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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
What are two conditions found on skin in UC?
1. Pyoderma gangrenosum | 2. Erythema nodosum
26
What are 3 joint conditions found with UC?
1. Spondylitis 2. Sacroillitis 3. Peripheral arthritis
27
What two conditions of the biliary tract relate to UC?
Gall stones | Primary Slerosing cholangitis
28
What condition in the liver is related to UC?
Steatosis/cirrhosis
29
What two conditions in the mouth relate to UC?
Stomatitis | Apthous ulcers
30
Name 1 eye condition found with UC?
Uveitis
31
What is the mean diagnosis age for Crohns?
27
32
Where can Crohns affect?
Any region of GI tract from mouth to anus
33
What are skip lesions and transmural inflammation found in?
Crohns disease
34
Where is the most common area for Crohsn?
Terminal ileum
35
What type of disease is associated with Crohns?
Perianal
36
What 4 features of peri-anal disease can Crohns cause?
1. Recurrent abscess formation 2. Pain 3. Fistula with persitent leakage 4. Damaged sphincter
37
What three symptoms of the mouth can appear with Crohns
1. Apthous ulcers 2. Swollen lips 3. Angular chielitis
38
Where can a mass commonly be felt in Crohns?
LIF
39
What 5 bloods are important to have with Crohns?
CRP, albumin, platelets, B12 (t.ileum), ferritin
40
What condition has cobblestoning and what has pseudopolyps?
``` Cobblestoning = crohns Pseudopolyps = UC ```
41
What do barium follow-through, small bowel MRI and technetium-labelled white cell scan assess?
Small bowel
42
Transmural inflammation with non-caseating granulomas present?
Crohns
43
How is Crohns diagnosed?
Colonoscopy and biopsy
44
What investigation for Crohnss shows cobblestoning and rose thorn ulcers?
Barium enema
45
What investigation do you not do in UC?
Barium enema
46
What has crypt absesses and continuous lesions>
uc
47
What are the 4 therapy options for UC?
1. 5ASA mesalazine 2. Steroids 3. Immunosuppressants 4. Anti-TNF therapy
48
What are the three therapy options for Crohns?
1. Steroids 2. Immunosuppressants 3. Anti-TNF
49
What are two side effects of 5ASA mesalazine?
1. Diarrhoea | 2. Idiosyncratic nephritis
50
What does mesalasine reduce the risk of?
cOLON CANCER
51
What are three features of Oral 5-aminosalicylic acid (5ASA)?
1. Prodrugs 2. pH dependent release 3. Delayed release
52
What are 2 features of topical 5ASA?
1. Suppositories | 2. Enemas
53
Name 4 5-ASA conjugates?
1. Sulphazalazine 2. Balsalazide 3. Mezavant 4. Mesalazine
54
Name a pH release drug for UC and a delayed release drug for UC?
Asacol - pH | Pentasa - Delayed
55
Where does salazopyrin 5-ASA release into?
Colon
56
Where does balsalazide 5-ASA release into?
Colon
57
Where do asacol and salofalk 5-ASA release into?
Ileum and colon
58
Where does pentasa 5-ASA release into?
Duodenum, jejunum, ileum and colon
59
Name two corticosteroids used for UC?
Prednisolone and Budesonide
60
What do corticosteroids to in UC?
Induce remission
61
What are two side effects of corticosteroids?
Avascular necrosis and osteoporosis
62
What are three metabolic side effects of corticosteroids?
Weight gain, diabetes and hypertension
63
In UC what immunosuppression should be used?
Steroid-sparing agents
64
In crohns what 3 immunosuppression drugs can be used for maintanence therapy?
1. Azathioprine 2. Mercaptopurine 3. Methotrexate
65
What immunosuppression drug has a slow onset of action (16 weeks), TPMT activity which contributes to toxicity?
Azathioprine
66
What drug should not be prescribed with azathioprine?
Allopurinol
67
What are 4 side effects of azathioprine?
Pancreatitis Leucopaenia Hepatitis Small risk of lymphoma, skin cancer
68
What is tumour necrosis factor alpha?
Proinflammatory cytokines
69
Name two anti-TNF therapy agents?
1. Chimeric (infliximab: IV infusion) | 2. Humanised (adalimumab:S/C injection)
70
What does anti-TNF therapy promote?
Apoptosis of activated T lymphocytes
71
In Crohns, what can repeated resection of the small intestine result in?
Short gut syndrome
72
Can surgery for UC be curative?
Yes
73
What are two otpions for UC therapy?
1. Permanent ileostomy | 2. Restorative proctocoloectomy and pouch
74
What is an abnormal communication between two epithelial surfaces?
Fistula
75
What are two planned emergency operations for UC and Crohns?
Subtotal colectomy for UC | Resection for Crohns
76
What are proctocolectomy with end ileostomy and proctocolectomy with ileorectal anastomosis elective operations on?
UC
77
What is usually left, usually flush and stool?
Colostmy
78
What is usually right, usually spouted and usually effluent?
Ileostomy
79
What assessment of severity is ESR, haemoglobin, bloody stools, temperature and heart rate from?
Truelove and Witt criteria
80
In a severe attack of IBD what is ESR?
>30
81
What is Rigler's sign and what can it be found in?
Toxic megacolon and gas on outside of bowel wall
82
In Crohns what does stenosis causing obstruction, enterocutaneous fistulas, intra-abdominal fistulas, abscesses, bleeding and free perforation indicate the need for?
Surgery
83
What investigations need to be done for diagnosing Crohns?
Endoscopy and mucosal biopsy
84
In Crohns pathology, what ileal and/or colonic chronic activate mucosal inflammation is present/
1. Cryptitis | 2. Crypt abscesses
85
What are 4 complications of Crohns disease?
1. Malabsorption 2. Iatriogenic - short bowel syndrome 3. Hypoproteinaemia, vitamin deficiency, anaemia 4. Gall stones
86
What is acute fulminant colitis found in UC?
Toxic megacolon
87
What is basal lymphoplasmacytic infiltrate with irregular shaped branching crypts found in?
UC
88
What kind of exudate is found with severe ulceration in UC?
Fibrinopurulent exudate
89
What condition are pseudopolyps seen in and the same condition does not have granulomas?
UC

JL Gastrointestinal (33 decks)

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