Inflammatory Bowel Disease Flashcards
1
Q
What are two types of IBD?
A
- Crohn’s disease
2. Ulcerative Colitis
2
Q
What are RF for CD?
A
- White
- FHx of CD
- 15-40year or 60-80years
- Smoking increases risk by 3-4times
3
Q
What are causes of CD?
A
unknown
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
5
Q
What does transmural mean?
A
affects WHOLE THICKNESS of the GI layer
6
Q
What sort of lesions are in Crohn’s?
A
skip
7
Q
What are the most commonly affected areas for Crohn’s?
A
- Terminal ileum
2. Peri anal
8
Q
What does the Crohn’s inflammation lead to?
A
ulceration to all layers affected to NON CEASTING Granuloma formation
9
Q
What is the tissue like between the lesions in Crohn’s?
A
Tissue is healthy between lesions
10
Q
What is the deinfiton of UC?
A
diffuse inflammation of colonic mucosa and relapsing remitting course
11
Q
What areas of the gastro tract are affected by UC?
A
Only RECTUM + COLON
12
Q
Where does UC start and extend?
A
- Starts from the rectum
- Extends proximally
- Affects variable lengths of the colon
13
Q
What layers of the bowel are affected in UC?
A
just mucosa (corhn’s affects all)
14
Q
What are RF for UC?
A
- Fhx
- HLA-B27 positive
- Not-smoking
15
Q
What is the cause of UC?
A
inappropriate immune response
16
Q
What is the usual epi of UC?
A
- M>F
- Western Countries
- Bimodal Peak
- 20-40 years
- 60 years
17
Q
What are the abdominal symptoms in Crohn’s?
A
- Abdominal pain
- Crampy or constant
- Right Lower Quadrant + Peri Umbilical (terminal ileum)
18
Q
What is the diarrhoea like in Crohn’s?
A
- Mucus, Blood, Pus
2. Nocturnal sometimes
19
Q
What are the perianal lesions like in Crohn’s?
A
skin tags, fistulae, absesses
20
Q
What are general symptoms of Crohn’s?
A
- Fatigue
- Weight loss (as malnourished)
- Painful oral lesions
21
Q
How common are extra-intestinal symptoms of Crohn’s?
A
20-40% have
22
Q
What are examples of extraintestinal manifestations in Crohn’s?
A
- Arthropathy (joint pain)
- Skin lesions
- Occular symptoms
23
Q
What skin lesions are in Crohn’s?
A
- Erythema nodosum
2. Pyoderma gangrenosum
24
Q
What are the occular symptoms of Crohn’s?
A
- Uveitis
2. Episcleritis
25
What are the examination findings for Crohn's?
1. Abdominal tenderness / mass
- lower right (terminal ileum)
2. Oral exam:
- Apthous ulcers
3. Peri anal lesions:
- Skin tags
- Fistulae
- Absesses
26
What are symptoms of UC?
1. Bloody diarrhoea
2. Rectal bleeding + mucus
3. Abdominal pain + cramps
4. Tenesmus
5. Weight loss
6. Clubbing
27
What are the joint extraintestinal manifestations of Crohn's?
1. Peripheral arthritis
| 2. Ankylosing spondylitis – HLA B27 gene
28
What are the skin extraintestinal manifestations of Crohn's?
1. Erythema nodosum
| 2. Pyoderma Gangrenosum
29
What are the eye extraintestinal manifestations of Crohn's?
Episcleritis > Uveitis
30
What would you find on examination for UC?
1. Anemia signs: pallor
2. DRE: dross or occult blood comes out
3. Abdominal tenderness
31
What are possible DDx for UC and CD?
1. UC/CD
2. Infectious colitis
3. Pseudomembranous colitis
4. Ischaemic colitis
5. Radiation colitis
6. IBS
32
What bloods are ordered for Crohn's?
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
What would FBC show in Crohn's?
anaemia; leukocytosis; may be thrombocytosis
34
What would ESR and CRP be in Crohn's?
high
35
What imaging is done in Crohn's?
1. ABx
2. Ct abdo
3. MRI abdomen.pelvis
4. Bowel series
5. Colonscopy and biopsy
36
What would plain Abx show in Crohn's?
bowel dilation
37
What would CT abdo show for Crohn's?
1. bowel wall thickening
| 2. skip lesions
38
What would Bowel series ( Xray and barium enema) show in corhn's?
1. rose thorn ulcers = deep ulceration
| 2. string sign of Kantor = fibrosis + strictures
39
What would the colonscopy show with biopsy in Crohn's?
1. Ulcers
2. “cobblestone” appearance
3. skip lesions
40
What is the string sign of Kantor?
edema and/or fibrosis with ulcerated mucosa (resembling frayed string)
41
What would histology of Crohn's be?
transmural involvement with non-ceasating granulomas
42
What do you need for UC?
endoscopy with biopsy and negative stool culture for diagnosis
43
What bloods are done for UC?
1. FBC
2. Metabolic panel
3. ESR
4. CRP
5. LFTS
6. pANCA (70% positive)
44
What would FBC show in UC?
anaemia, leukocytosis, or thrombocytosis
45
What would ESR and CRP be like in UC?
high
46
Why do you do LFTs in UC?
primary sclerositing cholangitis
47
What would stool sample in UC show?
increased faecal calprotectin (indicates inflammation)
48
What imaging is done for UC?
1. Plain AXR
2. Double contrast barium enema)
3. Colonscopy and biopsy
4. histology
49
What would plain XRAY show in UC?
1. dilated bowel (≧6cm = toxic megacolon)
| 2. “thumbprinting”
50
What would double contrast barium enema show in UC?
1. “lead pipe appearance”
2. complete loss of haustral marking
3. single is not sensitive enough
51
What would colonscopy and biopsy show in UC?
1. CONTINUOUS* erythema
2, bleeding
3. ulcers
52
What would histology show in UC?
1. Crypt abscesses
| 2. depletion of goblet cell mucin
53
What is the aim of Corhn's treatment?
induce and maintain remission and prevent relapse
54
What is the medication order for treating Crohn's?
1. Steroids
2. Immunomodulators
3. Biological therapy
4. Surgery
55
What steroids can be given for Crohn's?
- (oral or IV +/- topical)
2. Prednisolone
3. Budesonide
56
What immunomodulators are used in Crohn's?
- (oral or IV)
1. Azathioprine
2. Mercaptopurine
3. Methotrexate
57
What biological therapy can be given for Crohn's?
- IV
1. Adalimumab
2. Infliximab
3. Vedolizumab
58
What surgery can be offered to Crohn's?
for severe remissions/presentation, refractory disease and obstructed pts
59
What adjuncts are used in Crohn's management?
1. Nutritional therapy
2. Perianal disease mx
3. Smoking cessation
60
What are the extra-intestinal manifestations of Crohn's?
Require specific individualised management which may be best provided by a MDT
61
What treatment is used for acute relapse/intial presentation of Crohn's?
INTRAVENOUS administration (versus oral) for steroids + immunomodulator GIVEN IN acute relapse/ initial presentation
62
What type of medication is Adalimumab, Infliximab?
TNF alpha inhibitors
63
What type of medication if vedolizumab?
integrin receptor antagonsits
64
What medications are used to maintain remission in Crohn's?
1. IMMUNOMODULATORS
• Azathioprine, Mercaptopurine, Methotrexate
2. + / - BIOLOGICS
• Infliximab, Adalimumab, Vedolizumab
65
What adjuncts are used to maintain remission in Crohn's?
1. Anti-spasmotics (cramp relief)
| 2. Anti-diarrhoeals
66
What medications are used to induce remission in UC?
1. MESALAZINE (5-ASA)
- Oral / topical
2. STEROIDS
- Oral Beclamethasone
67
What treatments are used to maintain remission in UC?
1. Immunosuppresives
2. Biologics (anti TNF alpha)
3. Biologics (integrin receptor antagonsits)
4. Ciclosporin
5. Total colectomy
68
What immunosuppresive are used to maintain remission in UC?
1. Azathioprine
| 2. Mercaptopurine
69
What anti TNF alpha biologics are used to maintain remission in UC?
1. Infliximab
| 2. Adalimumab
70
What integrin receptor antagonsits alpha biologics are used to maintain remission in UC?
Vedolizumab
71
What sort of Drug is ciclosporin?
type of immunosuppresant
72
Why would you do a total colectomy in UC?
cure
73
What are examples of 5ASA?
Aminosalicylates — mesalazine and sulfasalazine may be considered for a mild-to-moderate first presentation
74
What are possible complications of CD?
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
What are possible complications of UC?
1. Colon adenocarcinoma: 3-5% patients
2. Toxic megacolon
3. Primary sclerosting cholangitis
4. Perofration
5. Infection
6. Benign stricture
