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GENERAL SURGERY > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

describe the external longitudinal muscle of the large intestine

A

incomplete
- three distinct bands: teniae coli
- haustra are sacculations caused by contraction of teniae coli

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2
Q

what is IBD

A

group of conditions characterised by idiopathic inflammation of the GI tract, affecting the function of the gut

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3
Q

what are the 2 most common types of IBD

A

crohn’s disease
ulcerative colitis (young adults)

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4
Q

give an overview of ulcerative colitis

A
  • Begins in rectum, can extend to involve entire colon
  • Continuous pattern
  • Mucosal inflammation (not transmural)
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5
Q

what are the extra-articular manifestations of IBD

A
  • extra-intestinal: MSK pain (up to 50%), arthritis
  • skin (up to 30%): erythema nodosum, pyoderma gangrenosum, psoriasis
  • liver/biliary tree: primary sclerosing cholangitis
  • eye: uveitis
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6
Q

what are causes of IBD

A

Genetic:
-1st degree relative increased risk
-Identical twins concordance 70%

Gut organisms

Immune response –>triggers –> antibiotics, infections, smoking, diet

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7
Q

how might a Crohn’s patient present

A
  • Loose stool - non bloody
  • Weight loss due to decreased nutrient absorption
  • RLQ pain (position of ileum)
  • Smoker
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8
Q

what are the examination findings of Crohn’s

A
  • Tender mass (RLQ)
  • Mild perianal inflammation/ulceration
  • Low grade fever
  • Mildly anaemic (blood loss due to perforation of ulcers)
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9
Q

what are the gross pathological features of Crohn’s

A
  • Cobblestone appearence (on colonoscopy)
  • Skip lesions
  • Hyperaemia (red)
  • Mucosal oedema
  • Discrete superficial ulcers
  • Deeper ulcers
  • Transmural inflammation which leads to thickening of bowel wall and narrowing of lumen
  • Can lead to formation of fistulae between bowel and bladder/vagina/skin
  • Fat wrapping: mesentery thickens and wraps around small bowel
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10
Q

what are the microscopic features of crohn’s

A

granuloma formation (pathognomonic): organised collection of epithelioid macrophages

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11
Q

how is Crohn’s investigated

A
  • Bloods - anaemia, FBC, ESR/CRP, C.diff to rule out other causes of diarrhoea, calprotectin always +ve in IBD
  • CT/MRI scans:
    -bowel wall thickening
    -obstruction
    -extramural problems
  • Barium enema - locates strictures and fistulae
  • Gross pathological changes visible during endoscopy
    - skip lesions
    - cobblestone
    - fistulae
    - strictures
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12
Q

what are the different types of UC

A
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13
Q

how might a patient with UC present

A

Passing MANY loose stools - bloody
-mucus in stools

Weight loss

Mild lower abdominal pain

Painful red eye

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14
Q

what might be found on examination of suspected UC patient

A

Mildly tender abdomen

No perianal disease - UC is only a superficial process

Normal temp

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15
Q

what gross pathological changes are seen in UC (2)

A

Pseudopolyps can develop after repeated episodes:
-Inflammation then healing
-Non neoplastic
-More common in UC (vs Crohn’s)

Loss of haustra - haustra are suculations formed by contraction of outer longitudinal muscle (teniae coli)

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16
Q

what microscopic pathological changes can be seen in UC

A
  • Chronic inflammatory infiltrate of lamina propria
  • Crypt abscesses (neutrophilic exudate in crypts)

Crypt distortion:
- Irregular shaped glands with dysplasia
- Darker crowded nuclei

  • Reduced numbers of goblet cells
17
Q

how is UC investigated

A
  • Bloods: Anaemia and Serum markers
  • Stool cultures
  • Colonoscopy:
    look for continuous pattern of inflammation
  • Plain abdominal radiographs
  • Barium enema (mild cases only)
  • CT/MRI:
    Less useful in diagnosing uncomplicated UC since only superficial
18
Q

compare distinguishing characteristics of crohn’s and ulcerative colitis

A
19
Q

compare the pathological features of UC and crohn’s disease

A
20
Q

compare endoscopic changes seen in UC and crohn’s disease

A
21
Q

what feature of crohn’s can be seen in barium follow through

A

long strictures known as string sign of kantour

22
Q

give 5 defining features of crohn’s

A
23
Q

what features of UC can be seen in a double contract enema

A
  • featureless descending and sigmoid colon: lacking haustral markings and lead pipe colon
  • continous lesions without skipping
  • whole colon
  • mucosal inflammation: causes granular appearance
24
Q

what are the medical treatments available for UC (5)

A
  1. aminosalicylates e.g. sulfasalazine for flares and remission/ 1st line for mild-moderate UC
  2. corticosteroids e.g. predinosolone for flares only not long term
  3. immunomodulators e.g. azathioprine for fistulas/maintenance of remission
  4. biologics e.g. anti TNF agents, anti integrins
  5. JAK inhibitors e.g. Tofacinitib primarily for UC
25
Q

describe surgical treatment for crohn’s

A
  • not curative
  • strictures (stricturoplasty)/fistulas or abscesses by drainage
  • as little bowel removed as possible
26
Q

what surgical treatment is available for UC

A
  • curable via colectomy (pan-proctocolectomy) + ileostomy
  • inflammation not settling potential complications of pouchitis
  • precancerous changes
  • toxic megacolon: swelling and inflammation spread into the deeper layers of your colon so colon stops working and widens; can rupture in severe cases
27
Q

what is looked for in stool cultures in suspected UC patients (2)

A

C.difficile - could be causing symptoms

Faecal calprotectin - raised when there is bowel inflammation

28
Q

give an overview of Crohn’s disease

A
  • Affects anywhere in the GI tract
  • Terminal ileum involved in most cases
  • Transmural (affects whole thickness of GI wall)
  • Skip lesions (parts of inflammation separated by normal tissue)
29
Q

what are the long term complications of IBD

A
  • toxic megacolon
  • increasing risk of colorectal cancer with increased disease duration
30
Q

what are the long term complications of crohns

A
  • strictures leading to obstruction
  • fistulas (enterocutaneous, enteroenteric)
  • malabsorption of nutrients e.g. Fe, B12
  • small bowel cancer (screen for bowel cancer by colonoscopy, MRI small bowel)
  • abscesses
31
Q

why might patients with Crohns be more susceptible to gallstones

A

decreased absorption of bile in the terminal ileum

32
Q

what are the management goals of IBD

A
  • induce and maintain remission
  • prevent complications
  • improve QoL
33
Q

What are the indications for surgery in UC

A
  • fulminant disease
  • chronic complications
  • bleeding
  • steroid dependent
34
Q

what is involved in monitoring and surveillance of IBD

A
  • routine endoscopy
  • disease active monitoring: CRP, FCP
  • vaccines due to immunosuppressive
  • lifestyle mods: low residue diet, smoking cessations in Crohns, stress management

GENERAL SURGERY (10 decks)

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