Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 - Gastroenterology > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the features of ulcerative colitis?

A

Starts at rectum - bloody diarrhoea, urgency, tenesmus, abdominal pain (particularly LLQ), extra-intestinal features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the investigations for suspected IBD?

A

Faecal calprotectin - 90% sensitivity,
Anti-TTG and IgA (to exclude coaliac’s disease from differential list.)
FBC, U&Es, LFTs, CRP, TFTs.
Stool culture and microscopy to rule out infective cause.
Colonoscopy with multiple biopsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the typical findings on colonoscopy and biopsy for UC?

A

Colonoscopy - raw mucosa, bleeds easily, limited to submucosa, psudopolyps due to widespread inflammation.
Biopsy - Inflammatory cell infiltrate, crypt abscess, depletion of goblet cells, NO granulomas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of ulcerative colitis on a barium enema?

A

Loss of haustrations, superfical ulceration, pseudopolyps and drainpipe colon if disease is long standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the conditions associated with ulcerative colitis?

A

Arthritis,
Erythema nodosum,
Episcleritis,
Osteoporosis,
Uveitis,
Pyoderma gangrenosum,
Clubbing
Primary sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some factors which can lead to a flare of UC?

A

Stress,
Medications - NSAIDs/antibiotics,
Cessation of smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the classification of UC flares?

A

Mild - <4 stools per day with tiny amounts of blood.
Moderate - 4 to 6 stools per day and mild amount of blood but no systemic upset.
Severe - >6 stools per day, visible blood and systemic upset. Should be admited to hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of proctitis and proctosigmoiditis flares in UC?

A
  1. Topical ASA,
  2. If remission not achieved within 4 weeks then add oral aminosalicylate.
  3. If remission still not achieved then add topical/oral steroid.
  4. If steroids do not help then consider adding tacrolimus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management of extensive flares in UC disease?

A
  1. Rectal aminosalicylate and a high dose oral aminosalicylate.
  2. If remission not achieved then add oral corticosteroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the management of severe colitis?

A
  1. IV steroids in hospital (if contraindicated then use ciclosporin)
  2. After 72hr if no improvement then add IV ciclosporin or consider surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can you maintain remission in proctitis/proctosigmoiditis in UC?

A

Topical aminosalicylate alone or with oral aminosalicylate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you maintain remission in left-sided and extensive disease in UC?

A

Oral aminosalicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What medication should be added if UC patient has severe relapse of >2 exacerbations in a year?

A

Oral azathioprine or oral mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of Crohn’s disease?

A

Weight loss and lethargy,
Diarrhoea (can be bloody),
Abdominal pain,
Perianal disease (ulcers or sikin tags)
Mouth ulcers
Extra-inteestinal features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the investigations for suspected Crohn’s disease?

A

Bloods - CRP, fecal calprotectin, FBC, UEs, LFTs, B12 and folate (due to terminal ileum affected)
Endoscopy and biopsy - Deep ulcers and skip lesions.
Small bowel enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the histology and enema findings for crohns disease?

A

Histology - Granulomas, goblet cells, transmural thickness affected.
Small bowel enema - Strictures (String sign of Kantor), rose thorn ulcers, fistulae, proximal bowel dilation

17
Q

What are the complications of Ulcerative colitis?

A

Short term - Toxic megacolon, massive lower GI bleed.
Long term - colorectal cancer, cholangiocarcinoma, colonic strictures.
Variable term - Primary sclerosing cholangitis, inflammatory pseudopolyps

18
Q

What is the treatment for inducing remission in Crohn’s disease?

A

1st line - Glucocorticoids (oral, topical or IV)
2nd line - Aminosalicylates (mesalazine) but not as affective.
Additions: Azathioprine, mercaptopurine or methotrexate.

19
Q

What treatment is used to maintain remission in Crohn’s disease?

A

1st - Azathioprine or mercaptopurine (must check TPMT activity before).
2nd line - methotrexate

20
Q

Describe features of perianal fistulae, investigations and treatment

A

Connection between anal canal and perianal skin.
Investigations - MRI
Treatment - Metronidazole +/- anti -TNF agents. May need drainage seaton if complex.

21
Q

Describe features of perianal abscess

A

Requires incision and drainage + antibiotics.
May need seaton drainage if tract is identified

22
Q

What are the complications of Crohn’s disease?

A

Small bowel cancer,
Colorectal cancer,
Osteoporosis

23
Q

What is Primary sclerosing cholangitis?

A

Inflammation and fibrosis of intra and extra-hepatic bile ducts. Mainly associated with UC but also Crohn’s and HIV

24
Q

What are the features of PSC?

A

Cholestasis (jaundice, raised bilirubin and ALP),
RUQ pain as backpressure of bile causes hepatitis which can lead to cirrhosis,
Fatigue

25
Q

What are the investigations for PSC?

A

Main - ERCP/MRCP which shows beads on string appearence.
Will also be pANCA positive.

26
Q

What are the complications and management of PSC?

A

Complications - Cholangiocarcinoma and colorectal cancer.
Management - liver transplant, colesytramine for pruritis relief

27
Q

What are the features of primary biliary cholangitis?

A

Autoimmune condition causing interlobular bile duct inflammation which causes progressive cholestasis -> cirrhosis. Classic presentation is a middle ages woman with itching.

28
Q

What are the clinical features of PBC?

A

Fatigue,
Pruritis.
Cholestatic jaundice,
Hyperpigmentation,
RUQ pain,
Xantholomata,
Clubbing,
Hepatosplenomegaly
May progress to liver failure

29
Q

What are the investigations of PBC?

A

Anti-mitochondrial antibodies, raised serum IgM.
MRCP - to exclude obstruction

30
Q

What is the management of PBC?

A

1st line - ursodeoxycholic acid
Pruritis relief - colestyramine
Fat soluble vitamin supplements
Liver transplant (reoccurrence in graft isn’t normally a problem)

31
Q

What drug can be used in Crohn’s following a bowel resecction?

A

Cholestyramide. Can reduce absorption of fat soluble vitamins and can cause abdo cramps/constipation

Phase 4 - Gastroenterology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions