Inflammatory Bowel Disease Flashcards
What are the two types of IBD?
Ulcerative Colitis
Crohn’s disease
What does Crohn’s clinically present with?
Abdominal pain
Peri-anal disease
What does UC clinically present with?
Diarrhoea
Bleeding
What are the genetic factors in IBD?
NOD2/ CARD15 (IBD-1)
What is the genetic pathology underlying IBD?
A mutated form of NOD2
Encodes a protein involved in bacterial recognition
NOD2 contributes to normal mucosal defences.
What is the role of gut flora in IBD?
Diverting faecal stream helps Crohn’s.
Altered bacterial flora in colons with UC.
What is the effect of overactive effector T-cells cause?
Inflammation/ Disease
What is the effect of absent regulatory T-cells?
Uncontrolled Inflammation/ Aggressive Disease
Which form of IBD is a Th1 mediated disease?
Crohn’s
Which form of IBD is a mixed Th1/ Th2 mediated disease?
UC
Which form of IBD is associated with natural killer T-cells?
UC
What is the effect of smoking on Crohn’s disease?
Aggravates disease
What is the effect of smoking of Ulcerative Colitis?
Protects against UC
What type of drug is associated with contributing to IBD?
NSAIDs
What is UC?
Inflammation of the colon.
What age is the peak incidence?
20s-30s
Which type of IBD affects rectum extending proximally?
UC
What are the common diseases of UC?
Pancolitis
Proctitis
Left-sided colitis
What are the symptoms of UC?
Diarrhoea Bleeding Increased bowel frequency Urgency Tenesmus Incontinence Night rising Lower abdominal pain (esp. LIF)
What symptom can proctitis cause?
Constipation
What tests would you do for UC?
FBC CRP Albumin Plain AXR Endoscopy Histology
What would you see on AXR for UC?
Stool distribution: Absent in inflamed colon.
Mucosal oedema/ “thumb-printing”
Toxic megacolon
What would you see on endoscopy for UC?
Confluent inflammation extending proximallty from anal margin to a “transition zone”
Loss of vessel pattern
Granular mucosa
Contact bleeding
Which form of IBD causes loss of vessel pattern (seen on endoscopy)?
UC
Which form of IBD causes confluent inflammation extedning proximally from anal margin to a “transition zone”?
UC
Which type of cancer does UC give an increased risk of?
Colorectal caner
What determines the risk of developing colorectal cancer from UC?
Severity of inflammation
Duration of disease
Disease extent
What extra-intestinal manifestation(s) of UC would present in the patient’s mouth?
Stomatitis
Apthou ulcers
What extra-intestinal manifestation(s) of UC would present in the patient’s eyes?
Episcleritis
Uveitis
What is primary sclerosing cholangitis?
PSC
Chronic inflammatory disease of biliary tree
associated with IBD
What symptoms are caused by primary sclerosing cholangitis?
Itch
Rigors
What effect does primary sclerosing cholangitis have on LFTs?
Causes cholestatic LFTs
Which form of IBD causes skip lesions?
Crohn’s
Which form of IBD causes Transmural inflammation?
Crohn’s
What is involved in peri-anal disease?
Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters
What are the consequences of long-term crohn’s disease?
Stricture
Fistula
Abscess
What are the symptoms of Crohn’s disease affecting the small intestine?
Abdominal cramps
Diarrhoea
Weight loss
What are the symptoms of Crohn’s disease affecting the colon?
Abdominal cramps
Diarrhoea with blood
Weight loss
What are the symptoms of Crohn’s disease affecting the mouth?
Painful ulcers
Swollen lips
Angular chielitis
What are the symptoms of Crohn’s disease affecting the anus?
Peri-anal pain
Abcess
What blood tests would you carry out for suspected crohn’s
CRP Albumin Platelets B12 Ferritin
What would colonoscopy show for crohn’s disease?
“cobblestoning”
thickened wall
fat-wrapping
(fissure?)
What would colonoscopy show for UC?
Ulceration
Surviving Mucosa (Pseudopolyps)
Loss of haustra
Which form of IBD may be present unrecognised for years?
Crohn’s
Which form of IBD has recurring periods of “flare-ups” and remission?
Crohn’s
Which form of IBD has a history of weeks
UC
Which form of IBD causes vomitting and nausea??
Crohn’s
Which form of IBD is continuous from rectum up to colon?
UC
Which form of IBD affects terminal ileum and may involve colon, stomach, mouth etc?
Crohn’s
What is seen histologically with Crohn’s disease?
Granuloma
What is seen histologically with UC?
Shortened and branched crypts
Plasma cell infiltrates
What symptom of IBD affects the skin?
Pyoderma gangrenosum
What effect does IBD have on the blood?
Anaemia
First line drug for IBD?
for decades
5-AS
