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Z Year3 Gastro Conditions > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are two types of IBD?

A
  1. Crohn’s disease

2. Ulcerative Colitis

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2
Q

What are RF for CD?

A
  1. White
  2. FHx of CD
  3. 15-40year or 60-80years
  4. Smoking increases risk by 3-4times
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3
Q

What are causes of CD?

A

unknown

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4
Q

What is the defintion of Crohn’s disease?

A

A disease of unkown aetiology, characterised by TRANSMURAL inflammation of the GI tract that can affect any part from mouth to anus

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5
Q

What does transmural mean?

A

affects WHOLE THICKNESS of the GI layer

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6
Q

What sort of lesions are in Crohn’s?

A

skip

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7
Q

What are the most commonly affected areas for Crohn’s?

A
  1. Terminal ileum

2. Peri anal

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8
Q

What does the Crohn’s inflammation lead to?

A

ulceration to all layers affected to NON CEASTING Granuloma formation

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9
Q

What is the tissue like between the lesions in Crohn’s?

A

Tissue is healthy between lesions

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10
Q

What is the deinfiton of UC?

A

diffuse inflammation of colonic mucosa and relapsing remitting course

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11
Q

What areas of the gastro tract are affected by UC?

A

Only RECTUM + COLON

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12
Q

Where does UC start and extend?

A
  • Starts from the rectum
  • Extends proximally
  • Affects variable lengths of the colon
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13
Q

What layers of the bowel are affected in UC?

A

just mucosa (corhn’s affects all)

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14
Q

What are RF for UC?

A
  1. Fhx
  2. HLA-B27 positive
  3. Not-smoking
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15
Q

What is the cause of UC?

A

inappropriate immune response

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16
Q

What is the usual epi of UC?

A
  1. M>F
  2. Western Countries
  3. Bimodal Peak
    - 20-40 years
    - 60 years
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17
Q

What are the abdominal symptoms in Crohn’s?

A
  1. Abdominal pain
  2. Crampy or constant
  3. Right Lower Quadrant + Peri Umbilical (terminal ileum)
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18
Q

What is the diarrhoea like in Crohn’s?

A
  1. Mucus, Blood, Pus

2. Nocturnal sometimes

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19
Q

What are the perianal lesions like in Crohn’s?

A

skin tags, fistulae, absesses

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20
Q

What are general symptoms of Crohn’s?

A
  1. Fatigue
  2. Weight loss (as malnourished)
  3. Painful oral lesions
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21
Q

How common are extra-intestinal symptoms of Crohn’s?

A

20-40% have

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22
Q

What are examples of extraintestinal manifestations in Crohn’s?

A
  1. Arthropathy (joint pain)
  2. Skin lesions
  3. Occular symptoms
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23
Q

What skin lesions are in Crohn’s?

A
  1. Erythema nodosum

2. Pyoderma gangrenosum

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24
Q

What are the occular symptoms of Crohn’s?

A
  1. Uveitis

2. Episcleritis

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25
Q

What are the examination findings for Crohn’s?

A
  1. Abdominal tenderness / mass
    - lower right (terminal ileum)
  2. Oral exam:
    - Apthous ulcers
  3. Peri anal lesions:
    - Skin tags
    - Fistulae
    - Absesses
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26
Q

What are symptoms of UC?

A
  1. Bloody diarrhoea
  2. Rectal bleeding + mucus
  3. Abdominal pain + cramps
  4. Tenesmus
  5. Weight loss
  6. Clubbing
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27
Q

What are the joint extraintestinal manifestations of Crohn’s?

A
  1. Peripheral arthritis

2. Ankylosing spondylitis – HLA B27 gene

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28
Q

What are the skin extraintestinal manifestations of Crohn’s?

A
  1. Erythema nodosum

2. Pyoderma Gangrenosum

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29
Q

What are the eye extraintestinal manifestations of Crohn’s?

A

Episcleritis > Uveitis

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30
Q

What would you find on examination for UC?

A
  1. Anemia signs: pallor
  2. DRE: dross or occult blood comes out
  3. Abdominal tenderness
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31
Q

What are possible DDx for UC and CD?

A
  1. UC/CD
  2. Infectious colitis
  3. Pseudomembranous colitis
  4. Ischaemic colitis
  5. Radiation colitis
  6. IBS
32
Q

What bloods are ordered for Crohn’s?

A
  1. FBC
  2. Serum vitamin B12
  3. Serum folate
  4. Serum iron, ferritin, TIBC, transferrin saturation
  5. CMP: hypoalbuminaemia, hypocholesterolaemia, hypocalcaemia
  6. CRP and ESR: high
  7. Yersinia enterocolitica serology
33
Q

What would FBC show in Crohn’s?

A

anaemia; leukocytosis; may be thrombocytosis

34
Q

What would ESR and CRP be in Crohn’s?

A

high

35
Q

What imaging is done in Crohn’s?

A
  1. ABx
  2. Ct abdo
  3. MRI abdomen.pelvis
  4. Bowel series
  5. Colonscopy and biopsy
36
Q

What would plain Abx show in Crohn’s?

A

bowel dilation

37
Q

What would CT abdo show for Crohn’s?

A
  1. bowel wall thickening

2. skip lesions

38
Q

What would Bowel series ( Xray and barium enema) show in corhn’s?

A
  1. rose thorn ulcers = deep ulceration

2. string sign of Kantor = fibrosis + strictures

39
Q

What would the colonscopy show with biopsy in Crohn’s?

A
  1. Ulcers
  2. “cobblestone” appearance
  3. skip lesions
40
Q

What is the string sign of Kantor?

A

edema and/or fibrosis with ulcerated mucosa (resembling frayed string)

41
Q

What would histology of Crohn’s be?

A

transmural involvement with non-ceasating granulomas

42
Q

What do you need for UC?

A

endoscopy with biopsy and negative stool culture for diagnosis

43
Q

What bloods are done for UC?

A
  1. FBC
  2. Metabolic panel
  3. ESR
  4. CRP
  5. LFTS
  6. pANCA (70% positive)
44
Q

What would FBC show in UC?

A

anaemia, leukocytosis, or thrombocytosis

45
Q

What would ESR and CRP be like in UC?

A

high

46
Q

Why do you do LFTs in UC?

A

primary sclerositing cholangitis

47
Q

What would stool sample in UC show?

A

increased faecal calprotectin (indicates inflammation)

48
Q

What imaging is done for UC?

A
  1. Plain AXR
  2. Double contrast barium enema)
  3. Colonscopy and biopsy
  4. histology
49
Q

What would plain XRAY show in UC?

A
  1. dilated bowel (≧6cm = toxic megacolon)

2. “thumbprinting”

50
Q

What would double contrast barium enema show in UC?

A
  1. “lead pipe appearance”
  2. complete loss of haustral marking
  3. single is not sensitive enough
51
Q

What would colonscopy and biopsy show in UC?

A
  1. CONTINUOUS* erythema
    2, bleeding
  2. ulcers
52
Q

What would histology show in UC?

A
  1. Crypt abscesses

2. depletion of goblet cell mucin

53
Q

What is the aim of Corhn’s treatment?

A

induce and maintain remission and prevent relapse

54
Q

What is the medication order for treating Crohn’s?

A
  1. Steroids
  2. Immunomodulators
  3. Biological therapy
  4. Surgery
55
Q

What steroids can be given for Crohn’s?

A
  • (oral or IV +/- topical)
    2. Prednisolone
    3. Budesonide
56
Q

What immunomodulators are used in Crohn’s?

A
  • (oral or IV)
    1. Azathioprine
    2. Mercaptopurine
    3. Methotrexate
57
Q

What biological therapy can be given for Crohn’s?

A
  • IV
    1. Adalimumab
    2. Infliximab
    3. Vedolizumab
58
Q

What surgery can be offered to Crohn’s?

A

for severe remissions/presentation, refractory disease and obstructed pts

59
Q

What adjuncts are used in Crohn’s management?

A
  1. Nutritional therapy
  2. Perianal disease mx
  3. Smoking cessation
60
Q

What are the extra-intestinal manifestations of Crohn’s?

A

Require specific individualised management which may be best provided by a MDT

61
Q

What treatment is used for acute relapse/intial presentation of Crohn’s?

A

INTRAVENOUS administration (versus oral) for steroids + immunomodulator GIVEN IN acute relapse/ initial presentation

62
Q

What type of medication is Adalimumab, Infliximab?

A

TNF alpha inhibitors

63
Q

What type of medication if vedolizumab?

A

integrin receptor antagonsits

64
Q

What medications are used to maintain remission in Crohn’s?

A
  1. IMMUNOMODULATORS
    • Azathioprine, Mercaptopurine, Methotrexate
    • / - BIOLOGICS
      • Infliximab, Adalimumab, Vedolizumab
65
Q

What adjuncts are used to maintain remission in Crohn’s?

A
  1. Anti-spasmotics (cramp relief)

2. Anti-diarrhoeals

66
Q

What medications are used to induce remission in UC?

A
  1. MESALAZINE (5-ASA)
    - Oral / topical
  2. STEROIDS
    - Oral Beclamethasone
67
Q

What treatments are used to maintain remission in UC?

A
  1. Immunosuppresives
  2. Biologics (anti TNF alpha)
  3. Biologics (integrin receptor antagonsits)
  4. Ciclosporin
  5. Total colectomy
68
Q

What immunosuppresive are used to maintain remission in UC?

A
  1. Azathioprine

2. Mercaptopurine

69
Q

What anti TNF alpha biologics are used to maintain remission in UC?

A
  1. Infliximab

2. Adalimumab

70
Q

What integrin receptor antagonsits alpha biologics are used to maintain remission in UC?

A

Vedolizumab

71
Q

What sort of Drug is ciclosporin?

A

type of immunosuppresant

72
Q

Why would you do a total colectomy in UC?

A

cure

73
Q

What are examples of 5ASA?

A

Aminosalicylates — mesalazine and sulfasalazine may be considered for a mild-to-moderate first presentation

74
Q

What are possible complications of CD?

A
  1. Extraintestinal involvement
  2. Intestinal obstruction
  3. Abscess formation
  4. Sinuses
  5. Fistulae
  6. SBO
  7. Anaemia
  8. Toxic megacolon
  9. Perianal disease: 50%
75
Q

What are possible complications of UC?

A
  1. Colon adenocarcinoma: 3-5% patients
  2. Toxic megacolon
  3. Primary sclerosting cholangitis
  4. Perofration
  5. Infection
  6. Benign stricture

Z Year3 Gastro Conditions (48 decks)

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