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Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is IBD? 2 Main conditions?

A

Chronic inflammation of the bowel with a relapsing-remitting disease course. Consists of Crohn’s Disease (CD) and Ulcerative Colitis (UC)

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2
Q

Which part of the bowel is commonly affected in Crohns?

A

Terminal ileus

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3
Q

Cause of IBD?

A

Unknown. Believed to be a mixture of genetics, immune system and environment.

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4
Q

Classical presentation of Crohns? (4)

A
  • weight loss
  • abdominal pain
  • low grade fever
  • diarrhoea
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5
Q

Which IBD is more likely to cause bloody diarrhoea?

A

Ulcerative Colitis

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6
Q

Skin extra-intestinal manifestations in IBD? (2)

A 
Erythematus nodosum (painful purple/red nodules on shins) 
Pyoderma gangrenosum (nodules full of pus with black edges)
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7
Q

Musculoskeletal extra-intestinal manifestations in IBD? (1)

A

IBD/enteropathic arthritis - peripheral or Ankylosing spondylitis

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8
Q

Eyes extra-intestinal manifestations in IBD? (3) Which ones are most common in Crohns and UC?

A

Uveitis (more common in UC)
Episcleritis (more common in Crohns)
Conjunctivitis

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9
Q

Which is more common - Crohns or UC?

A

Ulcerative Colitis

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10
Q

Mouth extra-intestinal manifestations in IBD?

A

Aphthous ulcers

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11
Q

Hepatobilliary extra-intestinal manifestations in IBD?

A

Primary Sclerosing Cholangitis

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12
Q

Gold standard for the diagnosis of IBD?

A

Colonoscopy and biopsy

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13
Q

Macroscopic changes in Crohns? (3)

A
  1. Cobblestone appearance
  2. Skip lesions
  3. fistula formation
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14
Q

Which of the 2 diseases causes a continuous inflammatory pattern?

A

UC

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15
Q

Which of the 2 diseases causes a intermittent inflammatory pattern (skip lesions)?

A

Crohn’s disease

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16
Q

Which of the 2 diseases causes a transmural disease?

A

Crohn’s

17
Q

Which of the 2 diseases only affects the mucosa?

A

UC

18
Q

Which of the 2 diseases can affect the entire GI tract (from mouth to anus)?

A

Crohn’s

19
Q

Bedside investigations for IBD?

A
  1. obs
  2. stool culture (MSC, ova, cysts, parasites, C.diff toxin)
  3. urinalysis
  4. Faecal calprotectin
  5. ECG
20
Q

Bloods for IBD?

A

FBC, CRP, U&E, LFTs, Haematinics, Bone profile, clotting

21
Q

What can an Abdo X-ray show in Crohns?

A

Bowel wall thickening, perforation, free-fluid

22
Q

What can an Abdo X-ray show in UC?

A

Perforation, dilatation

23
Q

What are we particularly worried about if a patient with UC comes in with severe abdo pain, distension and systemically unwell?

A

Toxic megacolon

24
Q

Management to induce remission in Crohns? (4)

A
  1. Exclusive Enteric Nutrition
  2. Budesonide
  3. Systemic Steroids (e.g. Prednisolone)
    Severe - Azathioprine, Methotrexate or Biologics
25
Q

Management to maintain remission in Crohns?

A
  1. Thiopurines (e.g. Azathioprine)
  2. Methotrexate
  3. Biologics - monoclonal antibodies (e.g. Infliximab)
26
Q

What test must you do before starting Azathioprine (and other thiopurines?)

A

TMTP enzyme

27
Q

Classical presentation of UC? (6)

A 
Bloody diarrhoea 
Abdominal pain 
Bowel distension 
Weight loss 
Febrile 
Tenesmus/Urgency
28
Q

Which part of the bowel is commonly affected in UC?

A

Rectum (proctitis)

29
Q

Management to induce remission in UC?

A
  1. 5- ASA (e.g. mesalazine, sulphasalazine)
  2. Steroids (e.g. Prednisolone)
  3. Biologics
    Severe - IV Hydrocortison or IV Ciclosporin
30
Q
  1. How is the 5-ASA delievered in patients with a localised rectum inflammation (proctitis) in UC?
  2. How is it delivered if they have pancolitis or left sided colitis?
A
  1. suppository only

2. suppository and orally

31
Q

Management to maintain remission in UC? (3)

A
  1. Thiopurines
  2. Biologics
  3. 5-ASA may be continued if used to induce
32
Q

Complications of UC? (4)

A
  1. Toxic megacolon
  2. Colorectal cancer
  3. Osteoporosis (malabsorption)
  4. Pouchitis (from ileoanal anastomosis/J pouch)
33
Q

Complications of Crohn’s? (6)

A
  1. Fistulas
  2. strictures
  3. vitamin b12 (malabsorption due to terminal ileitis)
  4. osteoporosis (malabsorption)
  5. renal stones (high oxalate due to calcium malabsorption)
  6. Colorectal cancer
34
Q

Surgery that is used in UC? What can be made (2)?

A
  1. Proctocolectomy

2. End ileostomy or Ileoanal anastomosis (J-pouch)

35
Q

Which of the 2 diseases commonly present with perianal disease?

A

Crohn’s

36
Q

What type of perianal disease can patients with Crohn’s present with?

A
  1. fistula
  2. abscess
  3. anal canal stenosis
  4. fissures
37
Q

Complication in patients who have undergone ileo-anal anastomosis (J-pouch)?

A

Pouchitis

38
Q

Severity scoring tool used in UC? What factors does it look at?

A
  1. Truelove and Witts

2. Number of bowel motions, amount of blood in stools

Gastrointestinal (9 decks)

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