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Year 2- GIT > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

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1
Q

Name the two types of IBD

A

Crohn’s Disease
Ulcerative Colitis

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2
Q

When do these IBD conditions usually present?

A

Teens and twenties

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3
Q

What is meant by IBD?

A

Chronic relapsing inflammatory conditions of the bowel

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4
Q

Some patients have features of both types of IBD- what is this known as?

A

IBD-U (IBD unclassified)

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5
Q

Microscopic colitis is another type of IBD but very rare and less problematic.
What are the two types of microscopic colitis?

A

Collagenous colitis
Lymphocytic collitis

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6
Q

How does microscopic colitis present?

A

Chronic, watery, non-bloody diarrhoea

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7
Q

Who would be more likely to get microscopic colitis?

A

Older women

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8
Q

Which conditions can microscopic colitis be associated with?

A

Autoimmune conditions like rheumatoid arthritis, coeliac disease and thyroid conditions.

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9
Q

Which medications can cause microscopic colitis?

A

NSAIDs
PPI
SSRI drugs (taken for depression)

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10
Q

What is the first line treatment for microscopic colitis?

A

Stop any drugs that could be causing it.
Start on a steroid called budesonide.

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11
Q

Discuss the affects of smoking on CD and UC.

A

Smoking gives greater risk of CD.
However, stopping smoking increases risk of UC.

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12
Q

What are some of the factors which contribute to IBD?

A

Environmental factors
Genetic factors
Microbiome/diet

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13
Q

Who is more likely to develop UC?

A

Males = females

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14
Q

Which age range is where most people with UC find out?

A

20-40

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15
Q

What are the symptoms of UC?

A

Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue

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16
Q

Which of the GIT is affected by UC?

A

Colon

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17
Q

Whereabouts does UC begin?

A

Rectum and spreads proximally

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18
Q

What is proctitis?

A

Inflammation of rectum only

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19
Q

What are the symptoms of proctisis?

A

Frequency, urgency, incontinence, tenesmus

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20
Q

What is tenesmus?

A

Frequent urge to go to the toilet without actually needing to go

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21
Q

What may be passed instead of poo in those with proctitis?

A

Small volume of mucus and blood

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22
Q

What is the treatment for proctisis?

A

Topical therapies

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23
Q

What can cause proctisis?

A

UC
STD’s like chlamydia or gonorrhoea

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24
Q

Which investigations are carried out in someone with suspected UC?

A

Bloods
Stool culture
Faecal calprotectin
Colonoscopy

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25
Q

What will blood tests show in someone with UC?

A

Decreased albumin levels
Increased CRP/WCC/platelets

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26
Q

Why is a stool culture done in investigations for UC?

A

To see if it is infection causing the bloody diarrhoea

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27
Q

Which level of calprotectin is considered to be elevated?

A

> 200ug/g

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28
Q

What is faecal calprotectin?

A

Protein biomarker that’s released when there’s inflammation of the colon.

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29
Q

High faecal calprotectin does not always mean IBD. Which other conditions will there be a high calprotectin level?

A

Gastroenteritis, diverticulitis, ischaemic colitis.

30
Q

Initial treatment of acute severe colitis is very important.
Describe the initial treatment.

A

Blood tests
Stool chart, stool cultures
IV glucocorticoids
IV hydration
AXR

31
Q

Which drugs should you stop in someone who has acute severe colitis?

A

Non-steroidal analgesics
Opiates
Anti-diarrhoeals
Anti-cholinergics

32
Q

How many stool cultures are required to detect C.difficile?

A

4

33
Q

Where can Crohn’s disease affect?

A

Anywhere in the GIT

34
Q

Why do symptoms for Crohn’s disease vary?

A

It can affect anywhere in the GIT so symptoms differ depending on the location

35
Q

List some of the possible symptoms seen in CD.

A

Diarrhoea
Abdominal pain
Weight loss
Malabsorption
Lethargy
Nausea and vomiting
ANorexia

36
Q

List the investigation done in someone with possible CD.

A

Bloods (for markers of inflammation)
Stool culture
Faecal calprotectin
Colonoscopy
MRI small bowel study
Capsule endoscopy

37
Q

Describe the difference in pathology between UC and CD in histology.

A

CD- granulomas, transmural inflammation

UC- depleted goblet cells, more crypt abscesses than CD, inflammation limited to mucosa

38
Q

Which evolves over time- UC or CD?

A

Crohn’s disease

39
Q

What can CD form as it progresses?

A

Forms strictures which can develop into fistulas

40
Q

Okay, just checking, what is a fistula?

A

An abnormal connection between two parts of the body

41
Q

What are some of the perianal symptoms of CD?

A

Pain
Pus secretion
Unable to sit down

42
Q

What are the investigations for perianal CD?

A

MRI pelvis
Examination under anaesthesic (EUA)

43
Q

What is treatment for perianal CD?

A

Surgery to drain abscess and place seton stitch
Antibiotic and biologic therapy

44
Q

What are some of the extra-intestinal manifestations of CD?

A

Mouth ulcers
Skin rashes/lesions
Musculoskeletal problems
Eye problems
Liver- primary sclerosing cholangitis

45
Q

What are some of the differential diagnoses for IBD?

A

Chronic diarrhoea
Ileo-caecal TB
Infective colitis, amoebic colitis, ischaemic colitis

46
Q

Which conditions can cause chronic diarrhoea which are not IBD?

A

Malabsorption e.g. pancreatic insufficiency, bile acid malabsorption, coeliac disease.
IBS
Overflow diarrhoea

47
Q

What is the long term complication of colonitis?

A

Colonic carcinoma

48
Q

What in is place to reduce bowel cancer?

A

Bowel cancer screening for those who have IBD

49
Q

Describe what is meant by the relapse and remission nature of UC and CD.

A

Patients can go through stages of being completely well and then have a flare up.

50
Q

What is the initial drug treatment for those with UC?

A

5-ASAs (aminosalicyclates)

51
Q

Are 5ASAs used for induction of remission for UC or maintenance of remission?

A

Both

->Induce remission but also help to maintain it (remission=period where the patient is completely well)

52
Q

How can 5-ASAs be taken?

A

Orally
Topically if affecting the distal GIT

53
Q

What are the side effects of 5ASAs?

A

Usually pretty well tolerated but can cause sickness and nausea, sometimes watery diarrhoea

54
Q

What is the second line of treatment for UC which can also be used to treat those with CD?

A

Steroids

55
Q

What do patients on prednisolone also need to take?

A

Calcium and vitamin D supplements

56
Q

These steroids are not for long term use. What are some of the side effects of prednisolone?

A

Increased risks of obesity, diabetes, mood changes, cataracts and osteoporosis.

57
Q

Which drugs are used for immunomodulation in UC and CD?

A

Thiopurines- used for maintenence of remission

->this makes sense as they are third line of treatment (at least for UC) so induction of remission has already started

58
Q

Name the type of thiopurine most commonly used for immunomodulation.

A

Azathioprine

59
Q

There are many side effects to azathioprine, name some.

A

Hepatotoxicity
Leucopoenia (lots of WBC)
Pancreatitis
Long term risk of lymphoma and non-melanoma skin cancers

60
Q

Name an immunomodulator which is only used in individuals with CD.

A

Methotrexate

61
Q

Biologics can be used in treatment of IBD.
Name some of the groups of monoclonal anitbody biologics.

A

Anti-TNF alpha antibodies (like Infliximab containing Remicade, remsima)

Alpha 4b7 antibodies (like Adalimumab containing Humira, amgevita)

IL12/ IL23 blockers (like Ustekinumab)

62
Q

Which order of treatment should IBD patients get?

A

Uncertain…personalised medicine

63
Q

In which situations would surgery be performed as an ‘emergency’ choice for those with acute severe colitis?

A

If the acute severe colitis is not responding to high dose IV steroids +/- anti-TNF biologic therapy
OR
There are complications such as abscess, perforation or obstruction

64
Q

In which elective settings may surgery be performed in those with acute severe colitis?

A
  1. Frequent relapses despite medical therapy
  2. Not able to tolerate medical therapy
  3. Steroid dependant
  4. Patient choice
65
Q

Which surgeries may be carried out for acute severe colitis?

A

Subtotal colectomy

66
Q

What happens in a subtotal colectomy?

A

Large bowel removed but rectal stump kept.
Ileum is brought out the anterior wall be a stoma.

-Liz:)

67
Q

What are the two options after the subtotal colectomy?

A
  1. Rectal removal at later date
    or
  2. Pouch procedure
68
Q

What happens during the pouch procedure?

A

Small intestine is lengthened and mobilised and stapled into place

69
Q

Which IBD is pouch procedure recommended in?

A

UC

->btw idk if this is what Liz had done…think it’s more to do w the rectum, might be worth a quick google x

70
Q

What are some of the indications for surgery in those with CD?

A

-Failure of medical management
-Relief of obstructive symptoms
-Management of fistulae
-Management of intra-abdominal abscess
-Management of anal conditions
-Failure to thrive

Year 2- GIT (37 decks)

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