Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI -S > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What two conditions come under the umbrella term of inflammatory bowel disease?

A

Crohn’s Disease and Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a good way to think about inflammatory bowel disease?

A

Think of IBD as a spectrum.

Overlap between Crohn’s and Ulcerative colitis and can be hard to distinguish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Montreal Classification?

A

Classifies people on age, location, behaviour, extent and severity so that you can best treat their disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the aetiology of IBD?

A

Basically it is unknown

Environmental trigger as IDB used to be unheard of in the east but incidence has shot up now as people adopt a western lifestyle.
-Role of bacteria, Diet, vaccination history, social factors

Possibly genetically susceptible people.
Candidate gene identified NOD2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the epidemiology of Ulcerative colitis?

A

VERY common
Can affect any age but peak incidence is 20-40 (when your most active in society)

More common in females
Local incidence 11.3 per 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do people with ulcerative colitis present?

A

Bloody diarrhoea
Abdominal pain
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between Crohn’s disease and UC in terms of location where they effect?

A

UC = Large intestine is the only affected site.
Disease starts at rectum and moves proximally.
Inflammation is continuous along the affected areas length

Crohn’s = Inflammation may occur in any part of the GI tract.
Inflammation may occur in patches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference in pain location in UC and Crohn’s?

A

UC common in lower left abdomen

Crohn’s common in lower right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does the appearance of Uc and Crohn’s differ?

A

UC = Colon wall is thinner and shows continuous inflammation.
Mucosal layer may have ulcers but these do not extend beyond the inner lining.

Crohn’s = Wall may be thickened and may have a rocky appearance.
Ulcers along the digestive tract are deep and may extend through all layers of the bowel wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does bleeding differ in Crohn’s and UC?

A

Crohn’s bleeding from the bowel through the rectum is not common.

UC = Bleeding through the rectum during bowel movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What percentage of UC patients go on to have surgery?

A

3% at first attack

8% at 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the clinical markers of a severe UC attack?

A

Stool frequency > 6 a day with blood

PLUS 1 of:
Fever >37.5
Tachycardia >90
ESR raised
Anaemia Hb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is leucocytosis?

A

Increase in the number of WBC’s in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is thombocytosis?

A

The production of too many platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the epidemiology of Crohn’s disease?

A

M = F
Two peaks:
-Early adulthood (20-40)
-Over 60s (F>M)

Incidence 8.5 per 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do the clinical features of patients suffering from Crohn’s disease differ?

A

Clinical features depend on the regions involved

Very difficult to predict how it will present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why can fistula’s occur in crown’s disease?

A

Ulceration occurs all the way through the wall so Crohn’s can lead to fistula.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the clinical features of Crohn’s Disease?

A 
Diarrhoea
Abdominal Pain
Weight loss
Malaise, lethargy, anorexia Nausea and Vomiting
Low grade fever
Malabsorption
-Anaemia, vitamin deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the complications of crown’s disease?

A

Inflammation
Stricture
Fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can you use to detect inflammation in IBD?

A 
High ESR and CRP
High Platelet count
High White Cell Count
Low Hb
Low Albumin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the histological differences between UC and CD?

A

Granulomas in Crohn’s Disease (hard to find)

Goblet cells depleted in UC

Crypt accesses: UC > CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Fistulae and peri-anal disease are present in which form of IBD?

A

Crohn’s Disease

23
Q

Give some examples of extra-intestinal manifestations of IBD

A

Eyes: conjunctivitis

Joints

Renal calculi (CD only)

Liver and biliary tree (fatty change, sclerosing cholangitis, gallstones)

Skin (Erythema nodosum, vasculitis)

24
Q

What is the differential diagnosis of IBD?

A

Chronic diarrhoeas

  • Malabsorption
  • Malnutrition

Ileo-caecal TB

Colitis must be distinguished from
-Infective, amoebic and ischaemic colitis

25
Q

What is Sclerosing Cholangitis?

A

Disease of the bile ducts
Multiple strictures
Slowly progressive, can lead to cirrhosis

Colon cancer bigger risk if IBD and Sclerosing cholangitis

26
Q

What is the complication of long term colitis?

A

Colonic Carcinoma

Extent and Duration significantly increases risk

27
Q

How do you monitor patients who are at risk of progressing from chronic colitis to cancer?

A

Surveillance colonoscopy

  • Extensive colitis
  • –8-20 yrs (3 yearly)
  • –30-40 yrs (2 yearly)
  • –40+ years (annually)
28
Q

What is the medical management of outpatient IBD?

A 
5ASA
Steroids
Immunosuppression
-Azathioprine
-Mercaptopurine
-Methotrexate
-Infliximab
29
Q

What is the hospital management of IBD patients?

A 
Steroids
Anticoagulation
Rest
Other
-Cyclosporin
-Infliximab
-Surgery
30
Q

Give some examples of Aminosalicylates.

What must you be careful of when prescribing these?

A

Mesalazine

  • Acrylic Resin
  • Ethylcellulose Microgranules

Pro-drugs

  • Balsalazide
  • Olzalazine
  • Sulfasalazine

Prescribe by the BRAND.
Brands are slightly different

31
Q

What is the first line treatment in Mild-Moderate UC for achieving an induction in remission?

A

5ASA (5-aminosalicylic acid)
>3g per day

Rectally for distal and more extensive disease

32
Q

How do Steroids compare to 5ASA in induction of remission in Mild Moderate UC?

A

Steroids have similar effects but work faster with more side effects

Rectal 5ASA better than steroids

33
Q

What is the first line therapy for the maintenance of remission in Mild-Moderate UC?

A

5ASA

34
Q

What is the maintenance of remission of UC with 5ASA associated with?

A

Reduced number and severity of relapses
Reduced CRC risk
-Lifeling therapy with >2g per day

35
Q

How is 5ASA used in Crohn’s?

A

Widely used but limited evidence.

Induction of remission in mildly active ileocolonic disease

Maintenance of remission if induction is by 5ASA
Post small bowel resection

Help prevent progression to cancer

36
Q

What steroids do you prescribe in IBD?

A

Prednisolone

  • Optimal dose is 40mg daily
  • Tapering reduction over 4 weeks

Budenoside

  • Slightly less effective than Prednisolone
  • Better side effect profile
  • Ileal and ascending colon disease only.
37
Q

What is the next step up in treatment of IBD after steroids?

A

Immunosuppression

Thiopurines = azathioprine (6-Mercaptopurine)
Methotrexate

Others:
Ciclosporin
Mycophenolate
Tacrolimus

38
Q

Describe the use of Azathioprine to treat IBD

A

Induction (Number needed to treat NNT = 5)
Maintenance (NNT = 7)

Most patients feel rotten for the first few weeks then get better. Some don’t.

39
Q

What is leucopenia?

A

Decrease of WBC’s found in the blood

40
Q

What do you need to do with hepatotoxicity from azathioprine?

A

Blood Monitoring

  • Weekly for 8 weeks then every 8 weeks
  • Patients must see GP if sore throat/infection
41
Q

What are the significant side effects of azathioprine?

A

Significant side effects (NNT = 14):

  • Leucopenia
  • Hepatoxicity
  • Pancreatitis
  • Possible long term lymphoma risk
  • Up to 28% intolerence
42
Q

Describe the use of methotrexate to treat IBD

A

Unlicensed use

Works better for Crohn’s but still sometimes used for UC
Induction and maintenance of remission

Require specialist follow up

43
Q

What side effect do you have to keep in mind when prescribing methotrexate?

A

Cannot become pregnant on this

Long term treatment so have to look 10 years ahead

44
Q

Describe the use of other immunosuppressants other than azathioprine and methotrexate

A

Ciclosporin

  • Salvage therapy for refractory UC
  • 3-6 months as bridge to azathioprine

Mycophenolate

  • Rarely used (no evidence)
  • If you see someone on this they are clutching at straws

Tacrolimus
-Increasing anecdotal evidence

45
Q

What is the next step up in treatment of IBD after you have tried immunosuppressants?
Give some examples

A

Biologics
Anti TNF-a antibodies

Infliximab (Remicade)
-8 weekly IV infusions
Adulimumab (Humera)
-2 weekly SC injections (patient can administer)

46
Q

What are the risks of biologics?

A

1 in 100 will get cancer from these drugs

Symptoms are so shit patients are willing to risk it

47
Q

Why do anti TNF-a antibody drugs sometimes just stop working?

A

Body may start to produce anti anti TNF-a antibodies

48
Q

What drug is used to treat peri anal disease in Crohn’s?

A

Metronidazole

Also used to treat small bowel overgrowth

49
Q

What is elemental feeding?

A

Exclusive elemental feeding
Can be as effective as steroids
Works better in children because parents can force them and they have no other choice.
Adults really struggle to comply because it tastes shit

50
Q

Give an overview of some of the failures of medical therapy in IBD

A 
Recurrent courses of steroid
Relapse prior to or shortly after stopping therapy
Failure to control symptoms
Unacceptable complications of steroids:
-Diabetes
-Severe osteoporosis
-Psychosis
51
Q

What are the surgical options in UC?

A

Emergency or Elective

PROCTOCOLECTOMY
Total colectomy with ileostomy and rectal preservation
This gives a rectal stump that may have symptoms
Wall in rectum is thick so shouldn’t perforate

May also do a pouch procedure which doesn’t give an ileostomy

52
Q

What are the surgical options in Crohn’s?

A

Never going to cure
take away the smallest area possible
Chances of needing another operation 60%

53
Q

What are the surgical indications for Crohn’s?

A

Failure of medical management
Relief of obstructive symptoms (small bowel)
Management of fistulae (e.g. bowel to bladder)
Management of intra-abdominal accesses
Management of anal conditions
Failure to thrive

GI -S (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions