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JL Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Abdominal pain and peri-anal disease?

A

Crohns

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2
Q

Diarrhoea and bleeding?

A

UC

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3
Q

What does NOD2/CARD15 (1BD-1) genes do?

A

Encodes a protein involved in bacterial recognition

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4
Q

In the innate immunity of the bowel, what do tight junction regulate?

A

Epithelial permeability

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5
Q

In innate immunity, what protects the epithelial cell layer in the bowel?

A

Hydrophobic mucus

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6
Q

In innate immunity of the bowel, what can be activated constitutively or in response to bacterial components?

A

Defensins (cationic anti-microbial peptides)

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7
Q

What gene contributes to normal mucosal defences in innate immunity of bowel?

A

NOD2

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8
Q

What two factors can lead to maladaptive responses of the adaptive immune system?

A
  1. Overactive effector T cells = inflammation and disease

2. Absence of regulatory T cells = uncontrolled inflammation/aggressive disease

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9
Q

What is a Th1 mediated disease?

A

Crohns

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10
Q

What is a mixed Th1/Th2 mediated disease/NKTC?

A

UC

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11
Q

What disease has reduced antimicrobial activity?

A

Crohns

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12
Q

What disease is aggravated by smoking and what disease protects against it?

A

Crohns is aggravated

UC its protective in

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13
Q

Other than smoking, what is another environmental factor for IBD?

A

NSAIDs

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14
Q

What age group is peak incidence for UC?

A

20-30

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15
Q

What area of the colon does UC affect?

A

Affects rectum extending proximally

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16
Q

What are increased bowel frequency, urgency, tenesmus, incontinence, night rising, lower abdominal pain and sometimes constipation all suggest?

A

UC

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17
Q

What is classed as severe UC?

A

> 6 bloody stools/24 hours + 1 or more of: fever, tachycardia, anaemia Hb30

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18
Q

What two blood test features are important in UC?

A

CRP and albumin

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19
Q

What three investigations can be used to help diagnose UC?

A
  1. Plain AXR
  2. Endoscopy
  3. Histology
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20
Q

On a plain AXR, what three features suggest UC?

A
  1. Absent stool distribution in inflamed colon
  2. Mucosal oedema/thumb printing
  3. Toxic megacolon (transverse>5.5cm and Caecum>9cm)
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21
Q

What can confluent inflammation extending proximally from anal margin to transition zone, loss of vessel pattern, granular mucosa and contact bleeding all be found on in UC?

A

Endoscopy

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22
Q

Which condition affects the mucosal layer only?

A

UC

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23
Q

What two histological features are found in UC?

A

Absence of goblet cells

Crypt distortion and abscess

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24
Q

What is a long term increased risk for UC patients?

A

Colorectal cancer

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25
Q

What are two conditions found on skin in UC?

A
  1. Pyoderma gangrenosum

2. Erythema nodosum

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26
Q

What are 3 joint conditions found with UC?

A
  1. Spondylitis
  2. Sacroillitis
  3. Peripheral arthritis
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27
Q

What two conditions of the biliary tract relate to UC?

A

Gall stones

Primary Slerosing cholangitis

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28
Q

What condition in the liver is related to UC?

A

Steatosis/cirrhosis

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29
Q

What two conditions in the mouth relate to UC?

A

Stomatitis

Apthous ulcers

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30
Q

Name 1 eye condition found with UC?

A

Uveitis

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31
Q

What is the mean diagnosis age for Crohns?

A

27

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32
Q

Where can Crohns affect?

A

Any region of GI tract from mouth to anus

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33
Q

What are skip lesions and transmural inflammation found in?

A

Crohns disease

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34
Q

Where is the most common area for Crohsn?

A

Terminal ileum

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35
Q

What type of disease is associated with Crohns?

A

Perianal

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36
Q

What 4 features of peri-anal disease can Crohns cause?

A
  1. Recurrent abscess formation
  2. Pain
  3. Fistula with persitent leakage
  4. Damaged sphincter
37
Q

What three symptoms of the mouth can appear with Crohns

A
  1. Apthous ulcers
  2. Swollen lips
  3. Angular chielitis
38
Q

Where can a mass commonly be felt in Crohns?

39
Q

What 5 bloods are important to have with Crohns?

A

CRP, albumin, platelets, B12 (t.ileum), ferritin

40
Q

What condition has cobblestoning and what has pseudopolyps?

A 
Cobblestoning = crohns
Pseudopolyps = UC
41
Q

What do barium follow-through, small bowel MRI and technetium-labelled white cell scan assess?

A

Small bowel

42
Q

Transmural inflammation with non-caseating granulomas present?

43
Q

How is Crohns diagnosed?

A

Colonoscopy and biopsy

44
Q

What investigation for Crohnss shows cobblestoning and rose thorn ulcers?

A

Barium enema

45
Q

What investigation do you not do in UC?

A

Barium enema

46
Q

What has crypt absesses and continuous lesions>

47
Q

What are the 4 therapy options for UC?

A
  1. 5ASA mesalazine
  2. Steroids
  3. Immunosuppressants
  4. Anti-TNF therapy
48
Q

What are the three therapy options for Crohns?

A
  1. Steroids
  2. Immunosuppressants
  3. Anti-TNF
49
Q

What are two side effects of 5ASA mesalazine?

A
  1. Diarrhoea

2. Idiosyncratic nephritis

50
Q

What does mesalasine reduce the risk of?

A

cOLON CANCER

51
Q

What are three features of Oral 5-aminosalicylic acid (5ASA)?

A
  1. Prodrugs
  2. pH dependent release
  3. Delayed release
52
Q

What are 2 features of topical 5ASA?

A
  1. Suppositories

2. Enemas

53
Q

Name 4 5-ASA conjugates?

A
  1. Sulphazalazine
  2. Balsalazide
  3. Mezavant
  4. Mesalazine
54
Q

Name a pH release drug for UC and a delayed release drug for UC?

A

Asacol - pH

Pentasa - Delayed

55
Q

Where does salazopyrin 5-ASA release into?

56
Q

Where does balsalazide 5-ASA release into?

57
Q

Where do asacol and salofalk 5-ASA release into?

A

Ileum and colon

58
Q

Where does pentasa 5-ASA release into?

A

Duodenum, jejunum, ileum and colon

59
Q

Name two corticosteroids used for UC?

A

Prednisolone and Budesonide

60
Q

What do corticosteroids to in UC?

A

Induce remission

61
Q

What are two side effects of corticosteroids?

A

Avascular necrosis and osteoporosis

62
Q

What are three metabolic side effects of corticosteroids?

A

Weight gain, diabetes and hypertension

63
Q

In UC what immunosuppression should be used?

A

Steroid-sparing agents

64
Q

In crohns what 3 immunosuppression drugs can be used for maintanence therapy?

A
  1. Azathioprine
  2. Mercaptopurine
  3. Methotrexate
65
Q

What immunosuppression drug has a slow onset of action (16 weeks), TPMT activity which contributes to toxicity?

A

Azathioprine

66
Q

What drug should not be prescribed with azathioprine?

A

Allopurinol

67
Q

What are 4 side effects of azathioprine?

A

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

68
Q

What is tumour necrosis factor alpha?

A

Proinflammatory cytokines

69
Q

Name two anti-TNF therapy agents?

A
  1. Chimeric (infliximab: IV infusion)

2. Humanised (adalimumab:S/C injection)

70
Q

What does anti-TNF therapy promote?

A

Apoptosis of activated T lymphocytes

71
Q

In Crohns, what can repeated resection of the small intestine result in?

A

Short gut syndrome

72
Q

Can surgery for UC be curative?

73
Q

What are two otpions for UC therapy?

A
  1. Permanent ileostomy

2. Restorative proctocoloectomy and pouch

74
Q

What is an abnormal communication between two epithelial surfaces?

75
Q

What are two planned emergency operations for UC and Crohns?

A

Subtotal colectomy for UC

Resection for Crohns

76
Q

What are proctocolectomy with end ileostomy and proctocolectomy with ileorectal anastomosis elective operations on?

77
Q

What is usually left, usually flush and stool?

78
Q

What is usually right, usually spouted and usually effluent?

79
Q

What assessment of severity is ESR, haemoglobin, bloody stools, temperature and heart rate from?

A

Truelove and Witt criteria

80
Q

In a severe attack of IBD what is ESR?

81
Q

What is Rigler’s sign and what can it be found in?

A

Toxic megacolon and gas on outside of bowel wall

82
Q

In Crohns what does stenosis causing obstruction, enterocutaneous fistulas, intra-abdominal fistulas, abscesses, bleeding and free perforation indicate the need for?

83
Q

What investigations need to be done for diagnosing Crohns?

A

Endoscopy and mucosal biopsy

84
Q

In Crohns pathology, what ileal and/or colonic chronic activate mucosal inflammation is present/

A
  1. Cryptitis

2. Crypt abscesses

85
Q

What are 4 complications of Crohns disease?

A
  1. Malabsorption
  2. Iatriogenic - short bowel syndrome
  3. Hypoproteinaemia, vitamin deficiency, anaemia
  4. Gall stones
86
Q

What is acute fulminant colitis found in UC?

A

Toxic megacolon

87
Q

What is basal lymphoplasmacytic infiltrate with irregular shaped branching crypts found in?

88
Q

What kind of exudate is found with severe ulceration in UC?

A

Fibrinopurulent exudate

89
Q

What condition are pseudopolyps seen in and the same condition does not have granulomas?

JL Gastrointestinal (33 decks)

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