Inflammatory Bowel disease Flashcards
definiton
Inflammatory bowel diseases are a generic
entity that includes two conditions,
characterised by:
* Chronic evolution,
* Characterized by immunological damage,
* Recurrent inflammation of the
gastrointestinal tract.
Includes:
* Crohn’s disease,
* Ulcerative colitis.
How does smoking affect the occurrence of ulcerative colitis and Crohn’s disease?
Ulcerative colitis occurs more frequently among former smokers and non-smokers.
Crohn’s disease occurs more often among smokers.
How does socio-economic development influence the occurrence of inflammatory bowel diseases?
Inflammatory bowel diseases occur more often in developed countries.
The occurrence is more common in urbanized areas compared to rural areas.
What lifestyle changes associated with “westernization” are believed to contribute to the increased occurrence of IBD?
Changes in diet.
Smoking.
Difference in exposure to sunlight.
Pollution.
Exposure to various chemicals of industrial origin.
How many genes have been associated with inflammatory bowel disease?
A number of genes associated with inflammatory bowel disease have been identified.
110 associated with both diseases.
30 specific to Crohn’s.
23 specific to ulcerative colitis.
What is the first known susceptible gene for Crohn’s disease?
NOD2
What are other genes associated with IBD?
ATG16L1 and IRGM.
What is the effect of smoking on ulcerative colitis?
Protective effect in ulcerative colitis.
What is the effect of smoking on Crohn’s disease?
risk factor
What is the immunological role of vitamin D in IBD?
Low levels increase the risk of developing inflammatory bowel disease.
What is the effect of antibiotic use on IBD?
The use of antibiotics - increased occurrence of inflammatory bowel disease.
What is the effect of aspirin and other nonsteroidal anti-inflammatories on IBD
The use of aspirin and other nonsteroidal anti-inflammatories can become triggers for relapses.
what gut microbs dominate the guts?
Firmicutes and Bacteroidetes phyla predominate,
What is the central idea of the first hypothesis regarding the pathogenesis of IBD, involving microbial pathogens?
The antigenic trigger is represented by microbial pathogens.
According to this theory, the immune response in inflammatory bowel diseases is adequate but exaggerated for these pathogenic germs.
This type of “hyperreactive” immune response can cause the proliferation and persistence of microbial germs.
What changes in intestinal bacteria are observed in Crohn’s disease?
In Crohn’s disease, there is a relative lack of certain bacteria, and an excessive presence of enterobacteria occurs.
What is the second hypothesis regarding the antigenic trigger in IBD?
The antigenic trigger may be a common antigen that occurs in the diet or a non-pathogenetic microbial agent to which an abnormal immune reaction occurs.
What auto-antibodies are known to be more specific and can be highlighted in ulcerative colitis, as mentioned in the third hypothesis?
pANCA
Antibodies directed to tropomyosin
What is the central idea of the third hypothesis, the “autoimmune” theory, regarding the pathogenesis of IBD?
The antigenic trigger is produced by the patient’s own cells, and especially by the cells of the intestinal epithelium.
In this “autoimmune” theory, an adequate response against an intraluminal, dietary, or microbial antigen occurs due to the similarity between the luminal antigen and the protein on the epithelial cells.
They are destroyed by a directly cell-mediated cytotoxic mechanism or by antibody-dependent cytotoxic mechanism.
What characteristics may be present in the stool of IBD patients with diarrhea?
The stool may contain mucus and blood.
What is a common gastrointestinal symptom in IBD?
Diarrhea
What are two specific patterns of diarrhea that can occur in IBD?
Nocturnal diarrhea
Incontinence
In what form of ulcerative colitis is constipation a primary symptom?
Ulcerative colitis limited to the rectum (proctitis)
block of gases
What type of intestinal pain is a medical emergency?
Severe spasms in the intestine
What is tenesmus?
(The feeling of needing to pass stool, even though your bowels are already empty)
Where is abdominal pain commonly located in Crohn’s disease?
Those in the lower abdominal right quadrant
Where is abdominal pain commonly located in moderate and severe forms of ulcerative colitis?
Periumbilical ones, or in the left lower quadrant
Are nausea and vomiting more likely in Crohn’s disease or ulcerative colitis?
They are more likely to be highlighted in Crohn’s disease than in ulcerative colitis.
In some cases, the following symptoms may
occur:
- Fever
- Lack of appetite,
- Weight loss,
- Fatigue,
- Night sweats,
- Decrease in the growth rate,
- Primary amenorrhea.
What type of intestinal lesions are the source of hemorrhage in ulcerative colitis?
Profuse, starting from ulcerative lesions in ulcerative colitis.
What percentage of people with Crohn’s disease have ulcers in the stomach and duodenum?
5–10% of people with Crohn’s disease have ulcers in the stomach and duodenum.
In Crohn’s disease, where does damage to the proximal segment of the small intestine occur more frequently?
children
What are other intestinal complications that can occur in IBD?
Intestinal perforations.
Intra-abdominal abscesses that can occur with Crohn’s disease.
In which IBD are strictures a common complication?
Crohn’s disease
What type of strictures in Crohn’s disease require endoscopic or surgical interventions?
Strictures that occur as a result of fibrous scars.
What is the nature of strictures that occur in Crohn’s disease, and how are they managed?
Often inflammatory (they can be resolved by appropriate treatment).
What is the concern about colonic strictures in ulcerative colitis?
Strictures in the colon that can occur in ulcerative colitis are supposed to be malignant in nature until proven otherwise.
What is a risk associated with fistulas in IBD?
There is a risk of recurrence.
How are simple fistulas in IBD typically treated?
Simple fistulas are treated surgically if no medical therapy is available.
How are complex fistulas in IBD typically treated?
In complex fistulas, surgical treatment is resorted to simultaneously with drug treatment.
What are some examples of fistulas that can occur in IBD, and what can they lead to?
Fistulas to the urinary tract or vagina are not uncommon and can lead to pneumaturia (air in urine) or fecaluria (feces in urine) or air passage from the vagina.
As a consequence of these changes is the induction of urinary infections or gynecological inflammations.
How is toxic megacolon treated?
Toxic megacolon requires aggressive medical therapy and emergency surgery if there is no therapeutic response within 24 hours.
How is toxic megacolon diagnosed?
This complication is characterized by a dilation of the colon that is diagnosed based on an abdominal X-ray.
How does the risk of malignancy change in IBD?
The risk increases in direct proportion to the duration of the disease, the early period of occurrence of the disease, and whether there is a family history of colorectal cancer, even sporadically.
What is the typical relationship between arthralgias and intestinal disease activity in IBD?
In many situations, arthralgias are present in parallel with the disease at the intestinal level.
What percentage of IBD patients experience arthralgia, and what about the rest?
15-20% have arthralgia and the rest localization in other organs.
When can some extraintestinal complications of IBD occur?
Some complications can occur before the diagnosis of inflammatory bowel disease is established.
What is a common arthritic complication of IBD?
Arthritis - more common complication
What are some other musculoskeletal complications of IBD?
Ankylosing spondylitis
What are some dermatologic complications of IBD?
Pyoderma gangrenosum
Erythema nodosum
What are some ocular complications of IBD?
Iritis
Uveitis
Episcleritis
What is a hepatobiliary complication of IBD?
Primary sclerosing cholangitis
What complications are more specific to Crohn’s disease?
In Crohn’s disease, nephrolithiasis (kidney stones) and cholelithiasis (gallstones) may occur.
What is the purpose of a routine copro-parasitological examination in IBD?
To eliminate bacterial, viral, and parasitic contamination as the causes of diarrhea.
What specific bacterial infection should be tested for in stool samples of IBD patients?
The presence of Clostridium difficile (even in the absence of antibiotic treatments).
What does the presence of occult hemorrhages in the stool of IBD patients indicate?
May be an indication for colonoscopy.
What viral infection should be considered in IBD patients who have undergone immunosuppressive or corticoid treatments?
CMV
What stool markers are used to assess inflammation in IBD?
Calprotectin, lactoferrin, α1-antitrypsin - inflammatory markers
What are the p-ANCA and ASCA tests used for in IBD?
For cases of unclassified inflammatory bowel disease.
What do p-ANCA positive and ASCA negative results suggest?
Ulcerative colitis.
What do p-ANCA negative and ASCA positive results suggest?
Crohn’s disease.
When should a celiac disease antibody test be performed in IBD?
It should be performed unless obvious non-celiac features such as fistulas, perineal disease or hemorrhages in the stool occur.
What tests can be done to exclude intestinal tuberculosis in IBD (in areas of high probability)?
Tegumentary PPD (“purified protein derivative”) test.
PPD serum antibody test.
Interferon-γ tests (QuantiFERON-TB, T-SPOT, TB test).
When is an abdominal X-ray indicated in IBD?
If intestinal occlusion, perforation, or toxic megacolon is suspected.
When is a barium swallow X-ray recommended in IBD?
Not usually recommended in severe cases.
Barium swallow for the small intestine (Pansdorff) is still commonly used in the evaluation of the distal portion of the small intestine.
Barium enema can be useful in areas that cannot be reached by colonoscopy or in the case of an incomplete colonoscopy.
What are the purposes of transverse imaging (CT, ultrasonography, MRI) in IBD?
Assessment of the extent of the disease.
The degree of severity of the disease.
Determines the possibility of developing perforations in the case of Crohn’s disease.
When are MRCP or ERCP indicated in IBD?
If there are signs of cholestasis.
What is the purpose of a chest X-ray in IBD?
The presence of a film of air below the diaphragm that may occur in the event of perforation must also be assessed.
What are the purposes of rectosigmoidoscopy and colonoscopy in IBD?
Examination for ulcers, inflammation, bleeding, stenosis.
Multiple biopsy of the colon and terminal ileum.
What is a limitation of colonoscopy in severe or fulminant forms of IBD?
Limited applicability due to the risk of perforation.
When is upper gastrointestinal endoscopy indicated in IBD?
Symptoms such as nausea, vomiting, epigastric pain.
What are push enteroscopy and double balloon enteroscopy used for in IBD
To investigate damage to the small intestine when other diagnostic modalities have not been conclusive.
It can be a means of reaching strictures on the small intestine for dilation.
What is the primary advantage of using an endoscopic capsule in IBD?
Allows a visualization of all segments of the digestive tract.
Allows a positive diagnosis if colonoscopy, gastrointestinal endoscopy and radiological investigation have led to negative results.
What additional benefits does the endoscopic capsule provide in IBD?
Allows to assess the extent of lesions.
Quantify the response to therapy.
Detects the occurrence of relapses.
What is a significant limitation of the endoscopic capsule in IBD?
It does not allow biopsies to be taken from the areas affected by the disease.
What histological findings are specific to chronic colitis (IBD) and atypical for infectious colitis?
Evaluation of crypt distortions
Increase in subcryptal space
Basal plasmocytosis
What histological finding is suggestive of Crohn’s disease?
Evaluation of non-caseating granulomas
What histological finding would suggest tuberculosis instead of Crohn’s disease?
Large or necrotic/caseous granulomas
Why is it important to identify histological changes in areas with a normal endoscopic appearance?
This can indicate the degree of extent of the disease.
When is it important to look for Cytomegalovirus (CMV) in tissue samples?
In patients undergoing immunosuppressive treatments or corneal treatments with corticosteroids.
What serological test can be used as an adjuvant measure for CMV?
CMV IgM
When is an investigation for dysplasia or tumor mass warranted?
In the case of screening for dysplasia.
In the situation of the presence of a tumor mass.
