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YEAR 3 GASTRO > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is inflammatory bowel disease?

A

Umbrella term for idiopathic inflammatory chronic conditions UC and Crohn’s

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2
Q

What is ulcerative colitis?

A

Type of IBD characterised by diffuse (continuous) inflamm of colonic mucosa. Has relapsing, remitting course.

Can be anywhere from colon to rectum.
Only innermost layer affected (mucosa)

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3
Q

What is Crohn’s disease?

A

Type of IBD characterised by transmural inflammation of GIT. May involve any or all parts, from mouth to anus.

Skip lesions.

Can occur in all layers of bowel.

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4
Q

Layers of large bowel?

A

4 layers (from lumen outward):mucosa, submucosa, muscular layer, and serosa

Muscular layer made up of 2 layers of smooth muscle: inner circular layer and outer longitudinal layer

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5
Q

Pathophysiology of ulcerative colitis?

A

Most cases in rectum, w some developing terminal ileitis

Oedema, accumulation of fat, and hypertrophy of muscle layer→ impression of thickened bowel wall.

Only involves mucosa

Formation of crypt abscesses and depletion of goblet cell mucin.

Undermining of mucosa + excesses granulation tissue→ inflammatory polyps/ pseudopolyps.

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6
Q

What is proctitis (in context of ulcerative colitis)?

A

When inflammation limited to rectum

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7
Q

Aetiology of ulcerative colitis?

A

Unclear

  • Genetic predisposition
  • Potentially autoimmune, initiated by inflammatory response to colonic bacteria
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8
Q

Risk factors for ulcerative colitis? (3 main)

A

Family Hx of IBD
HLA B27
Infection

Weak:
- NSAID use
- Not smoking or former smoker

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9
Q

Signs and symptoms of ulcerative colitis?

A
  • Subacute onset <2 w
  • Rectal bleeding and blood in stool
  • Diarrhoea
  • Diffuse abdominal pain and tenderness
  • Spondylitis and arthritis
  • Malnutrition and dehydration
  • DRE: blood and mucus on glove

Uncommon: fever, weight loss, rash, uveitis

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10
Q

Ix: Non-imaging investigations for ulcerative colitis?

A

Stool study: negative culture and C. diff toxins A and B; WBC present

Faecal calprotectin: elevated
- Elevated w bowel inflamm. Useful in supporting differential of IBS vs IBD

FBC: variable degree of anaemia, leukocytosis, or thrombocytosis
ESR: high/ normal
Low B12 and folate
High pANCA

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11
Q

Ix: What is a pANCA test? (ulcerative colitis)

A

Testmeasures amount of peripheral antineutrophil cytoplasmic antibodies (p-ANCA) in blood (ABs to neutrophils)

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12
Q

Ix: Imaging investigations (and respective results) for ulcerative colitis?

A

Abdominal XR:
- Thumbprinting
- Toxic megacolon (over 6cm diameter)
- Dilated loops
- Double contrast barium enema “lead pipe appearance”

Flexible unprepared sigmoidoscopy: acute
Flexible sigmoidoscopy/ colonoscopy: not acute
- Continuous erythema
- Ulceration
- Crypt abscess
- Loss of vascular marking
- Mucosal granularity

Biopsies: obtained during endoscopy
- Continuous distal disease, mucin and goblet cell depletion, diffuse mucosal atrophy, absence of granulomata, and anal sparing

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13
Q

Acute management for ulcerative colitis?

A

Nutritional support
Manage extra-intestinal manifestations

Corticosteroids (IV/ oral hydrocortisone, severity-dependent)
Hospital admission if acute and severe
IV fluids, and analgesia
ABs
Ciclosporin/biologicals

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14
Q

When is surgery done for acute management of ulcerative colitis?

A

Toxic megacolon (proctosigmoidectomy and ileostomy) or failure to respond to steroids in 48h

Colectomy (3rd line)

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15
Q

Management for ulcerative colitis when trying to maintain remission?

A

Mild: 5-ASA (aminosalicyclates- reduce inflammation of intestine) + biologics

Severe: immunomodulators + biologics

Surgery: if medical fails and complications

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16
Q

Potential complications of ulcerative colitis? (6)

A
  • Toxic megacolon
  • Perforation
  • Massive haemorrhage
  • Colon cancer
  • PSC (primary sclerosing cholangitis)
  • Cholangiocarcinoma (ca19-9 diagnostic tumour marker)
17
Q

What is primary sclerosing cholangitis?

A

Disease of bile ducts. In PSC→ inflamm scars within bile ducts.

Signs and symptoms inclu: intermittent abdominal pain (under ribs/ pinching pain RUQ), diarrhoea, jaundice, fever, fatigue

18
Q

Pathophysiology of Crohn’s disease?

A

Inflamm + ulceration→ non-caseating granulomas

Granulomas involve all layers of intestinal wall and mesentery and regional lymph nodes

Lesions separated by normal bowel mucosa discontinuously (skip lesions)

18
Q

Aetiology of Crohn’s disease?

A

Unclear

Suggested environmental and genetic factors
- Genetic susceptibility and heritable risk
- Smoking, OCP, NSAIDs, diet, Campylobacter infections

19
Q

Risk factors for Crohn’s disease?

A

White ethnicity
Age 15-40/ 50-60 (bimodal age dist)
Fam Hx of CD

Weak:
- Cigarette smoking, low fibre diet
- OCP, NSAIDs

20
Q

Signs and symptoms of Crohn’s disease?

A
  • RLQ (or peri-umbilical) abdominal pain
  • Abdominal tenderness
  • Prolonged diarrhoea (may be bloody)
  • Perianal lesions (skin tags, fistulae, abscesses, scarring, etc)
  • Bowel obstruction
  • Fever and fatigue

Uncommon: weight loss, arthropathy, erythema nodosum, ocular signs (inclu uveitis)

21
Q

Ix: Standard tests (non-imaging) done for Crohn’s disease?

A

FBC, iron studies, B12 and folate, metabolic panel, ESR and CRP

May show anaemia, leukocytosis, thrombocytopenia; low/ normal iron; low/ normal B12/ folate (may be secondary to malnourishment); hypoalbuminaemia, hypocholesterolaemia, hypocalcaemia; elevated ESR/ CRP

DRE exam (PR bleed)

Stool test (Check for infections, esp C.difficile if recent AB use)

22
Q

Ix: Imaging investigations for Crohn’s disease and possible findings?

A

Abdo XR (or CT)
- Part of initial tests
- Skip lesions, bowel wall thickening, surrounding inflamm, abscess, fistulae

ACUTE: Flexible unprepared sigmoidoscopy
NOT ACUTE: Ileocolonoscopy + biopsy

23
Q

Conservative management done for Crohn’s disease?

A
  • Stop smoking
  • Nutritional advice
  • Manage peri-anal abscess
  • Refer to MDT to manage extra-intestinal manifestations (steroids)
24
Q

Medical management for INDUCING remission, for Crohn’s disease?

A

Prednisolone/biologics (e.g. infliximab)
- Steroids - osteoporosis, immunosuppression, hirsutism

25
Q

Medical management for MAINTAINING remission, for Crohn’s disease? (and their potential side effects)

A

Immunomodulators (azathioprine) + biologics

- Azathioprine - can cause bone marrow suppression, non-melanoma

- Methotrexate - must monitor LFTs, injection weekly + folate - liver fibrosis, bone marrow suppression, can't be taken during pregnancy

- Infliximab = TNF alpha inhibitor - myelosuppression, reactivation of TB and Hep B
26
Q

When is surgical management used for Crohn’s disease and what might it involve?

A

Failure to thrive and medication not working

Surgical resection (consider carefully)

If obstructive symptoms, may consider: surgery/ dilation

27
Q

Potential complications of Crohn’s disease? (3)

A

Extra-intestinal involvement
Intestinal obstruction
Abscess/ fistulae formation

YEAR 3 GASTRO (18 decks)

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