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GI and metabolism > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

What are the two diagnoses that fall under the inflammatory bowel disease label?

A

Ulcerative colitis and Crohn’s disease.

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2
Q

What is the age range for IBD?

A

15-40

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3
Q

Describe the process of early gut inflammation.

A

Antigenic activation of innate immune cells (NK cells, mast cells neutrophils, macrophages, and dendritic cells).

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4
Q

Describe the processes behind the maintenance of the inflammatory response in the gut.

A

Maintained by the adaptive immune response. Abnormally activated CD4+ cells release pro-inflammatory mediators leading to chronic tissue damage.

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5
Q

What is the cause of inflammatory bowel disease?

A

Failure to maintain oral tolerance.

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6
Q

What are the genetic factors associated with IBD?

A

NOD2 (Crohn’s) - involved in intracellular processing of bacterial antigens.

IL-23R (Crohn’s and UC) - involved in regulation of Th-1 and Th-17 cell differentiation.

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7
Q

What is the largest independent risk factor for IBD.

A

Positive family history.

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8
Q

How does the distribution of UC differ from Crohn’s?

A

UC- Rectum and colon only

Crohn’s - GI tract, mouth and anus

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9
Q

How does the histology of UC differ from Crohn’s?

A

UC - mucosa/submucosa

Crohn’s - transmural

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10
Q

What impact does smoking have upon UC and Crohn’s?

A

UC - seems to improve?

Crohn’s - worsens

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11
Q

What surgical interventions may be used in UC and Crohn’s?

A

UC - pan-protocolectomy +/- pouch

Crohn’s - depends on distribution

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12
Q

What features present in Crohn’s are not present in UC?

A

Reccurance after surgery, peri-anal diseas, fistulae and abcesses.

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13
Q

What are the possible extraintestinal manifestations of IBD?

A

Arthritis, sacroiliitis, ankylosing spondylitis, osteoporosis

Various dermatologic.

Thrombotic events, vasculitis.

Uveitis, scleritis, episcleritis.

Various renal, pancreatic and hepatobiliary.

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14
Q

What blood tests might you do for inflammatory bowel disease?

A

CRP, calprotectin and other markers of inflammation.

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15
Q

What radiology investigations might you do for IBD?

A

Barium series, CT, MRI.

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16
Q

What are the different types of ulcerative colitis?

A

Proctitis, left-sided colitis and pan-colitis.

17
Q

What are the possible symptoms of UC?

A

Diarrhoea with blood and mucous, urgency, weight loss, abdo pain, cramps and nocturnal symptoms.

18
Q

What are the possible signs of UC?

A

Tender abdomen, tachycardia, pyrexial and extra-intestinal manifestitions.

19
Q

What is the initiating stimulus in IBD?

A

Commensal gut flora - patient studies demonstrate hypersensitivity to own gut bacterial antigens.

20
Q

Which immunomodulatory drug would be used to treat UC but not Crohn’s.

A

Ciclosporin

21
Q

What other immunomodulatory drugs may be used in IBD?

A

Methotrexate and azathioprine.

22
Q

For which condition are the mesalazines better?

A

UC

23
Q

What biologics may be used in the treatment of IBD?

A

Anti-TNF and vedolizumab.

24
Q

What is the mechanism of action for methotrexate?

A

Inhibits folate metabolism. Cytotoxic effects via DHFR inhibition. Also anti-inflammatory effect. Leads to IL-1 receptor blockade, increase IL-2, decrease IL-6 and 8 and impaired neutrophil chemotaxis.

25
Q

Under what circumstances would you perform emergency surgery for IBD?

A

Bowel perforation, bowel obstruction, toxic dilatation, severe bleeding and abcess.

26
Q

Under what circumstances would you perform elective surgery for IBD?

A

Cancer (pre-cancer), failed medical treatment and choice.

27
Q

What is a proctocolectomy with ileostomy?

A

Removal of rectum, colon and anus with ileostomy.

28
Q

How might a loop ileostomy be closed?

A

Creation of an ileal J-pouch and anal anastamosis.

29
Q

What is an ileocaecal resection?

A

Part of the bowel is removed and the healthy parts anastamosed together.

30
Q

What is a colectomy with ileorectal anastamosis?

A

Removal of the colon, anastamosis of ileum to rectum.

31
Q

What are other potential forms of therapy for IBD.

A

Inhibitors of inductive cytokines, cytokines to induce Tregs, vectors, attenuated helminths, faecal transplantation.

32
Q

What genetically modified probiotic organism may be used in the treament of IBD and what are its limitations?

A

Lactococcus lactis secreting IL-10. IL-10 production cannot be regulated and L.lactis is non-colonising.

33
Q

How does worm therapy work?

A

Trichuris suis can colonise people but not replicate. May work by stimulation of Tregs. 80% response and 72% remission.

GI and metabolism (25 decks)

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