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Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is inflammatory bowel disease?

A

Group of condition characterised by idiopathic inflammation of the GI tract

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2
Q

What are the 2 common types of inflammatory bowel disease?

A

Crohn’s disease
Ulcerative colitis

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3
Q

Location of Crohn’s disease

A
  • Affects anywhere in GI tract: terminal ileum in most cases + rarely affects rectum
  • Skip lesions (multiple places)
  • transmural (full thickness)
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4
Q

Location of ulcerative colitis

A

Begins in rectum
Can extend to involve the entire colon
Continuous pattern

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5
Q

Presentation of Crohn’s disease

A
  • weight loss
  • right lower quadrant pain
  • low grade fever
  • mildly anaemic
  • perianal inflammation/ulceration/lesions e.g. skin tags, fistulae, abscesses, scarring
  • multiple non-bloody loose stools a day
  • 15-30 year olds
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6
Q

Presentation of ulcerative colitis

A
  • multiple blood stools per day
  • mild abdominal pain
  • no perianal disease
  • normal temperature
  • 20-30 year olds
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7
Q

Skin changes in inflammatory bowel disease

A

Erythema nodosum
Pyoderma gangrenosum
Psoriasis

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8
Q

What other symptoms can you get if you have inflammatory bowel disease other than the GI?

A
  • arthritis
  • MSK pain
  • skin problems: erythema nodosum, pyoderma gangrenosum, psoriasis
  • primary sclerosing cholangitis
  • uveitis
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9
Q

Causes of inflammatory bowel disease

A
  • genetic pre-disposition
  • gut organisms
  • immune response
  • triggers: antibiotics, infection, diet
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10
Q

Affect of smoking on Crohn’s disease and ulcerative colitis

A
  • worsens Crohn’s disease
  • can be beneficial to ulcerative colitis
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11
Q

What is a fistula?

A

Abnormal connection between two epithelial lined things

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12
Q

Classic microscopic presentation of Crohn’s disease

A

Epitheloid granuloma formation

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13
Q

What are people with Crohn’s disease likely to have that those with UC don’t?

A

Perianal disease
e.g. skin tags, fistula, abscesses, scarring

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14
Q

Investigation of IBD

A
  • FBC: anaemic
  • U&Es: possibly deranged electrolytes or AKI due to GI losses
  • stool sample: exclude infective colitis
  • CT/MRI scan: bowel wall thickening, obstruction
  • barium enema/follow through
  • colonoscopy
  • flexible sigmoidoscopy
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15
Q

What is the safest test in cases of bloody diarrhoea?

A

flexible sigmoidoscopy

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16
Q

What does Crohn’s disease look like?

A
  • skip lesions
  • red appearance
  • ulcers
  • mucosal oedema
  • transmural inflammation + thickening of bowel wall + narrowing lumen (strictures)
  • cobblestone appearance
17
Q

Features of Crohn’s disease

A
  • C: obblestone appearance
  • R:ose thorn ulcers (deep penetrating linear ulcers)
  • O:bstruction of bowel
  • H:yperplasia of mesenteric lymph nodes
  • N:arrowing of intestinal lumen
  • S:kip lesions

granuloma formation

18
Q

What is pathognomonic to Crohn’s disease?

A

Epithelioid granuloma formation

19
Q

Pathological changes in ulcerative colitis

A
  • chronic inflammatory infiltrate of lamina propria
  • crypt abscesses + distortion
  • reduced numbers of goblet cells
  • pseudopolyps after repeated episodes
  • loss of haustra (inflammation reduces appearance)
20
Q

Compare Crohn’s disease + ulcerative colitis:
- location
- rectal involvement
- continuous
- gross bleeding
- perianal disease
- fistula formation
- malnutrition
- smoking affect
- transmural inflammation
- granulomas
- fibrosis
- crypt abscesses

A

_Crohn’s disease
- location: anywhere in GI tract, mainly terminal ileum
- rectal involvement: rarely
- continuous: no, skip lesions
- gross bleeding: 25%
- perianal disease: yes
- fistula formation: yes
- malnutrition: potential
- smoking affect: damaging
- transmural inflammation: yes
- granulomas: yes
- fibrosis: common
- crypt abscesses: rare

Ulcerative colitis
- location: from rectum to colon
- rectal involvement: yes
- continuous: yes
- gross bleeding: yes
- perianal disease: no
- fistula formation: no
- malnutrition: no
- smoking affect: potentially beneficial
- transmural inflammation: no
- granulomas: no
- fibrosis: no
- crypt abscesses: yes

21
Q

What are haustra?

A

Small pouches of the colon wall between folds

22
Q

Treatment of IBD in hopsital

A
  • IV hydrocortisone 100mg qds
  • heparin to reduce risk of VTE whilst in hospital
23
Q

Treatment of UC flare up

A
  • first line: mesalazine
  • second line: oral prednisolone
    .
    if severe:
  • first line: IV hydrocorisone
  • additional options: IV ciclosporin, infliximab or surgery
24
Q

Maintenance drug treatment of ulcerative colitis

A

mesalazine first line
azathioprine if M doesn’t work

25
Q

Surgical options for ulcerative colitis

A
  • panprotocolectomy - removal of the large bowel + rectum
    then:
  • ileostomy: ileum is brought onto the skin with a spout into stoma bag
  • J-pouch: ileum is folded back on itself + fashioned into a larger pouch which attaches to the anus (acting like a rectum)
26
Q

Treatment of Crohn’s flare up

A
  • first line: oral prednisolone or IV hydrocortisone
  • enteral nutrition
  • addition of azathioprine, infliximab, metocaptopurine if needed
27
Q

How does enteral nutrition induce remission in crohn’s?

A
  • treating nutritional deficiencies
  • improving gut microbiome
  • removing inflammatory foods
28
Q

maintenance drug treatment of Crohn’s

A

azathioprine or mercaptopurine
or biologics (first line in perianal or fistulating crohn’s)

29
Q

Surgical options for Crohn’s

A
  • resecting distal ileum
  • treating strictures of fistulas

Gastrointestinal (28 decks)

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