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Inflammatory Bowel Disease Flashcards

1
Q

What is inflammatory bowel disease?

A

chronic recurring inflammation secondary to abnormal prolonged immune response to a normal stimulus in genetically susceptible individuals

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2
Q

What is the cause of Crohn’s disease?

A

immune dysregulation and dysbiosis which promotes chronic inflammation, the ultimate cause of which is not fully understood

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3
Q

what are the risk factors for crohn’s disease?

A
  1. active and passive smoking of tobacco
  2. familial aggregation
  3. genetic predisposition - NOD2 gene
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4
Q

What are skip lesions?

A

pattern of patchy, discontinuous inflammation in the bowel

affected areas interspersed with normal tissue

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5
Q

What is the pathology of crohn’s disease? (4)

A
  1. skip lesions
  2. creeping fat
  3. hypertrophic lymph nodes
  4. transmural inflammation
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6
Q

What are the histological characteristics of crohn’s disease?

A
  1. noncaseating granulomas
  2. giant cells
  3. distinct lymphoid aggregates of the lamina propria
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7
Q

What are the constitutional symptoms of crohn’s disease? (3)

A
  1. low grade fever
  2. weight loss
  3. fatigue
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8
Q

What are the intestinal symptoms of crohn’s disease? (6)

A
  1. chronic diarrhoea - nonbloody
  2. abdominal pain - typically in the right lower quadrant
  3. malabsorption
  4. palpable abdominal mass in the right lower quadrant
  5. enterocutaneous perianal fistulas
  6. oral aphthae
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9
Q

Where does crohn’s disease typically manifest?

A

in the terminal ileum

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10
Q

What are the joint manifestations of crohn’s disease?

A

enteropathic arthritis

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11
Q

what are the manifestations of crohn’s disease in the eyes? (3)

A
  1. uveitis
  2. Iritis
  3. episcleritis
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12
Q

What are the manifestations of crohn’s disease in the liver/bile ducts?

A

cholelithiasis

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13
Q

Why does crohn’s disease cause cholelithiasis?

A

Due to malabsorption, the bile acid for lipid digestion is lost, increased cholesterol concentration promotes stone formation

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14
Q

What are the manifestations of crohn’s disease in the urogenital system?

A

urolithiasis

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15
Q

What does a crohn disease activity index (CDAI) score of 0-149 indicate?

A

asymptomatic remission

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16
Q

What does a crohn disease activity index (CDAI) score of 150-220 indicate?

A

low to moderate activity

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17
Q

What does a crohn disease activity index (CDAI) score of 221-450 indicate?

A

moderate to high activity

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18
Q

What does a crohn disease activity index (CDAI) score of 451-1100 indicate?

A

high activity, fulminant disease

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19
Q

How is crohn’s disease diagnosed? (3)

A
  1. coloscopy
  2. gastroscopy
  3. x ray of small intesting
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20
Q

How is crohn’s disease monitored?

A
  1. ultrasound

2. CT

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21
Q

What is the pathophysiology of crohn’s disease?

A

mediated by dysfunctional IL-23-Th17 signalling

22
Q

What is the pathophysiology of ulcerative colitis?

A

mediated by Th2 cells

23
Q

What is the frequency and characteristics of defaecation in crohn’s disease? (2)

A
  1. increased defaecation

2. typically nonbloody, watery diarrhoea

24
Q

What is the frequency and characteristics of defaecation in ulcerative colitis? (4)

A
  1. greatly increased
  2. bloody diarrhoea with mucous
  3. tenesmus
  4. urgency
25
Q

What is the nutritional status of someone with crohn’s disease?

A

poor or malnurished

26
Q

what is the nutritional status of someone with ulcerative colitis?

A

mostly normal

27
Q

What is seen on physical examination of someone with crohn’s disease? (3)

A
  1. mostly constant pain in right lower quadrant
  2. palpable abdominal mass
  3. low grade fever
28
Q

What is seen on physical examination of someone with ulcerative colitis? (4)

A
  1. painful defaecation located in left lower quadrant
  2. abdominal cramps and tenderness
  3. tachycardia
  4. orthostatic hypotension
29
Q

What are the extraintestinal manifestations unique to crohn’s disease? (2)

A
  1. nephrolithiasis

2. cholelithiasis

30
Q

What are the extraintestinal manifestations unique to ulcerative colitis?

A

primary sclerosing cholangitis

31
Q

What are the extraintestinal manifestations common to crohn’s disease and ulcerative colitis? (7)

A
  1. pyoferma gangrenosum
  2. erythema nodosum
  3. uveitis
  4. episcleritis
  5. aphthous stomatitis
  6. peripheral arthritis
  7. spondylitis
32
Q

What are fistulas like in crohn’s disease?

A
  1. common to skin, bladder or in between loops

2. may cause pneumaturia and/or recurrent UTIs

33
Q

What are fistulas like in ulcerative colitis?

34
Q

What are the complications of crohn’s disease?

A
  1. abscess
  2. strictures
  3. perianal fissures
35
Q

What are the complications of ulcerative colitis?

A
  1. fulminant colitis
  2. toxic megacolon
  3. perforation
36
Q

What is the cancer risk common to CD and UC? (2)

A
  1. increased due to underlying pathology

2. increased secondary to immunosuppression

37
Q

What type of cancer is associated with crohn’s disease? (3)

A
  1. small intestine
  2. colon
  3. non-hodgkin lymphoma
38
Q

What type of cancer is associated with ulcerative colitis? (2)

A
  1. cholangiocarcinoma

2. colorectal cancer

39
Q

What antibodies are associated with crohn’s disease?

A

anti-saccharomyces cerevisiae antibodies (ASCA)

40
Q

What antibodies are associated with ulcerative colitis?

A

Myeloperoxidase antineutrophil cytoplasmic antibody (p-ANCA)

41
Q

Where is crohn’s disease located?

A
  1. terminal ileum and colon with rectal sparing

2. may affect the entire GI tract

42
Q

where is ulcerative colitis located?

43
Q

What is the pattern of inflammation seen with crohn’s disease?

A

discontinuous

skip lesions

44
Q

What is the pattern of inflammation seen with ulcerative colitis?

A

continuous

45
Q

What is the typical diagnostic findings with crohn’s disease? (5)

A
  1. cobblestone sign
  2. pinpoint lesions
  3. snail trails
  4. creeping fat
  5. string sign
46
Q

What is the typical diagnostic findings with ulcerative colitis? (4)

A
  1. friable mucosa
  2. mucosal ulcerations - deep or superficial
  3. crypt abscesses
  4. loss of haustra - led pipe sign
47
Q

What is the histology of crohn’s disease? (4)

A
  1. transmural inflammation
  2. noncaseating granulomas
  3. giant cells
  4. lymphoid aggregates
48
Q

What is the histology of ulcerative colitis? (2)

A
  1. confined to mucosa and submucosa

2. no granulomas

49
Q

What is the medication used to treat crohn’s disease? (4)

A
  1. corticosteroids
  2. thiopurine analogues
  3. anti-p40 antibodies
  4. alpha 4 integrase inhibitors
50
Q

What is the medication used to treat ulcerative colitis?

A
  1. 5-aminosalicylic acid
  2. 6-mercaptopurine
  3. calcineurin inhibitors
51
Q

What surgical treatment is used for crohn’s disease?

A

noncurative surgery can be used to alleviate symptoms

52
Q

What surgical treatment is used for ulcerative colitis?

A

curative surgery possible

proctocolectomy

GI/GU Illness (15 decks)

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