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Gastroenterology (Own) > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

what are the two idiopathic chronic inflammatory diseases involved in IBD?

A

Ulcerative colitis

Crohn’s disease

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2
Q

what do ulcerative colitis and Crohn’s disease have in common?

A

epidemiology
clinical cases
therapeutic characteristics

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3
Q

How do ulcerative colitis and Crohn’s disease differ?

A

clinical presentation

pathology

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4
Q

what are the 3 main factors involved in the pathogenesis of IBD?

A

Genetic predisposition
Mucosal Immune system
Environmental triggers

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5
Q

Is there a genetic link in IBD?

A

yes

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6
Q

which chromosome is thought to be involved in the genetic link in IBD?

A

Chromosome 16

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7
Q

In Crohn’s disease what is the section in which a mutated form causes the disease?

A

NOD2

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8
Q

How does NOD2 cause Crohn’s disease?

A

encodes for a protein involved in bacterial recognition

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9
Q

What is used in the treatment of peri-anal Crohn’s disease?

A

antibiotics

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10
Q

In which type of Crohn’s disease is antimicrobial activity highest?

A

Colonic Crohn’s

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11
Q

what was does smoking effect IBD?

A

Aggravates Crohn’s disease

Protects agains ulcerative colitis

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12
Q

What environmental factors can cause IBD?

A 
smoking
NSAIDs use 
Vasculitis
Infectious agents
Sterile environment therapy
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13
Q

what is pancolitis?

A

Ulcerative colitis which affects the whole colon

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14
Q

what is proctitis?

A

Ulcerative colitis which affects the anus and anal canal only

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15
Q

what are the symptoms of ulcerative colitis?

A 
Diarrhoea and bleeding
Increased bowel habit
urgency
Tenesmus 
Incontinence
Lower abdominal pain - LIF
Night rising
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16
Q

to determine sever UC 6 or more bloody stool need to be passed in 24 hours along with what else?

A 
one or more of the following:
Fever
Tachycardia
Anaemia
Elevates ESR
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17
Q

what investigations would be used for ulcerative colitis?

A

Bloods - CRP and albumin
AXR
Endoscopy
Histology

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18
Q

what might an AXR show in ulcerative colitis?

A

no stool present in inflamed colon
Mucosal oedema - thumb printing
Toxic megacolon

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19
Q

what would be present at endoscopy in a patient with ulcerative colitis?

A

loss of vessel pattern
Granular mucosa
Contact bleeding

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20
Q

what differs in the histology of ulcerative colitis?

A

abscence of goblet cells

crypt distortion and abscess

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21
Q

which layer does ulcerative colitis effect in the colon?

A

mucosal layer

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22
Q

what determines the risk of cancer in ulcerative colitis?

A

Severity of inflammation
Duration of disease
Disease extent

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23
Q

what is Primary sclerosing cholangitis?

A

Chronic inflammatory disease of the biliary tree

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24
Q

How may primary sclerosing colangitis present?

A

mostly asymptomatic or presents as an itch and rigors

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25
Q

In which IBD does primary sclerosing colangitis present?

A

Ulcerative colitis

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26
Q

Which region of the GI tract does Crohn’s affect?

27
Q

What are the common characteristics of Crohn’s?

A

Skip lesions

Transmural inflammation

28
Q

what is peri-anal disease?

A

Recurrent abscess formation which can then lead to fistula formation with a persistent leak - damaged sphincters

29
Q

what are Crohn’s symptoms when affecting the small intestine?

A

abdominal cramps
diarrhoea
weight loss

30
Q

what are Crohn’s symptoms when affecting the colon?

A

abdominal cramps
diarrhoea with blood loss
weight loss

31
Q

what are the Crohn’s symptoms when affecting the mouth?

A

Painful ulcers
Swollen lips
Angular chielitis - inflammation at the side of the mouth

32
Q

what are the Crohn’s symptoms when affecting the anus?

A

peri-anal pain

abscess

33
Q

what are the investigations for Crohn’s disease?

A

clinical examination
FBC
CRP, albumin, platelets

34
Q

what might be found on examination of a patient with Crohn’s disease?

A

evidence of weight loss
Right iliac fossa mass
Peri-anal signs

35
Q

In which IBD are granulomas present?

A

Crohn’s disease

36
Q

How can the small bowel be assessed in Crohn’s disease?

A

Barium follow through
Small bowel MRI
Technetium-labelled white cell scan

37
Q

Define Crohn’s disease

A

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

38
Q

Where does Crohn’s disease most commonly present?

A

Terminal ileum and colon

39
Q

How does Crohn’s disease generally present?

A 
Abdominal pain
Small bowel obstruction
Diarrhoea
Bleeding PR
Anaemia
Weight loss
40
Q

what is this patient most likely to have:

22years
Male
Abdominal pain
Bloody diarrhoea for 3/12
Tender abdomen
A

Crohn’s disease

41
Q

Is Crohn’s does not respond to medical therapy what can this cause?

A

A bowel obstruction - leads to surgery

42
Q

Is Crohn’s disease patchy?

A

Yes - it is a segmented disease

43
Q

Where does the inflammation occur in Crohn’s?

A

Ileal and or colonic mucosa - includes cryptitis and crypt abscesses

44
Q

what kind of inflammation occurs in Crohn’s?

A

Transmural

45
Q

How can the ulcers be described in Crohn’s?

A

Deep knife-like fissuring

46
Q

what are the complications of Crohn’s disease?

A 
Malabsorption
Fistula formation
Anal disease
Intractable disease
Bowel obstruction
perforation
Malignancy
Amylodiosis
Toxic megacolon
47
Q

what does iretractable disease cause?

A

continous diarrhoea or pain

48
Q

How does the immune system respond in Crohn’s?

A

persistent activation of T-cells - don’t switch off

excessive pro inflammatory cytokine production

49
Q

what is ulcerative colitis?

A

Chronic inflammatory disorder confined to colon and rectum

50
Q

which layers are inflamed in ulcerative colitis?

A

mucosal and submucosal

51
Q

which part of the body does ulcerative colitis almost always involve?

52
Q

How can ulcerative colitis present clinically in terms of incidence?

A

Chronic course with exacerbation and remission
Continuous low grade activity
A single attack

53
Q

what is this patient most likely suffering from:

32 years
Female
Bloody diarrhoea and mucus
Goes to toilet 25 times a day

A

Ulcerative colitis

54
Q

what might need to be done if a patient doesn’t respond to medical therapy?

A

subtotal colectomy

55
Q

Are granulomas present in ulcerative colitis?

56
Q

What are the complications of ulcerative colitis?

A 
Intractable disease
Toxic megacolon
Colorectal carcinoma
Blood loss
Elecrolyte disturbance - hypokalaemia 
Anal fissures
GI mannifestations
57
Q

what is toxic megacolon?

A

When the colon swells up to a point where it will rupture unless removed

58
Q

what GI manifestations may present in the eye?

A

Uveitis - eye redness

59
Q

what GI manifestations may present in the liver?

A

Primary clerosing cholangitis

60
Q

what GI manifestations may present in the joints?

A 
Arthritis
Ank spondylitis (spinal arthritis)
61
Q

what GI manifestations may be present on the skin?

A

Pyoderma gangrenosum, erythema nodusum

62
Q

What genetic factor is ulcerative colitis associated with?

63
Q

How is the immune system affected by ulcerative colitis?

A

Persistent activation of T-cells and macrophages - causes damage due to neutrophilic inflammation

Gastroenterology (Own) (18 decks)

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