Inflammatory Bowel Disease Flashcards by Jenny Green

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

Ulcerative colitis

Crohn’s disease

How well did you know this?

Not at all

Perfectly

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

epidemiology
clinical cases
therapeutic characteristics

How well did you know this?

Not at all

Perfectly

How do ulcerative colitis and Crohn’s disease differ?

clinical presentation

pathology

How well did you know this?

Not at all

Perfectly

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

Genetic predisposition
Mucosal Immune system
Environmental triggers

How well did you know this?

Not at all

Perfectly

Is there a genetic link in IBD?

yes

How well did you know this?

Not at all

Perfectly

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

Chromosome 16

How well did you know this?

Not at all

Perfectly

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

NOD2

How well did you know this?

Not at all

Perfectly

How does NOD2 cause Crohn’s disease?

encodes for a protein involved in bacterial recognition

How well did you know this?

Not at all

Perfectly

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

antibiotics

How well did you know this?

Not at all

Perfectly

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

Colonic Crohn’s

How well did you know this?

Not at all

Perfectly

what was does smoking effect IBD?

Aggravates Crohn’s disease

Protects agains ulcerative colitis

How well did you know this?

Not at all

Perfectly

What environmental factors can cause IBD?

smoking
NSAIDs use 
Vasculitis
Infectious agents
Sterile environment therapy

How well did you know this?

Not at all

Perfectly

what is pancolitis?

Ulcerative colitis which affects the whole colon

How well did you know this?

Not at all

Perfectly

what is proctitis?

Ulcerative colitis which affects the anus and anal canal only

How well did you know this?

Not at all

Perfectly

what are the symptoms of ulcerative colitis?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

what investigations would be used for ulcerative colitis?

Bloods - CRP and albumin
AXR
Endoscopy
Histology

How well did you know this?

Not at all

Perfectly

what might an AXR show in ulcerative colitis?

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

How well did you know this?

Not at all

Perfectly

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

loss of vessel pattern
Granular mucosa
Contact bleeding

How well did you know this?

Not at all

Perfectly

what differs in the histology of ulcerative colitis?

abscence of goblet cells

crypt distortion and abscess

How well did you know this?

Not at all

Perfectly

which layer does ulcerative colitis effect in the colon?

mucosal layer

How well did you know this?

Not at all

Perfectly

what determines the risk of cancer in ulcerative colitis?

Severity of inflammation
Duration of disease
Disease extent

How well did you know this?

Not at all

Perfectly

what is Primary sclerosing cholangitis?

Chronic inflammatory disease of the biliary tree

How well did you know this?

Not at all

Perfectly

How may primary sclerosing colangitis present?

mostly asymptomatic or presents as an itch and rigors

How well did you know this?

Not at all

Perfectly

In which IBD does primary sclerosing colangitis present?

Ulcerative colitis

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

Any

What are the common characteristics of Crohn's?

Skip lesions | Transmural inflammation

what is peri-anal disease?

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

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

abdominal cramps diarrhoea weight loss

what are Crohn's symptoms when affecting the colon?

abdominal cramps diarrhoea with blood loss weight loss

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

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

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

peri-anal pain | abscess

what are the investigations for Crohn's disease?

clinical examination FBC CRP, albumin, platelets

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

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

In which IBD are granulomas present?

Crohn's disease

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

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

Define Crohn's disease

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

Where does Crohn's disease most commonly present?

Terminal ileum and colon

How does Crohn's disease generally present?

``` Abdominal pain Small bowel obstruction Diarrhoea Bleeding PR Anaemia Weight loss ```

what is this patient most likely to have: ``` 22years Male Abdominal pain Bloody diarrhoea for 3/12 Tender abdomen ```

Crohn's disease

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

A bowel obstruction - leads to surgery

Is Crohn's disease patchy?

Yes - it is a segmented disease

Where does the inflammation occur in Crohn's?

Ileal and or colonic mucosa - includes cryptitis and crypt abscesses

what kind of inflammation occurs in Crohn's?

Transmural

How can the ulcers be described in Crohn's?

Deep knife-like fissuring

what are the complications of Crohn's disease?

``` Malabsorption Fistula formation Anal disease Intractable disease Bowel obstruction perforation Malignancy Amylodiosis Toxic megacolon ```

what does iretractable disease cause?

continous diarrhoea or pain

How does the immune system respond in Crohn's?

persistent activation of T-cells - don't switch off | excessive pro inflammatory cytokine production

what is ulcerative colitis?

Chronic inflammatory disorder confined to colon and rectum

which layers are inflamed in ulcerative colitis?

mucosal and submucosal

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

Rectum

How can ulcerative colitis present clinically in terms of incidence?

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

what is this patient most likely suffering from: 32 years Female Bloody diarrhoea and mucus Goes to toilet 25 times a day

Ulcerative colitis

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

subtotal colectomy

Are granulomas present in ulcerative colitis?

What are the complications of ulcerative colitis?

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

what is toxic megacolon?

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

what GI manifestations may present in the eye?

Uveitis - eye redness

what GI manifestations may present in the liver?

Primary clerosing cholangitis

what GI manifestations may present in the joints?

``` Arthritis Ank spondylitis (spinal arthritis) ```

what GI manifestations may be present on the skin?

Pyoderma gangrenosum, erythema nodusum

What genetic factor is ulcerative colitis associated with?

HLA-DR2

How is the immune system affected by ulcerative colitis?

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