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Alimentary System > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the possible contributory factors to inflammatory bowel disease?

A 
Genetics 
Bacteria 
Diet 
Vaccination history 
Social factors 
Ethnicity
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2
Q

What age group is the highest incidence for ulcerative colitis and in what gender is it more common?

A

20-40 years

More common in females

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3
Q

What part of the GI tract does ulcerative colitis affect?

A

Small intestine only

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4
Q

What is the pathology of ulcerative colitis?

A

Continuous inflammation of the small bowel with varying distribution and severity

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5
Q

What are the typical clinical features of ulcerative colitis?

A 
Stool frequency > 6 times a day with blood 
Fever
Tachycardia 
ESR raised 
Anaemia with Hb < 10 g/dl
Albumin < 30 g/l
Leucocytosis and thrombocytosis
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6
Q

What age groups have the highest incidence of Crohn’s disease

A

20-40 years and over 60s

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7
Q

What disease is more likely in children presenting with irritable bowel disease symptoms, Crohn’s or ulcerative colitis?

A

Crohn’s

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8
Q

What is the pathology of Crohn’s disease?

A

Patchy disease that affects anywhere in the GI tract from mouth to anus, discontinuous skip lesions causing patchy inflammation in multiple places

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9
Q

What are the clinical features of Crohn’s disease?

A 
Diarrhoea 
Abdominal pain 
Weight loss 
Malaise 
Lethargy 
Anorexia
Low grade fever 
Malabsorption
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10
Q

What differential diagnoses must be ruled out before confirming Crohn’s disease?

A

Chronic diarrhoea due to malabsorption or malnutrition

Ileo-caecal TB

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11
Q

Why is it important to differentiate between Crohn’s disease and ileo-caecal TB?

A

Ileo-caecal TB can look exactly like Crohn’s but the steroid treatment that might improve Crohn’s disease will cause rapid deterioration in the health of patients with ileo-caecal TB

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12
Q

What are the differential diagnoses of ulcerative colitis?

A

Infective, amoebic and ischaemic colitis

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13
Q

What is inflammatory bowel disease?

A

Chronic relapsing inflammatory conditions of the bowel

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14
Q

How might inflammatory bowel disease appear pathologically?

A

Microscopic colitis
Collagenous colitis
Lymphocytic colitis

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15
Q

What can be tested for in the blood that would be indicative of inflammation?

A 
High ESR and CRP 
High platelet count 
High WCC 
Low Hb
Low albumin
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16
Q

How does Crohn’s disease appear pathologically?

A 
Granulomas on histology is the biopsy is taken at the exact site 
Non-specific inflammation 
Fistulae 
Peri-anal disease 
Entire bowel wall affected
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17
Q

What part of the bowel layer does ulcerative colitis affect?

A

The mucosal layer only

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18
Q

What investigations can be helpful when suspecting inflammatory bowel disease?

A

Radiology investigations
Colonoscopy and biopsy
Dye spray colonscopy

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19
Q

What drugs can be used to treat inflammatory bowel disease?

A 
5ASAs
Steroids 
Immunosuppressants 
Thiopurines 
Methotrexate
Biologics - antibody medication 
Metronidazole
Elemental Feeding
20
Q

What is the first line treatment for mild-moderate ulcerative colitis and what are its benefits?

A

Sulfasalazine (pro-drugs, 5ASA)
60% of flare-ups will go into remission with this therapy
First line therapy for maintenance of remission
Reduced number and severity of relapses
Reduced colorectal cancer risk with daily lifelong therapy

21
Q

If giving steroids for ulcerative colitis, what course would you give?

A

Short term treatment only, 4-8 week course

22
Q

Name the immunosuppressive drugs used in the treatment of inflammatory bowel disease

A

Azathioprine
Mercaptopurin
Methotrexate
Infliximab

23
Q

Under what circumstances would 5ASA maintain remission in Crohn’s?

A

Only if remission was induced by 5ASA

24
Q

Name the steroids commonly used in treatment of inflammatory bowel disease

A

Prednisolone

Budenoside - slightly less effective than prednisolone but better side effect profile

25
Q

For what areas affected by inflammatory bowel disease could you give budenoside?

A

For ileal and ascending colon disease only

26
Q

What are the side effects of Azathioprine?

A 
Leucopenia 
Hepatotoxicity 
Pancreatitis 
Long term lymphoma risk 
Non-specific flu-like symptoms e.g. malaise, muscle and joint aches, fatigue
27
Q

What percentage of people will be intolerant to Azathioprine?

A

Up to 18%

28
Q

In how many people with Azathioprine induce and maintain remission?

A

1/7

29
Q

Methotrexate is only used in which inflammatory bowel disease?

A

Crohn’s

30
Q

What percentage of people will be intolerant to methotrexate and what side effects can it cause?

A

10-18% intolerant

Can cause liver and lung problems

31
Q

Under what circumstances would Cyclosporin be used?

A

As a salvage therapy for an acute attack of ulcerative colitis if the patient isn’t already on immunosuppressant therapy

32
Q

What biologic antibody medication might be used in 8 weekly IV infusions for the treatment of inflammatory bowel disease?

A

Anti-TNF alpha antibodies

Alpha-4b7 Integrin blockers

33
Q

Under what circumstances might metronidazole be used?

A

For Crohn’s peri-anal disease or sepsis or for small bowel bacterial overgrowth

34
Q

In what age group is elemental feeding more effective?

A

Due to the disgusting taste it works better in children as they are more compliant

35
Q

What would indicate a failure of medical therapy in the treatment of inflammatory bowel disease?

A

Recurrent courses of steroids needed
Relapse prior to or shortly after stopping therapy
Failure to control symptoms
Severe complications from steroids
Generally poor response to medical therapy

36
Q

Surgery in inflammatory bowel disease may be either

A

emergency or elective

37
Q

If acutely ill with severe ulcerative colitis, what surgical treatment is indicated?

A

Total colectomy with rectal preservation and ileostomy

38
Q

What surgical procedure is indicated for patients chronically ill with ulcerative colitis?

A

Pouch procedure without ileostomy or proctocolectomy

39
Q

What are the indications for surgery in Crohn’s disease?

A

Failure of medical management
For relief of obstructive symptoms
For management of fistulae e.g. bowel to bladder
For management of intra-abdominal abscess
For management of anal conditions
Failure to thrive

40
Q

What are the common extra-intestinal complications of inflammatory bowel disease of the eyes?

A

Uveitis, episcleritis, conjunctivitis

41
Q

What are the common extra-intestinal complications of inflammatory bowel disease of the joints?

A

Sacrolitis, monoarticular arthritis, ankylosing spondylitis

42
Q

What are the common extra-intestinal complications of inflammatory bowel disease of the kidneys?

A

Renal calculi - only in Crohn’s

43
Q

What are the common extra-intestinal complications of inflammatory bowel disease of the liver and biliary tree?

A

Fatty change, pericholangitis, sclerosing cholangitis, gallstones

44
Q

What are the common extra-intestinal complications of inflammatory bowel disease of the skin?

A

Pyoderma gangrenosum, erythema nodosum, vasculitis

45
Q

What is the main long term complication of ulcerative colitis?

A

Colonic carcinoma - dependent on the extent and duration of the disease

Alimentary System (29 decks)

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