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Inflammatory Bowel Disease Flashcards

0
Q

What are some IBD conditions?

A 
Ulcerative colitis
Crohn's disease
Diversion colitis
Diverticular colitis 
Radiation, drug, infectious, ischaemic colitis
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1
Q

What is IBD?

A

A group of conditions characterised by idiopathic inflammation of the GI tract

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2
Q

What is colitis?

A

Inflammation of the lining of the colon

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3
Q

Pathophysiology of IBD?

A

Unknown
Most likely to be immune dysfunction which is genetically mediated, causes inappropriate immune activation in response to luminal microorganisms

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4
Q

Where does ulcerative colitis affect?

A

Rectum
Extends proximally IN CONTINUITY to affect a variable extent of the colon
Inflammation confined to mucosa

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5
Q

Who does ulcerative colitis affect?

A

High incidence in UK, US and Northern Europe

Young adults, more commonly females

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6
Q

What is UC a result of?

A

Environmental trigger in a genetically susceptible person

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7
Q

Pathology of UC?

A

Bacterial/dietary antigens taken up by M cells in Peyer’s patches and pass into lamina propria
Antigens picked up by antigen-presenting cells in lamina propria
APCs release inflammatory cytokines - IL-12 and 18, α-ΤΝF
This and presentation of antigens to CD4+ T cells -> activation of TH1 cells
Secrete more cytokines and attract more T cells -> inflammatory response

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8
Q

What is the result of the pathology of UC?

A

Ulceration and stricture formation

There may be an accompanying fever, malaise, anorexia

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9
Q

What does UC present with?

A 
Rectal bleeding
Diarrhoea
Abdominal pain
Fever
Malaise
Anorexia
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10
Q

What is Crohn’s disease and where does it affect?

A

A condition of chronic inflammation
Can involve any part of GI tract, from mouth to anus
Not continuous

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11
Q

Symptoms of Crohn’s disease?

A 
Diarrhoea
Abdominal pain
Weight loss
Fever
Malaise
Anorexia
Nausea
Vomiting
Constipation if in terminal ileum/causing a blockage
Anaemia if terminal ileum is involved due to B12 nor absorbed
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12
Q

What gene is affected in Crohn’s disease?

A

IBD1

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13
Q

Environmental factors for development of UBD?

A 
NSAIDs - can alter intestinal barrier
Low residue, high refined sugar diet
Antibiotics because they can get rid of normal flora
Diet
Acute infections
Smoking 
Stress (Crohn's)
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14
Q

How does smoking affect UC and CD?

A

Smoking can protect against UC

Can increase chance of Crohn’s

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15
Q

What investigations would you do for IBD?

A

Colonoscopy - take biopsy of mucosa and look at ulceration
Stool analysis - look at parasites, C. Diff toxin, culture to exclude infectious cause
Barium radiograph
CT scan - acute attacks
Capsule endoscopy - examine small intestine
Plain X-ray if vowel obstruction/perforation is suspected

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16
Q

What can a barium radiograph show?

A

Macroscopic extent of the disease
Ulceration
Loss of Haustra
Shortened colon as a result of scarring/fibrosis

17
Q

What macroscopic changes are seen in Crohn’s?

A

Bowel is thickened and narrowed
Deep ulcers and fissures five cobblestone appearance
Fistulae
Abscesses

18
Q

Macroscopic appearance of ulcerative colitis?

A

Reddened mucosa
Inflamed
Bleeds easily

If severe

  • extensive ulceration
  • adjacent mucosa appears as inflammatory pseudopolyps
19
Q

Microscopic features of Crohn’s disease?

A

Inflammation through all layers of the bowel (transmural)
Increase in chronic inflammatory cells
Lymphoid hyperplasia
Granulomas from T helper cell response

20
Q

Microscopic features of UC?

A

Superficial inflammation
Chronic inflammatory cells in lamina propria
Crypt abscesses
Goblet cell depletion

21
Q

If you cannot distinguish between UC and CD in a patient, what is the patient said to have?

A

Colitis of Undetermined Type and aEtiology (CUTE)

22
Q

What can be used to help in differentiating between UC and CD?

A

Serological testing
UC - anti-neutrophil cytoplasmic antibodies (ANCA)
CD - anti-Saccharomyces cervisiae (ASCA)

23
Q

What endoscopic abnormalities are seen in CD?

A

Colonoscopy - cobblestoning

24
Q

What is seen in imaging of the small bowel in Crohn’s disease?

A

String sign of Kantor
Asymmetrical alteration in mucosal pattern with deep ulceration
Areas of narrowing/strictures

25
Q

What methods can be used for imaging of the small bowel?

A

Barium follow through
CT scan with oral contract
Small bowel ultrasound
MRI

26
Q

What is gold standard for the diagnosis of ulcerative colitis?

A

A colonoscopy to take a biopsy

Allows you to assess disease activity and extent

27
Q

What is seen in an abdominal X ray for UC?

A

Excludes colonic dilation

Collar button ulcers (ulcers through the bowel mucosa into the muscle, then up and down like a T)

28
Q

In the treatment of CD, how is remission induced and maintained?

A

Induced: corticosteroids (oral/IV), enteral nutrition, anti-TNF antibodies (Infliximab), methotrexate (modifies and suppresses immune system)

Maintained: methotrexate, azathioprine (same as methotrexate), infliximab

29
Q

How does infliximab work?

A

Binds to membrane-bound TNF-α to induce immune cell apoptosis

30
Q

When and how is CD surgically managed?

A

If there is failure of therapy, still acute and chronic symptoms
If there are complicatins eg dilation, obstruction, perforation, abscesses
Failure to grow in children despite treatment

Colectomy or ileorectal anastamosis is done

31
Q

How is ulcerative colitis treated?

A

Distal disease - topical/suppository corticosteroids
Left-sided colitis - topical corticosteroid enema
Extensive colitis - oral corticosteroids, infliximab

32
Q

When and what surgery is done for UC?

A

Patients with complications/corticosteroid dependence.

In acute disease, subtotal collecting with end ileostomy preservation of rectum.

33
Q

What is the cancer risk of UC and CD?

A

UC: colorectal

CD : colorectal, small bowel (depends on location)

34
Q

In which one is perianal disease more common in?

A

CD

35
Q

In which one are you more likely to find granulomas?

A

Crohn’s

36
Q

In which one do you get straightening of the colon?

A

Ulcerative colitis after a long time

37
Q

When are the two peaks in incidence for IBD?

A

15-30

60

38
Q

What is the mucosa of CD patients dominated by?

A

TH2 (T-helper) cells

They release interferon γ and IL-2

39
Q

Presentation of Crohn’s if there is upper GI involvement?

A 
Nausea and vomiting
Dyspepsia
Small bowel obstruction
Anorexia and weight loss
Loose stools
40
Q

Presentation of Crohn’s if there is lower GI involvement?

A

Diarrhoea

Passage of obvious blood

41
Q

What is the mucosa of UC patients dominated by?

A

TH2 cells which produce transforming growth factor (TGF) and IL-5

GI (21 decks)

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