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GI System > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is Inflammatory Bowel Disease (IBD)?

A

Chronic relapsing inflammatory conditions of the bowel

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2
Q

What do most cases of inflammatory conditions fall into?

A

A spectrum between Crohn’s Disease (CD) & Ulcerative Colitis (UC)

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3
Q

When can UC affect someone and in what sex is it more prominent?

A

Any age

More common in females

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4
Q

What does UC present with?

A

Bloody diarrhoea
Abdominal pain
Weight loss

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5
Q

What is specific about the inflammation in UC?

A

It is continuous (only affecting the colon) and always start at the rectum and works it way distally from the rectum
Variable distribution and severity

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6
Q

What is the cure for UC and what happens to the mucosa in UC?

A

Surgical removal

Mucosa goes from healthy to inflamed

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7
Q

What indicates a severe UC attack?

A 
Stools frequency >6 stools/day with blood
Fever
ESR is raised
Tachycardia
Anaemia
Albumin
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8
Q

What cells are depleted in UC?

A

Goblet cells

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9
Q

Are there more crypt abscesses in UC or Crohn’s?

A

UC

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10
Q

When is Crohn’s most common in people and in what sex?

A

Early adulthood and over 60s

More common in females

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11
Q

What type of disease is Crohn’s and what is indicative of it?

A

Patchy disease
Skip lesions from the mouth to the anus
Classically it is spread along the bowel
Clinical features related to where the disease is situated

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12
Q

What are the clinical features of CD? (9)

A 
Diarrhoea
Weight loss
Abdominal pain 
Fever
Malaise
Lethargy
Anorexia
N&V
Malabsorption - Unusual presentation
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13
Q

What is CD like histologically?

A

Granulomas

Affects the whole thickness of the colon

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14
Q

What is UC like histologically?

A

No granulomas

Only affects the inner lining of the colon

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15
Q

What is found in CD?

A

Fitulae

Peri-anal disease

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16
Q

What are the extra-intestinal manifestations of IBD?

A 
Eyes
Joints
Renal calculi
Liver and biliary tree
Skin
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17
Q

What are the differential diagnoses for IBD?

A

Chronic diarrhoea
Ileo-caecal TB
Colitis - Infective/Ameobic/Ischaemic

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18
Q

What classification is used for IBD?

A

Montreal

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19
Q

What are in indices for IBD inflammation?

A 
High ESR & CRP
High platelet count
High WCC
Low Hb
Low albumin
20
Q

What drops during active inflammation?

A

Albumin

21
Q

What investigations should be done for IBD?

A

Colonoscopy

Medical management – Outpatient and Hospital

22
Q

How often should colonoscopies be done in patients with IBD?

A

Extensive colitis for 8-20 years = Once every 3 years
Extensive colitis for 30-40 years = Once every 2 years
Extensive colitis for 40+ years = Annually

23
Q

What drugs are aminosalicylates (5ASA) and give an example?

A

Mesalazine - Acrylic resin

Prodrugs - Sulfasalazine

24
Q

What does 5ASA help to control?

A

Moderate UC flare-ups within 2-3 weeks

Can be used in the long term

25
Q

How is it best to distribute 5ASA in distal and more extensive disease?

A

Rectally

Patients may be on this till the end of their life

26
Q

What is the first line therapy in the induction and maintenance of remission of mild-moderate UC?

A

5ASA

27
Q

For what use are 5ASA’s used in CD?

A

Mildly active ileocolonic disease and in the maintenance of remission for post small bowel resection

28
Q

What two steroids are used to treat IBD?

A

Prednisolone - Optimal dose is 40mg/day and tapering reduction over 4 weeks
Budesonide - Slightly less effective than Prednisolone but it has a better side effect profile

29
Q

What thiopurine is used in the treatment of IBD?

A

Azathioprine - Steroid sparing

30
Q

What are the significant side effects of thiopurines?

A 
Leucopenia
Hepatoxicity
Pancreatitis
Possible long term lymphoma risk
28% of people are intolerant
31
Q

What percentage of people are intolerant of Methotrexate and what is its main side effect?

A

10-18%

Stops women having children

32
Q

What immunosuppressants are used in the treatment of IBD and what is their risk?

A

Ciclosporin
Mycophenolate
Tacrolimus
Risk of infection

33
Q

What biologics are used in the treatment of IBD?

A

Infliximab
Adulimumab
Anti-TNFα-antibodies

34
Q

When is Metronidazole used?

A

Crohn’s peri-anal disease with small bowel over growth

35
Q

What are the advantages and disadvantages of elemental feeding?

A

Advantages - Can be as effective as steroids with it being more efficacious in children
Disadvantages - Compliance can be difficult

36
Q

What are unacceptable complications of steroids?

A

Diabetes
Severe osteoporosis
Psychosis

37
Q

What occurs when there are poor responses to Medical Rx?

A

Fistulas
Fibrotic strictures
Peri-anal disease
Severe fulminating disease

38
Q

Is surgery for IBD done electively or in an emergency?

A

Both

39
Q

What does Acutely Ill result in?

A 
Total Colectomy
or
Rectal preservation
or
Ileostomy
40
Q

How does the colon appear in severe colitis?

A

Paper thin and very inflammed

41
Q

What is pouch surgery?

A

Happens in a total colectomy with the colon being removed so the small bowel must be mobilised and lengthened to create a pouch

42
Q

UC - What does the pouch procedure not have?

A

No ileostomy

43
Q

What is a proctocolectomy?

A

When the colon and rectum are removed but it has an ileostomy

44
Q

What are the surgical indications for Crohns? (6)

A 
Failure of medical management
Relief or obstructive symptoms
Management of fistulae  - Bowel to bladder
Management of inta-abdominal mass
Management of anal conditions
Failure to thrive
45
Q

What is sclerosing cholangitis?

A

Disease of the bile ducts, multiple strictures and it is slowly progressive which can lead to cirrhosis

46
Q

What is the long-term complication of colitits?

A

Colonic carcinoma

47
Q

How does anal CD vary?

A

It can be non-ulcerating or severely ulcerated

GI System (38 decks)

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