inflammatory bowel disease Flashcards

1
Q

inflammation ….. infection

A

IS NOT

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2
Q

What are the two major forms of IBD

A
  1. Crohn’s disease
  2. Ulcerative colitis
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3
Q

epidemiology of IBD

A

o Peak between the ages of 15-30 and second peak between the ages of 60-80.
oMore frequent in“rich” countries/places such as north America, Scandinavia, andEurope.

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4
Q

Where does UC begin

A

Colon and rectum

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5
Q

Where does CD begin

A

Any part of the GI tract

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6
Q

describe the development of UC

A

Continuous pattern of inflammation

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7
Q

describe the development of CD

A

Skips lesions

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8
Q

describe the onset of UC

A

Acute (sudden/rapid) onset

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9
Q

describe the onset of CD

A

Gradual onset

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10
Q

What happens within patients with UC

A

»Ulcers, ulcerations, (pseudo)polyps, bulges in mucosa
»Normal architecture damaged
»Microbiome affected.
» BLOOD IN STOOL
»Can cause colon cancer

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11
Q

What happens within patients with CD

A

» Entire intestinal wall affected.
» Granulomas (inflammations)
» Thicker wall, smaller lumen
» Cobble stones
» Perforations – stool leaks into abdominal cavity

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12
Q

What are the symptoms of UC

A

» Rectal bleeding
» Having to go to the toilet very often
» Loose stools
» Abdominal pain on the lower left side
»Tenesmus: urge to defecate
» Blood in stool

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13
Q

WHat are the symptoms of CD

A

» Chronic and nocturnal diarhhea OR constipated
» Pain in lower right abdomen
» Weight loss
» Mild fever
» Increases in severity with age = progressive disease
» absecces and fistulae

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14
Q

What are the extra intestinal symptoms of UC

A

»Joint pain
»Canker sore(aften) in mouth
»Spinal deformation due to inflammation
»Slow healing wounds
»Erythema nodosum
»Eye bleeding

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15
Q

WHat are the extra-intestinal symptoms of CD

A

» Inflammated joints
» Same as ulcerative colitis
» Kidney problems
» Galstones
» Liver problems

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16
Q

Crohn’s disease clinical features

A

(1) Inflammation -> small intestine (abdominal pain, diarrhea, and fever) & large intestine (diarrhea, blood loss, weight loss and fever)
(2) Stricturing -> Bowel obstructions due to wall thickening
(3) Penetration -> abscesses and fistulae (abnormal passages get formed)

17
Q

describe the pathogenesis of IBD

A
  1. Genetic susceptibility: some kind of genetic predisposition – variants that cause an exaggerated inflammatory response.
  2. Immune response: the overreactive immune response – people with IBD react worse to inflammations.
  3. Environmental triggers: we see that IBD is more common inn wealthy countries so environmental factors do play a role HOWEVER we’re not really sure which ones.
  4. Microbiome (more recently added): the collection of all bacteria that live inside our intestines – people with IBD have distinctively different microbiomes than their family members without IBD.
18
Q

Risk factors that can cause IBD

A

» Diet
» Infection – if people with a genetic predisposition get certain infections, their body will react with an exaggerated inflammatory
response = the start of IBD
o Crohn’s – mycobacterium paratuberculosis
o Ulcerative colitis - after episodes of infective diarrhea
» Appendectomy (ONLY UC)
» Stress – stress triggers a relapse of IBD (NOT THE CAUSE BUT CAN TRIGGER RELAPSE)

19
Q

What actually happens within the body during the overreactive immune response? (IBD)

A

= it’s an abnormal reaction of the T-cells that cause an exaggerated inflammatory response
o (Causative agents+luminal factors+modifying factors)–cause an inflammation.

But HOW?
o Lymphatic T-cells get sent to the affected zone.
o These T-cells cause the exaggerated inflammatory response.
o If the response is not transmural then it’s UC, if it is then it’s Crohn’s disease.

20
Q

Explain the diagnosis of IBD

A
  1. Blood tests – check for c-reactive protein which gets released in blood during an inflammatory reaction
  2. Stool studies
  3. Colonoscopy (=most frequently done) and endoscopy
    a. Ileo-colonoscopy with biopsies (sometimes with small intestine as well)
    b. Upper endoscopy with biopsies
    (Capsule endoscopy - capsule with camera = still in development)
21
Q

Explain the treatment of IBD

A

= the main goal of the treatment is to minimize the intestinal inflammation + improve general health + repair/heal the mucosa

Pharmacological management
o Anti-inflammatory agents: 5-amino salicylic acid (5-ASA)
o Steroids, cortisone they suppress the immune system HOWEVER can only be given for acertain number of days.
o Anti-tumor necrosis factor(anti-TNF) agents–TNF is a protein in your body that causes inflammation (everything that can be given ends with …mab)
o Probiotics – they strengthen the microbiome daily.

22
Q

Is UC transmural or not

A

no, NOT transmural

23
Q

Is CD transmural or not

A

yes, transmural

24
Q

Tenesmus

A

urge to defecate

25
Q

abscesses

A

localized collections of pus that result from an infection

26
Q

fistulae

A

abnormal connections or tunnels that form between two organs or between an organ and the outside of the body
- the transmural inflammation can lead to the formation of fistulae

27
Q

Erythema nodosum

A

red spots on legs

28
Q

explain the role of appendectomy in UC

A

people that get an appendectomy are less likely to develop UC, and people who developed UC after appendectomy were less likely to develop recurrent disease. = less severe course