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Gastroenterology > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Acronym NEST for Crohn’s disease

A

No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum most affected and Transmiral inflammation
Smoking is risk

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2
Q

Acronym CLOSE UP for ulcerative colitis

A

Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking is protective
Excrete blood and mucus
Use aminosalicyclates
Primary sclerosing cholangitis

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3
Q

What does faecal calprotectin indicate

A

Released by the intestines when inflamed for useful screening which is 90% specific and sensitive

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4
Q

What is the diagnostic test for IBD

A

Endoscopy with OGD and colonscopy with biopsy

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5
Q

What are US, CT and MRI’s useful for in IBD

A

Look for complications such as fistulas, abscesses and strictures

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6
Q

What do routine bloods look for

A

Anaemia, infection, thyroid, kidney and liver function

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7
Q

What tests should be undertaken in IBD

A

Routine bloods, CRP, faecal calprotectin, endoscopy with biopsy, imaging

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8
Q

What is first line for inducing remission in Crohn’s

A

Steroids - oral pred or IV hydrocortisone

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9
Q

What immnuosuppressants can be used to induce remission in Crohn’s

A

Azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab

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10
Q

First line drugs for maintaining remission in Crohn’s

A

Azathioprine and Mercaptopurine

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11
Q

What surgical options are there for Crohn’s

A

Surgical resection of distal ileum and treatment of strictures and fistulas

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12
Q

What is first line for inducing remission in moderate UC

A

Aminosalicyclate (mesalazine oral or rectal)

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13
Q

What is second line for inducing remission in moderate UC

A

Corticosteroids (prednisolone)

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14
Q

What is first line for inducing remission in severe UC

A

IV corticosteroids (hydrocortisone)

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15
Q

What is second line for inducing remission in severe UC

A

IV ciclosporin

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16
Q

Maintaining remission in UC

A

Aminosalicyclate (mesalazine oral or rectal)
Azathioprine
Mercaptopurine

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17
Q

Surgical options for UC

A

Removing colon and rectum so then the patient is left with an ileostomy or ileo-anal anastomosis

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18
Q

Investigations into Crohns

A

Stool culture, faecal calprotectin raised, endoscopy for diagnosis, MRI in suspected small bowel disease, upper GI series showing ‘string sign of kantour’

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19
Q

Medical management in Crohn’s

A

Monotherapy with glucocorticoids - pred or IV hydrocortisone. Azathioprine or mercaptopurine may be added (after assess TPM). Methotrexate may be added if not tolerated

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20
Q

What is the treatment in children

A

Enteral nutrition as steroids suppress growth

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21
Q

Medical management in severe or unresponsive Crohn’s

A

Biological agents - infliximab or adalimub

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22
Q

Which areas does UC cover

A

Limited to colon - backwash ileitis. More severe in distal colon, and sometimes may only involve rectum. Caecal patch lesions

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23
Q

Microscopic features of UC

A

Inflammation limited to the mucosa, acute and chronic. Cryptitis and crypt abscesses. Evenly distributed inflammation, mucosal granulomas, distortion of glands

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24
Q

Macroscopic features of UC

A

Superficial mucosal ulceration, pseudopolyp formation, normal serosal surface, confluent involvement, featureless mucosa in chronic disease

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25
Q

Distribution in Crohn’s disease

A

May involve entire GI tract, oral ulceration, perianal fistulas, abscesses, classically involves terminal ileum

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26
Q

Rose-thorn ulcers in Crohn’s

A

Deep penetrating linear ulcers/ fissuring typically seen within stenosed terminal ileum with thickened wall

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27
Q

Signs and symptoms in UC

A

Diarrhoea with blood/mucus, tenesmus or ugency, pain LIF, weight loss, fever, pale (anaemia), clubbed, distension, tender on palpation, PR exam reveals tenderness, blood/mucus

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28
Q

Extramanifestations of UC

A

Erythema nodusum, pyoderma gangrenosum, anterior uveitis, episcleritis, conjunctivitis, arthritis, primary sclerosing cholangitis, amyloidosis

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29
Q

Bloods tests into UC

A

FBC - anaemia and raised WCC. ESR/CRP raised. LFT -malabsorption/low albumin

30
Q

To exclude infective colitis

A

Stool microscopy culture and C diff toxin

31
Q

Macroscopic features of Crohn’s

A

Deep ulceration - cobblestone mucosa. Bowel wall thickening and strictures. Abnormal serosa - fat wrapping. Patchy involvement - skip lesions

32
Q

Microscopic features of Crohn’s

A

Transmural inflammation - acute and chronic, lymphoid aggregates. Fissuring ulceration, patchy inflammation, transmural granulomas, neuronal hyperplasia

33
Q

Complications of Crohn’s

A

Fistula formation - enteroenteric, enterovesical, entervaginal, enterocutaneous. Abscess and sinus formation, bowel obstruction - inflammatory stricture formation. Malignancy

34
Q

Colonoscopy findings in UC

A

continuous inflammation with erythematoid mucos, loss of haustral markings and pseudopolyps

35
Q

Biopsy findings in UC

A

Loss of goblet cells, crypt abscesses and inflammatory cells.

36
Q

Barium enema findings in UC

A

Lead piping inflammation, thumb printing, pseudopolyps

37
Q

Acute exaccerbation scoring system in UC

A

Trustlove and Witt’s criteria for severity

38
Q

Aims of treatment in moderate disease of UC

A

Induce remission, if not improved after 4 weeks then add oral aminosalicyclate

39
Q

Drugs used in IBD

A

immunosuppressants and antibody therapy. Steroids and ASAs for inflammation

40
Q

Use of aminosalicyclates

A

First line treatments for mild to moderate UC

41
Q

Examples of ASA

A

Balsalazine, mesalazine, olsalazine, sulfasalazine

42
Q

Side effects of ASAs

A

Nausea, mouth ulcers, reduced WCC and platelets, rash, orange urine and sweat, oligospermia

43
Q

Uses of steroids

A

Main drugs used in acute attacks to induce and maintain remission. Adjunct to ASAs in refractory/moderate disease

44
Q

Investigations into Crohn’s

A

Stool culture, faecal calprotectin, endoscopy, MRI

45
Q

Manegement of Crohn’s

A

Monotherapy with glucocorticoids, enteral nutrition in children, azathioprine or mercaptopurine may be added

46
Q

Options for severe or unresponsive Crohn’s

A

Biological agents such as adalimumab or infliximab

47
Q

What drug can be used if patient is TPMT deficient

A

Methotrexate

48
Q

Signs and symptoms of UC

A

Diarrhoea with blood/mucus, tenesmus, urgency, pain in LIF, weight loss, fever, pale, clubbed, distension, tender on palpation

49
Q

Extra manifestations of UC

A

Erythema nodusum, pyoderma gangrenosum, anterior uveitis, episcleritis, conjunctivitis, arthritis, primary sclerosing cholangitis, amyloidosis

50
Q

Blood test results in UC

A

Anaemia and raised WCC, CRP raised, low albumin

51
Q

Microbiology investigations into UC

A

Exclude infective colitic with stool microscopy and culture. Faecal calprotectin

52
Q

Emergency surgical indications in UC

A

Acute fulminant UC, toxic megacolon with no improvement after IV steroids and worsening symptoms

53
Q

Surgical options for UC

A

Panproctacolectomy with permanent end ileostomy. Colectomy with temporary end ileostomy then ileal pouch and anastomosis

54
Q

Elective surgical indications for UC

A

Failure to induce remission, can perform ileorectal anastomosis with no stoma if elective

55
Q

Complications in UC

A

Toxic megacolon, massive lower GI haemorrhage, colorectal cancer, dysplasia, strictures, bowel onstruction, perforation, cholangiocarcinoma, primary sclerosing cholangitis, inflammatory polyps

56
Q

Signs and symptoms in Crohn’s

A

Crampy abdominal pain, diarrhoea, weight loss, fever, cachetic, pale, digital clubbing, apthous mouth ulcers, abdo/RLQ tenderness, RIF mass, skin tags, fistulae and perianal abscess

57
Q

Extra manifestations in Crohn’s

A

Erythema nodsum, pyoderma gangrenosum, anterior uveitis, episcleritis, arthritis, sacro-ileitis, gallstones, renal stones, amyloidosis

58
Q

Blood test results of Crohn’s

A

Raised WCC, ESR, raised, thrombocytosis, anaemia, low albumin, iron, B12, folate

59
Q

Management of proctitis and proctosigmoiditis

A

Topical aminosalicyclase or oral ASA. Consider adding oral pred, then consider oral tacrolimus

60
Q

Management of acute severe UC step 1

A

IV corticosteroids - if untolerated use IV ciclosporin

61
Q

Management of acute severe UC step 2

A

If worsens in 72 hours - add IV ciclosporin and if untolerated use infliximab. Consider surgery

62
Q

Side effects of azathioprine

A

Nausea, vomiting, pneumonia, herpes, diabetes, pancreatitis

63
Q

Side effects of calcineurin inhibitors

A

Expensive, toxic, opportunistic infection

64
Q

Antibody therapy examples

A

Ustekinumab, infliximab, vedolizumab

65
Q

Side effects of antibody therapies

A

Fever, chills, urticardia, serious infection

66
Q

Examples of steroids used in UC

A

Prednisolone, hydrocortisone, budesonide

67
Q

Route of administration for localised rectal disease

A

Liquid or foam enermas

68
Q

Route of administration for severe/extensive disease

A

Oral or parenteral

69
Q

Side effects of steroids

A

Osteoporosis, muscle wasting, diabetes, cushings, growth suppression, infection, adrenal atrophy long term. Unsuitable for maintenance

70
Q

Use of immunosuppressants

A

Azathioprine - steroid dependent Crohn’s
Methotrexate - Crohn’s
Calcineurin inhibitors - steroid resistant UC

71
Q

Eg of calcineurin inhibitors

A

Cyclosporin and Tacrolimus

Gastroenterology (19 decks)

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