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Alimentary > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is inflammatory bowel disease?

A

Chronic, relapsing, remitting inflammation of the GI tract

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2
Q

What are examples of inflammatory bowel disease?

A

Crohn’s disease

Ulcerative colitis

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3
Q

What do Crohn’s disease and ulcerative colitis differ in?

A

Location and inflammation

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4
Q

When does inflammatory bowel disease commonly present?

A

In the teens and twenties

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5
Q

What can IBD be due to?

A

Genome

Microbiome

Environment

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6
Q

Is IBD medelian inherited?

A

No, but has genetic susceptibility

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7
Q

What kind of genetic variation makes people genetically susceptible to IBD?

A

SNPs (single nucleotide polymorphisms)

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8
Q

What percentage of someones offspring who has IBD will also develop IBD?

A

10%

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9
Q

What do genes that cause inflammatory bowel disease regulate?

A

Epithelial barrier

Immune response

Bacterial handling

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10
Q

What is the pathogenesis of IBD?

A

Pathogenic gut causes altered microbiota

Damaged epithelial barrier increases bacterial adhesion and translocation

Chronic inflammation occurs

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11
Q

What is the ratio of microbial cells in the gut lumen to eukaryotic cells in the human body?

A

10:1

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12
Q

How many different species of bacteria are present in the gut?

A

At least 500 different species

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13
Q

What is the metabolic activity of all gut bacteria equivalent to?

A

That of the liver

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14
Q

What part of the gut contains the most bacteria?

A

Colon

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15
Q

What is different in the microbiota of people with IBD compared to those without?

A

In IBD there is a dysbosia in microbial communities

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16
Q

What kind of bacteria is massively more present in people with IBD than those who do not have it?

A

Proteobacteria

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17
Q

What is ulcerative colitis?

A

Chronic condition caused by inapropriate immune response against colonic flora in genetically susceptible people

It affects the colon and rectum

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18
Q

How does ulcerative colitis affect males compared to females?

A

Both affected the same

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19
Q

What are symptoms of ulcerative colitis?

A

Episodic / chronic diarrhoea

+/- blood and mucous

crampy abdominal discomfort

bowel movement frequency is related to severity

systemic symptoms - fever, malaise, anorexia, decreased weight

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20
Q

What is the pathology of ulcerative colitis?

A

Haemorrhagic colon mucosa +/- pseudopolyps formed by inflammation = limited to the mucosa

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21
Q

What is in the histology of ulcerative colitis?

A

mucosal

goblet cells are depleted

crypt abcesses are more likely

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22
Q

What investigations are done for ulcerative colitis?

A

Bloods for markers of inflammation

Stool culture to rule out infection = c.diff

Faecal calprotectin = released into intestines when inflammation is present

Colonoscopy/sigmoidoscopy and colon mucosal biopsies = assess disease severity

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23
Q

What are examples of markers of inflammation checked for in ulcerative colitis?

A

Normocytic anaemia

Increased CPR/platelets

Low albumin

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24
Q

What is considered normal faecal calprotectin?

A

<50ug/g of stool

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25
Q

What is considered elevated faecal calprotectin?

A

>200ug/g of stool

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26
Q

What is faecal calprotectin?

A

Substance that is released into the intestines when inflammation is present

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27
Q

Where in the GI tract is inflammation due to ulcerative colitis present?

A

Only in the colon, starting at the rectum and working proximally

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28
Q

What percentage of people with ulcerative colitis require a colectomy within 10 years of diagnosis?

A

20-30%

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29
Q

What are the different levels of severity of ulcerative colities?

A

Mild

Moderate

Severe

Fulminant

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30
Q

What are characteristics of mild ulcerative colitis?

A

<4 stools/day

With or without blood

Normal ESR

No signs of toxicity

31
Q

What are characteristics of moderate ulcerative colitis?

A

4-6 stools/day

Occasional blood

Minimal signs of toxicity

CRP less than or equal to 30mg/L

32
Q

What are characteristics of severe ulcerative colitis?

A

More than or equal to 6 blood stools/day

AND any of:

temperature > 37.8

tachycardia > 90bpm

anaemia (Hb < 105g/L)

ESR > 30mm/h, CRP > 30mg/L

33
Q

What are characteristics of fulminant colitis?

A

10 stools/day

Continuous bleeding

Toxicity

Abdominal tenderness or distention

Transfusion requirement

Colonic dilation on x-ray

34
Q

What is proctitis?

A

Condition where lining of tissue in inner rectum becomes inflammed

35
Q

What is stool like with proctitis?

A

Frequency, urgency, incontinence

Small volume mucus, blood

Constipation

36
Q

What does proctitis respond to?

A

Topical therapy

37
Q

What percentage of mortality does acute severe colitis have?

A

2%, very serious condition

38
Q

What percentage of people with acute severe colitis get an emergency colectomy at admission?

A

20-30%

39
Q

What do patients with acute severe colitis often look like?

A

Well

Self-caring

Mobilising around ward

Often young with physiogical reserve

40
Q

What is the main differential of acute severe colitis?

A

Infection

41
Q

What must be done within the first 24 hours of a patient being admitted with acute severe colitis?

A

IV glucocorticosteroids

LMWH

Abdomen x-ray

IV hydration

Stop non-steroidal analgesics, opiates, anti-diarrhoels, anti-cholinergics

Stool chart

Stool culture for C. Difficile

42
Q

Why are patients with acute severe colitis given LMWH?

A

They are at 3x increased risk of thromboembolism

43
Q

What is Crohn’s disease?

A

Inflammatory disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus - there is unaffected parts of bpwel between areas of active disease

44
Q

What is the pathology of crohn’s disease?

A

Mesentry thickening

oedomatous or fibrosis

narrowing of lumen

ulceration = cobblestone effect

45
Q

What is the histology of crohn’s disease?

A

Granulomatous

Transmural inflammation

46
Q

Where can Crohn’s disease occur?

A

Anywhere in the GI tract from mouth to anus

Patchy disease (skip lesions)

Clinical features depend on regions involved

47
Q

What are possible complications of Crohn’s disease?

A

Small bowel obstruction

Toxic dilation

Abcess formation

Fistulae

Colonic Cancer

48
Q

What are clinical features of Crohn’s disease?

A

Episodic abdominal pain = colicky

Diarrhoea

Systemic symptoms - fatigue, malaise, fever, anorexia, decreased weight loss, malabsorption, malnutrition

Oral and perianal involvement - oral aphthous ulcers, perianal abcess

49
Q

What investigations are done for Crohn’s disease?

A

Blood for markers of inflammation

Stool culture to rule out infection if dirrhoea

Faecal calprotectin

Colonoscopy with terminal ileum intubation and colon mucosal biopsies

MRI small bowel study

Capsule endoscopy

Occasionally CT if acutely unwell and want to rule out complications such as abscess

50
Q

What are differences in the histology of Crohn’s disease and ulcerative colitis?

A

Granulomas in CD

Transmural inflammation in CD

Mucosal in UC

Goblet cells depleted in UC

Crypt abscesses more likely in UC than CD

51
Q

What does PCD stand for?

A

Perianal Crohn’s disease

52
Q

What is perianal Crohn’s disease?

A

Inflammation at or near the anus

53
Q

What are symptoms of perianal Crohn’s disease?

A

Perianal pain

Pus secretion

Unable to sit down

54
Q

What investigations are done for perianal Crohn’s disease?

A

MRI pelvis

Examination under anaesthetic

55
Q

What is the treatment for perianal Crohn’s disease?

A

Surgery to drain abscess

Antibiotics and biological therapy (anti-TNF)

56
Q

What must be considered by IBD differential diagnosis?

A

Chronic diarrhoea

Ileocaecal TB

Colitis must also be distinguished from infective and amoebic and ischaemic colitis

57
Q

What does chronic diarrhoea cause?

A

Malabsorption

Malnutrition

58
Q

What is a possible long term complication of colitis?

A

Colonic carcinoma

59
Q

How do different kinds of colitis change the risk of colonic carcinoma?

A

Pancolitis 26x normal

Left colitis 6x normal

Proctitis minimal

60
Q

What is done for IBD management?

A

Colorectal surgeon with IBD specialist interest

Weekly IBD MDT

Dedicated colonoscopy lists for surveillance

Direct communication between GP and consultant

IBD specialist nurse telephone hotline

Nurse led infusion clinic every 3 weeks

IBD pharmacist

61
Q

What kind of approach does management of IBD use?

A

Step up approach

62
Q

What medication is given to treat Crohn’s disease by reducing inflammation?

A

Aminosalicylates

63
Q

What are aminosalicylates?

A

Family of medications with various formulations that deliver active ingredient, mesalamine, to target sites

64
Q

What is the abbreviation for aminosalicylates?

A

5-ASA

65
Q

How do amionsalicylates work?

A

Blocking prostaglandins and leukotrienes

66
Q

Is 5ASA effective with both ulcerative colities and Crohn’s disease?

A

No, only with ulcerative colitis

67
Q

When is rectal 5-ASA given?

A

For distal and left sided Crohn’s disease

68
Q

What do steroids induce in Crohn’s disease and ulcerative colitis?

A

Remission

69
Q

What are examples of steroids used to IBD?

A

Prednisolone

Budenoside

70
Q

What is an example of an immunomodulation therapy for IBD?

A

Azathioprine

71
Q

What are side effects of azithioprine?

A

Leucopenia

Hepatotoxicity

Pancreatitis

72
Q

What biological agents are used for IBD?

A

Anti-ANFa antibodies

A4b7 integrin blockers

73
Q

Explain each of the steps up in management of IBD?

A

1) 5-ASA
2) Steroids (prednisone or budesonide)
3) Immunomodulators
4) Biologic agents
5) Surgery

Alimentary (2 decks)

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