Inflammatory bowel disease Flashcards
what is the difference between the distribution of Crohn’s disease and UC?
Crohns can be anywhere from mouth to anus
UC only in colon and rectum
why does IBD occur?
failure to maintain oral tolerance –> breakdown in mucosal barrier –> activates innate and adaptive immune system –> inflammation
which type of IBD is transmural?
Crohns
which type of IBD destroys glands?
UC (loss of goblet cells, gland destruction, crypt abcess formation)
what are granulomas?
spherical areas of chronic inflammation in Crohns
what complications can arise with Crohn’s disease?
fistulas
perforations
stricturing (narrowing –> can cause blockages)
what complications can arise with UC?
chronic dilation
toxic megacolon
which disease may be improved by smoking?
UC (worsens Crohns)
can surgery correct Crohns?
depends on distribution
not a cure as it can return
what genetic mutation can predispose to crohn’s disease?
NOD2 mutation –> involved in antigen processing
What genetic polymorphism can result in crohns or UC?
IL-23R polymorphisms –> involved in regulation of Th1 and Th17 differentiation
what are the symptoms of IBD?
diarrhoeas (blood and mucus with UC) faecal urgency and incontinence weight loss abdominal pain/ cramps fatigue, lethargy perianal pain and discharge rectal bleeding aphthous ulcers in Crohns
what are the signs of IBD?
tender abdomen anaemia perianal absess fistulae and anal fissues vitamin deficiency
what are the extra-intestinal manifestations of IBD?
musculoskeletal dermatologic occular eg uveitis hepatobiliary disease pulmonary vascular renal pancreatitis
what basic tests can be used to diagnose IBD?
blood tests:
anaemia, inflammation markers (CRP/calprotectin)
which radiology scans can be used to help diagnose IBD?
barium studies
CT/ MRI studies
What are the different types of endoscopic tests?
sigmoidoscopy
colonoscopy
gastroscopy and biopsies
Why might a patient with IBD need emergency surgery?
sever bleeding bowel perforation bowel obstruction toxic dilation absess
Which IBD can have a protocolectomy and a pouch?
UC (crohns only proteoctomy no pouch)
What is proctitis?
UC only in the rectum
What is pan-colitis?
UC throughout whole colon and rectum
Which drugs induce remission?
steroids (short term eg prednisolone) and short term anti-inflammatory drugs
which drugs maintain remission?
immunosuppressants
azathioprine
methotrexate
aminosalicylates
how does azathioprine work?
effects apoptosis of T cells
how does methotrexate work?
decreases inflammatory cytokine production
which drugs could be used for resistant cases of IBD?
biologics
anti-TNF eg infliximab
vedolizumab
how does anti-TNF work?
TNF-a is a pro-inflammatory cytokine
anti-TNF binds TNF-a on cell surface –> apoptosis of inflammatory cell
How does vedolizumab work?
blocks a4b7 = integrin inhibitor (integrin expressed by t cells)
what are other potential treatments for IBD?
worm therapy –> anti-inflammatory cytokines
faecal transplantation
monoclonal antibody therapies
