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RW Gastroenterology > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the typical clinical presentations of Crohn’s?

A

Abdominal pain and peri-anal disease

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2
Q

What are the typical clinical presentations of UC?

A

Diarrhoea and bleeding

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3
Q

What genes are associated with IBD and what do these encode?

A

NOD2/CARD15 on chromosome 16 (IBD-1 cluster). They encode a protein involved in bacterial recognition

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4
Q

Which immune cell mediates Crohn’s?

A

Th1 cells

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5
Q

Which immune cells mediate UC?

A

Mixed Th1/Th2 cells

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6
Q

What are one of the main theories on the pathophysiology of IBD?

A

On culture, people with Crohn’s are less able to control the numbers of bacteria so have overpopulation, while UC have much lower numbers, as they may be attacking their own numbers

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7
Q

What is the peak age incidence for UC?

A

20-30s

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8
Q

Which criteria is used to determine the severity of UC?

A

Truelove and witt criteria Severe colitis: 6 bloody stools/24 hour + 1 or more of: • Fever (>37.8°C) • Tachycardia (>90/min) • Anaemia (Haemoglobin 30mm/hr)

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9
Q

What investigations would you do for UC?

A
  • Bloods:
    • CRP
    • Albumin
  • Plain AXR (thumb printing, absence of stool distribution due to inflammation, toxic megacolon)
  • Endoscopy (loss of vessel pattern, transition zone, granular mucosa, contact bleeding)
  • Histology
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10
Q

What extra-intestinal manifestations of IBD are there?

A
  • Skin
    • Erythema nodosum (shins)
    • Pyoderma gangrenous
  • Joints
    • Spondylitis
    • Joint pain
  • Eyes
    • Eye pain
    • Uveitis/scleritis
  • Deranged LFTs
  • Oxalate renal stones
  • Primary sclerosing cholangitis (UC)
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11
Q

When is the peak onset for Crohn’s?

A

15-40y then 60-80y

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12
Q

What are the symptoms of Crohn’s according to site?

A
  • Small intestine
    • Abdominal cramps
    • Diarrhoea
    • weight loss
  • Colon
    • Abdominal cramps (lower abdomen)
    • Diarrhoea with blood
    • Wt loss
  • Mouth
    • Painful ulcers
    • swollen lips
    • angular chielitis
  • Anus
    • peri-anal pain especially when sitting down, abscess
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13
Q

What could you find on examination for crohns?

A

Evidence of wt loss, RIF mass, peri-anal signs

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14
Q

What investigations would you do for Crohn’s?

A
  • Bloods
    • CRP, albumin, platelets – inflam markers
    • B12 (t.ileum), ferritin
  • Colonoscopy
    • Cobblestoning – loss of normal crypt architecture and thickening due to inflammation
    • Omentum wraps around these areas of inflame as bodies natural defence
    • Pseudopolyps develop also
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15
Q

At what site are the majority of Crohn’s found?

A

Terminal ileum

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16
Q

Chronic and active inflammation + granuloma indicates…?

A

Crohn’s

17
Q

Deep knife-like fissuring ulcers are associated with…

A

Crohn’s

18
Q

Which IBD is smoking a risk factor for, and for which is it protective?

A

Risk for Crohn’s - protective for UC

19
Q

Of UC and Crohn’s - which is more common in children?

A

Crohn’s

20
Q

Is UC more common in males or females?

A

Males

21
Q

Of Crohns and UC, which has a greater association with colorectal cancer?

A

UC

22
Q

Of Crohns and UC, which has a greater association with toxic megacolon?

A

US

23
Q

Of Crohns and UC, which has a greater association with fistulas?

A

Crohn’s

24
Q

Of Crohns and UC, which has a greater association with strictures?

A

Crohn’s

25
Q

Of Crohns and UC, which has a greater association with Primary sclerosis cholangitis?

A

UC

26
Q

What are the main differences between Crohn’s and UC?

A

.

27
Q

What are the main differences between Crohn’s and UC histologically?

A
28
Q

What are the main aims of IBD therapy?

A
  • Control inflammation + heal mucosa - Restore normal bowel habit - Improve quality of life - Balance the effects of disease with side effects of treatment - Avoid long-term complications
29
Q

What is the pharmacological therapy for UC?

A

1) Smoking cessation
2) 5ASA - anti-inflam (mesalazine)
3) Steroids (oral prednisolone/budenoside or IV hydrocortisone if acute)
4) Immunosuppressants (infliximab/ciclosporin)
5) Anti-TNF therapy

30
Q

What is the pharmacological therapy for Crohn’s?

A

1) Smoking cessation

(5ASA - anti-inflame (mesalazine) - though may be limited to ileocaecal disease)

2) Steroids (budenoside)
3) Immunosuppressants (infliximab/anzathioprine)
4) Anti-TNF therapy

31
Q

What is the surgical cure for UC?

A

Colectomy

32
Q

How does UC colon appear macroscopically?

A

Featureless

33
Q

What is a panproctocolectomy?

A

All large bowel is removed

34
Q

What are the two options for panproctocolectomy?

A

End ileostomy (stoma) or pouch formation (S/J pouch)

RW Gastroenterology (13 decks)

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