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Inflammatory Bowel Disease Flashcards

1
Q

What is IBD?

A

Chronic, relapsing and remitting inflammation of the GI tract

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2
Q

What are the 2 main types of IBD?

A

Ulcerative Colitis
Chron’s disease

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3
Q

How do UC and CD differ?

A

Differ in type and location of inflammation

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4
Q

What is IBD-U?

A

Unclassified. Isolated colonic IBD where the diagnosis remains unnkown.

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5
Q

What is microscopic colitis?

A

A type of IBD that can only be seen under the microscope

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6
Q

What are 2 types of microscopic colitis?

A

Collagenous colitis
Lymphocytic colitis

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7
Q

What is the cause of IBD?

A

Inappropriate immune response against colonic flora in genetically susceptible individuals

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8
Q

What is UC?

A

A relapsing and remitting inflammatory disorder of the colonic mucosa

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9
Q

What is proctitis?

A

Inflammation of the rectum only

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10
Q

What is proctosigmoiditis?

A

Inflammation of the rectum and sigmoid

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11
Q

What is left sided colitis?

A

Inflammation up to the splenic flexure?

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12
Q

What is extensive colitis?

A

Inflammation up to the hepatic flexure?

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13
Q

What is pancolitis?

A

Inflammation of the entire colon

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14
Q

What is the pathology of UC?

A

Large bowel only
Continuous pattern of inflammation
Rectum to proximal
Pseudo polyps
Ulceration
Limited to mucosa

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15
Q

What are the symptoms of UC?

A

Bloody/mucus diarrhoea
Abdominal pain
Urgency/tenesmus (Proctitis)
Weight loss
Fatigue
Fever

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16
Q

What are the signs of UC?

A

Fever
Tachycardia
Distended abdomen

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17
Q

What are the extra-intestinal manifestations of IBD?

A

Clubbing
Oral ulcers
Erythema nodosum
Conjunctivitis
Arthritis
PSC
Nutritional deficits

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18
Q

What are the investigations for UC?

A

Bloods: FBC, ESR, CRP, U&E, LEFT, Blood culture
Stool culture
Faecal calprotectin
AXR
Lower GI endoscopy

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19
Q

What is calprotectin?

A

Protein biomarker released by inflamed gut mucosa

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20
Q

What are the complications of UC?

A

Toxic dilatation of colon
Perforation
Haemorrhage
Venous thromboembolism
Dysplasia -> colonic cancer

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21
Q

What is mild UC?

A

Fewer than 4 bowel movements a day
No more than small amounts of blood
ESR 30 or below

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22
Q

What is moderate UC?

A

4-6 bowel movements a day
Mild-severe amounts of blood
ESR 30 or below

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23
Q

What is severe UC?

A

6 or more bowel movements a day
Visible blood
Pyrexia
Pulse>90
Anaemia
ESR above 30

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24
Q

What is CD?

A

A chronic inflammatory disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus

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25
Q

What are skip lesions?

A

Unaffected bowel between areas of active disease
Not present in UC

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26
Q

What is the pathology of CD?

A

Granular serosa
Thickened, oedematous, fibrotic mesentery
Narrowed lumen
Sharp demarcation of disease segments from normal tissue
Ulceration

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27
Q

What are the symptoms of CD?

A

Diarrhoea
Abdominal pain
Weight loss
Malaise
Lethargy
Anorexia
Fever
Malabsorption

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28
Q

What are the signs of CD?

A

Bowel ulceration
Abdominal tenderness
Perianal abscess/fistulae/skin tags
Anal strictures

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29
Q

What are the investigations for CD?

A

Bloods: FBC, ESR, CRP, U&E, LEFT, B12
Stool culture
Faecal calprotectin
Colonoscopy + biopsy
MRI small bowel study
Capsule endoscopy

30
Q

What are the complications of CD?

A

Small bowel obstruction
Toxic dilatation (rarer than in UC)
Strictures
Fistula
Abscess
Cancer risk

31
Q

What are the perianal manifestations of Chron’s disease?

A

Perianal fistula
Perianal abscess
Anal canal lesions (anal fissures and anal stricture)

32
Q

What are the investigations for perianal CD?

A

MRI pelvis
Examination under anaesthetic (EUA)

33
Q

Is UC more common in males or females?

34
Q

Is CD more common in males or females?

35
Q

What bowel regions do CD and UC cover?

A

CD- entire gut
UC- colon only

36
Q

What is the macroscopic distribution of CD and UC?

A

CD- Skip lesion
UC- Diffuse

37
Q

Are strictures present in CD and UC?

A

CD- variable
UC- Late, rare

38
Q

What is the wall appearance in CD and UC?

A

CD- Thick
UC- Thin

39
Q

What is the type of inflammation in CD and UC?

A

CD- Transmural
UC- Limited to mucosa

40
Q

Are pseudopolyps present in CD and UC?

A

CD- marked
UC- marked

41
Q

Are ulcers present in CD and UC?

A

CD- Deep
UC- Superficial

42
Q

Are there granulomas in CD and UC?

A

CD- Yes
UC- No

43
Q

Are there fistulae in CD and UC?

A

CD- Yes
UC- No

44
Q

What are the inflammatory markers in a flare of IBD?

A

High CRP
High platelets
High WCC
Anaemia
Low albumin

45
Q

Is there fibrosis in CD and UC?

A

CD- Moderate
UC- Mild

46
Q

What is the treatment for IBD?

A

Step up/ top down approach

47
Q

What are the steps to the step up/top down approach?

A
  1. 5-ASA
  2. Steroids
  3. Immunomodulators
  4. Biologic agents
  5. Surgery
48
Q

What is the aim of IBD treatment?

A

Induction and maintenance of remission?

49
Q

What are 5-ASAs given for?

A

Mild UC, not CD
1st line therapy for induction and maintenance of remission

50
Q

What are some examples of 5-ASAs?

A

Mesalazine
Pentasa

51
Q

How are 5-ASAs given?

A

PR: suppositories or enemas for distal disease
PO: for more extensive disease
Combine PR + PO in a flare

52
Q

What are some examples of steroids?

A

Prednisolone
Budesonide

53
Q

What is the first line of treatment for flare up of IBD?

A

IV steroids

54
Q

Why are steroids not give for long term use?

A

Adverse side effects

55
Q

What is immunomodulation?

A

Adjustment of the immune response to a desired level

56
Q

What are immunomodulators used for?

A

Maintenance or remission in UC and CD
Used on steroid dependant patients

57
Q

What are some examples of immunomodulators?

A

Azathioprine
Methotrexate

58
Q

What percentage of patients are intolerant to immunomodulators?

59
Q

What are the side effects of immunomodulators?

A
  • Leukopenia
  • Hepatotoxicity
  • Pancreatitis
  • Long term lymphoma risk
60
Q

What are biologics?

A

Monoclonal antibodies

61
Q

When are biologics used?

A

For patients intolerant of immunomodulation or developing symptoms despite and immunomodulator

62
Q

What are some examples of anti-TNF antibodies?

A

Infliximab
Adalimumab

63
Q

How do TNF antibodies work?

A

Counter neutrophil accumulation and granuloma formation and cause cytotoxicity to CD4+ T cells, thus clearing cells that drive the immune response

64
Q

What are some examples of anti-integrin antibodies?

A

Vedolizumab

65
Q

How do anti-integrin antibodies work?

A

Target adhesion molecules involved in gut lymphocyte trafficking

66
Q

What are examples of anti-L12/23 antibodies?

A

Ustekinumab

67
Q

How do anti-L12/23 antibodies work?

A

Cytokine target

68
Q

What is the surgery for IBD?

A

Subtotal colectomy + terminal ileostomy

69
Q

What is subsequent surgery options?

A

Completion proctectomy (permanent stoma)
Ileo anal pouch

70
Q

What is pouch surgery?

A

Only for UC not CD
Stoma reversal and the possibility of long term continence

71
Q

What are the indications for
surgery in IBD?

A

Drug failure
Perforation
OGI obstruction from stricture
Fistulae
Abscess
Steroid dependant

72
Q

What are the indications for
surgery in IBD?

A

Drug failure
Perforation
OGI obstruction from stricture
Fistulae
Abscess
Steroid dependant

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