 > inflammatory bowel disease > Flashcards

inflammatory bowel disease Flashcards

1
Q

what are the two main types of IBD ?

A

crohns and ulcerative colitis

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2
Q

what is the main aetiology of IBD ?

A

genetic susceptibility HLA-B27
host immune response
environmental factors

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3
Q

what areas of the gut are affected by Crohns disease ?

A

any part of the GI tract especially the terminal ileum and ascending colon

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4
Q

which IBD is known for having skip lesions?

A

Crohns disease

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5
Q

where is the affection of ulcerative colitis ?

A

can affect the rectum alone (procititis) and can extend proximally to involve the sigmoid and descending colon (left-sided colitis) or may involve the whole colon

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6
Q

what is backwash colitis ?

A

due to severity of inflammation towards the ileum the inflammation goes backwards into the ileum but in very severe cases of ulcerative colitis

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7
Q

what does Crohns look like on endoscope ?

A

apthoid ulcers along with cobblestone appearance

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8
Q

what does ulcerative colitis look like on endoscopy ?

A

inflammatory polyps ( superficial inflammation )

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9
Q

what is fulimant colonic disease ?

A

when ulcerative colitis progresses and affects all the layers of the mucosa

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10
Q

what are the microscopic features of crohns disease ?

A

transmural
lymphoid hyperplasia
granuloma

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11
Q

what are the microscopic features of ulcerative colitis ?

A

superficial inflammation
crypt abscess
goblet cell depletion

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12
Q

what are the extra gastrointestinal manifestations of IBD?

A

joints especially sacro-illiac and the knees
eyes uveitis
skin pyoderma gangrenosum erythema nodosum
liver primary sclerosing cholangitis

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13
Q

what are the clinical features of Crohn’s disease ?

A

diarrhea , abdominal pain and weight loss
constitutional symptoms
steatorrhea due to malabsorption
anal and perianal diseases

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14
Q

what investigations would be required for crohn’s disease ?

A 
CBC - shows normocytic normochromic anemia 
iron deficiency 
raised ESR , CRP 
hypoalbuminemia 
CT 
faecal calprotectin
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15
Q

what is the cause of the hypoalbuminemia ?

A

is a negative phase reactant so it decreases with inflammation
and inn cholitis there is a loss of protein

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16
Q

which serological investigation is for each IBD ?

A

ulcerative colitis - ANCA +ve

Crohns disease - ASCA +ve

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17
Q

what imaging would be required for the imaging of the small intestine ?

A

MRI

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18
Q

why would we use CT in an IBD patient ?

A

to look for abscess and perforation

19
Q

what is faecal calprotectin ?

A

calprotectin is an inflammatory marker specific to the gut

and is raised in cases of IBD and is very high in colorectal cancer

20
Q

what is the general treatment approach in CD ?

A

induce then maintain a remission
cigarrette smoking should be stopped
we provide symptomatic treatment- loperamide
anemia due to B12 deficiency/folic acid or iron deficiency

21
Q

what are the two approaches of management for Crohns disease ?

A

step down approach

step up approach

22
Q

what are the medications used for the induction phase in Crohns disease ?

A

steroids along with azathioprine ( by the time azathioprine works it reaches the maintenance phase)

23
Q

what are the medications for the maintenance of remission in Crohns disease ?

A

give immunosuppressive therapy :

azathioprine
mycophenolate

24
Q

what is an alternative method to induce remission inn crohns patients ?

A

enteral nutrition

25
Q

what are the possible side effects of mycophenolate ?

A

leucopenia

26
Q

what is the best management for patients with immunosuppressive therapy resistant crohns disease ?

A

methotrexate or IV cyclosporine which is effective in inducing remission but not maintaining it

27
Q

When are biological treatments indicated ?

A

when the patient suffers from :

  • fistulas
  • abscess
  • colorectal cancer
28
Q

when are biological treatments contraindicated?

A

when there is a latent infections such as :
TB
HBV

29
Q

what are the clinical features of ulcerative colitis ?

A

diarrhea with blood and mucus which is sometimes accompanied by lower abdominal pain
general features of fatigue

30
Q

when do we say that the patient is suffering from an acute attack of ulcerative colitis ?

A 
stool frequency of more than t6 times with blood 
fever above 37.5 
tachycardia 
elevated ESR 
anemia less than 10 hb 
albumin less than 30
31
Q

what investigations would be required for ulcerative colitis ?

A

full CBC- elevated ESR and CRP, anemia,
positive for pANCA
stool cultures should always be performed

32
Q

why should a stool culture be performed in ulcerative colitis patients ?

A

to exclude infective cause of colitis

33
Q

what imaging modality could be used for ulcerative colitis ?

A

a plain abdominal X-ray with an abdominal ultrasound are the key investigations

34
Q

how can the extent of the disease be judged in ulcerative colitis ?

A

by the air distribution in the colon and the presence of colonic dilatation

35
Q

when should you avoid performing a colonoscopy ?

A

in severe attacks of the disease for fear of perforation

36
Q

what should be maintained with patients that have had ulcerative colitis for more than 10 years ?

A

colonoscopy and multiple biopsy to exclude biopsy

37
Q

what should patients with ulcerative colitis be treated with ?

A

5-ASA

38
Q

where is 5-ASA absorbed ?

A

in the small intestine so patients who have affection of the small intestine cannot take 5-ASA

39
Q

what is the management inn proctitis ?

A

oral aminosalicylates plus a local rectal steroid preparation

40
Q

what is composition of the local rectal steroid preparation for ulcerative colitis ?

A

10% hydrocortisone foam

predinsolone 20mg enemas or foam

41
Q

in moderate or severe attacks of ulcerative colitis what is the best management option ?

A

patient should be admitted to the hospital and treated initially with hydrocortisone 100 mg

42
Q

when is surgery required for toxic dilatation ?

A

if it hasn’t revolved inn 48 hours

43
Q

what are the three types of remission ?

A

clinical remission
histological remission
colonoscopic remission

ICC2 (42 decks)

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