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Gastrointestinal > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

what is ibd

A

inflammation of the GI tract and the umbrella term for crohns and Ulcerative collitis

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2
Q

Distinguishing factors of Crohns disease

A

N – No blood or mucus (less common)

E – Entire GI tract

S – “Skip lesions” on endoscopy

T – Terminal ileum most affected and Transmural (full thickness) inflammation

S – Smoking is a risk factor (don’t set the nest on fire)

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3
Q

distinguishing factors of Ulcerative collitis

A

C – Continuous inflammation

L – Limited to colon and rectum

O – Only superficial mucosa affected

S – Smoking is protective

E – Excrete blood and mucus

U – Use aminosalicylates

P – Primary Sclerosing Cholangitis

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4
Q

What is UC

A

IBD
Involves rectum and extends to affect colon - never spread beyond ileocaecal valve - confined to large bowel

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5
Q

microscopic features of ulcerative collitis

A

-mucosa only inflamed
- crypt abscesses
-depleted goblet cells

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6
Q

microscopic features of Crohn’s disease

A
  • transmural inflammation
  • granulomas
  • increased chronic inflammatory cells and lymphoid hyperplasia
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7
Q

cause of Ulcerative colitis

A

inappropriate immune response against colonic flora in genetically susceptible individuals
HLAB27 association

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8
Q

risk factors for UC

A

Family history - HLA b27
NSAIDS
Onset
Flares/relapse
Chronic stress + depression - triggers flares
White

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9
Q

epidemiology of UC

A
  • 50/50 m and f
    -20-40 yr olds
  • incidence is 3x higher in smokers
  • Highest incidence and prevalence in Northern Europe, UK and North America
  • Affects caucasians and eastern European Jews most
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10
Q

Pathophysiology of UC

A

Form ulcers along the inner-surface or lumen of the large intestine, including both the colon and the rectum.

ulcers are spots in the mucosa and submucosa where the tissue has eroded away and left behind open sores or breaks in the membrane.

Cytotoxic T cells are often found in the epithelium lining the colon, and they may be responsible for destroying the cells lining the walls of the large intestine, leaving behind ulcers
P-ancas

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11
Q

Signs of UC

A
  • Abdominal tenderness
  • Fever - in acute UC
  • Tachycardia - in acute severe UC
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12
Q

Symptoms of UC

A
  • REMISSIONS and exacerbations
  • abdo pain, lower left quadrant
  • weight loss
  • episodic or chronic diarrhoes with blood
  • fever and malaise
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13
Q

systemic effects in UC attacks

A

fever
anorexia
malaise
weight loss

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14
Q

complications of UC with regards to the colon

A

Blood loss
Perforation
Toxic dilatation
Colorectal cancer

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15
Q

complications of UC and Crohns with regards to skin

A

Erythema nodosum
Tender red bumps
Symmetrically on shins

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16
Q

Complications of UC with regards to liver

A

Fatty change
chronic pericholangitis
sclerosing cholangitis

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17
Q

complications of uc with regards to joints

A

ankylosing spondylitis
arthritis

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18
Q

Primary investigations

A

Faecal calprotectin
FBC
LFTs
CRP/ESR
Colonoscopy + Biopsy GS

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19
Q

what may blood tests show for UC

A

Raised WCC4
Raised platelets
Raised CRP and ESR
Anaemia
pANCA may be positive

20
Q

what other investigations would you ask for if you suspect Ulcerative Collitis

A
  • stool samples, to exclde c diff
  • faecal calprotein
  • colonoscopy
  • abdo xray
21
Q

GS investigation for ulcerative collitis

A

colonoscopy
sigmoid oscopy

22
Q

what would colonoscopy show for UC

A
  • continous lead pipe inflammation
  • Crypt abscessesdue to neutrophil migration through gland walls
  • Goblet cell depletion, withinfrequentgranulomas
23
Q

mild to moderate management of Ulcerative Collitis

A

1st line- aminosalicylate
2nd line - corticosteroids

24
Q

how do aminosalicylate work

A

limiting the inflammation in the lining of the GI tract

25
Q

management for severe disease of UC

A

1st line- corticosteroids
2nd line- IV ciclosporin

26
Q

SEVERE cases with no response to treatmemt :

A

colectomy
- whole colon removed
-ileoanal anastomosis

27
Q

Complications of UC

A
  • Toxic megacolon:
  • Perforation: associated with high mortality
  • Colonic adenocarcinoma
  • Strictures and obstruction:
28
Q

What is Crohn’s disease

A

inflammatory bowel disease characterised by transmural inflammation of the gastrointestinal tract (anywhere from mouth to anus), with the terminal ileum and colon most commonly affected

29
Q

Epidemiology of Crohns

A
  • Highest incidence and prevalence in Northern Europe, UK and North America
  • The disease has its peak onset in early life (20-40 years) with a second peak among the elderly (50-80)
  • F>M
30
Q

cause of chrons disease

A

IM system triggered by foreign pathogen (TB or psudomona) in GI tract
IM system targets pathogen but large and uncontrolled > destruction of cells in GI tract
Th cells > cytokines > macrophages
Macrophages: proteases, Platelet activating factor and free radicals

31
Q

How does transmural inflammation occur?

A

The immune cells invade deep into the mucosa and organise themselves into granulomas. Eventually ulcers form, which can go through all the layers. This is known as transmural.

32
Q

risk factors for crohns disease

A

Family history
Stronger genetic association than UC
Smoking – 2-4x risk
NSAIDs – exacerbate it
Chronic stress + depression

33
Q

symptoms if crohns is in the small bowel

A
  • abdo pain
  • malabsorption
  • weight loss
  • terminal ileum— right iliac fossa pain
34
Q

What will malabsorption cause?

A
  • b12/folate deficiency
  • gall stones/ kidney stones
  • diarrhoea
  • failure to thrive
35
Q

clinical signs of crohns

A

Bowel ulceration
Abdo tenderness
Abdo mass
Perianal disease

36
Q

What investigations would you do for crohns

A

pANCA -ve
fecal calprotectin elevated
FBC
CRP/ESR
UE
LFT
Colonoscopy - GS

37
Q

DDs for Crohns

A
  • Ulcerative colitis
  • Alternative causes of diarrhoea should be excluded e.g. Salmonella spp, Giardia intestinalis and rotavirus
  • Chronic diarrhoea
38
Q

What would biopsy show for crohns

A

transmural inflammation with non caseating granulomas

39
Q

what would blood tests show with crohns

A

Raised WCC
Raised platelets
Raised CRP & ESR
pANCA negativw
Anaemia

40
Q

management for crohns disease to induce remission

A

1st line- Glucocorticoids ORAL PREDNISOLONE for flare ups or IV steroids
Immunosuppresants
Antibiotics

41
Q

To maintain remission

A

1st line:Azathioprine or Mercaptopurine

2nd line:Methotrexate, Infliximab, Adalimumab

Post-surgery: consider azathioprine, with or without methotrexate

42
Q

Non medical management of crohns

A

smoking cessation
iron/ folate/b12 supplements
Stop NSAIDs

43
Q

if a patient is non responsive to steroids in crohns disease what are the options…

A

Anti - TNF antibodies

44
Q

Histological features that will be seen in ulcerative collitis

A

Increase in plasma cells in lamina propria
Ulceration
Crypt distortion

45
Q

What does tnf-a cause

A
  • An increased immune response
  • Angiogenesis - formation of new blood vessels
  • Paneth cells necrosis
  • Intestinal epithelium cell death
46
Q

What would you give for remission in crohns

A

azathropine

Gastrointestinal (13 decks)

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