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GI Rafi Ahmed > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Inflammatory bowel disease mainly comprises of two idiopathic chronic inflammatory diseases - what are they?

A

Crohn’s disease

Ulcerative colitis

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2
Q

Which 3 factors link together in the pathogenesis of IBD?

A

Genetic predisposition
Impaired mucosal immunity
Environmental triggers

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3
Q

There is a stronger genetic link in UC than Crohn’s disease. True/False?

A

False

Stronger genetic link in Crohn’s (36%) than UC (16%)

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4
Q

Which gene is susceptible to mutation which causes inflammatory bowel disease?

A

NOD2 (IBD-1) on chromosome 16

Encodes protein involved in bacterial recognition

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5
Q

Crohn’s disease a TH1/TH2/TH1+TH2 mediated disease

A

TH1-mediated disease

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6
Q

UC is a TH1/TH2/TH1+TH2 mediated disease

A

(mixed) TH1 + TH2 -mediated disease

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7
Q

Smoking aggravates Crohn’s disease + UC. True/False?

A

False

Aggravates Crohn’s but no effect on/may even protect UC

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8
Q

Which age range is typical peak incidence of UC?

A

20-40s but variable

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9
Q

Where does the inflammation start in UC?

A

Rectum

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10
Q

Does UC produce skip lesions?

A

No

Continuous proximal inflammation from rectum to stop point

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11
Q

List typical symptoms of UC

A 
Diarrhoea + bleeding
Increased bowel frequency
Urgency, tenesmus, incontinence
Night rising
Lower abdo pain (LIF)
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12
Q

Define severe UC

A 
>6 bloody stools/day + 1 of:
Fever
Tachycardia
Anaemia
Elevated ESR
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13
Q

What is the classic sign of mucosal inflammation/oedema on an AXR?

A

Thumbprinting

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14
Q

How does toxic megacolon arise?

A

Persistent inflammation causes loss of muscle tone of the colon, resulting in distention

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15
Q

What are some extra-intestinal manifestations of UC?

A

Primary sclerosing cholangitis
Apthous ulcers
Erythema nodosum
Uveitis

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16
Q

Which age range is typical for Crohn’s disease?

A

Young children to 40 year olds

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17
Q

The inflammation in Crohn’s and UC is transmural, i.e. it breaches the mucosa and goes beyond muscle layer. True/False?

A

False

Inflammation in Crohn’s is transmural; inflammation in UC is confined to mucosa/submucosa

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18
Q

Does Crohn’s disease produce skip lesions?

A

Yes

Can affect anywhere from mouth to anus

19
Q

Can fistulas occur in Crohn’s and UC?

A

Yes

Leads to abscess formations, especially peri-anally

20
Q

Symptoms of Crohn’s disease are dependent on where the disease occurs. List some common symptoms

A 
Abdominal cramps
Diarrhoea
Weight loss
Painful ulcers
Abscesses
21
Q

How common is granuloma in Crohn’s disease?

A

50% of patients

22
Q

Where does Crohn’s disease most commonly occur?

A

Terminal ileum

Colon

23
Q

Fissures are associated with which IBD - Crohn’s or UC?

A

Crohn’s disease

Deep, knife-like fissures

24
Q

List some complications of Crohn’s disease

A

Malabsorption
Short bowel syndrome
Vitamin deficiencies, anaemia
Fistulas

25
Q

What are the 4 treatments available (excluding surgery) for UC and Crohn’s disease, in order of step-up therapy?

A

5-ASA (mesalazine - UC ONLY)
Steroids
Immunosuppression
Anti-TNF drugs

26
Q

How can mesalazine be administered?

A

Orally

Topically as a rectal suppository/enema

27
Q

What is the main action of mesalazine?

A

Anti-inflammatory

28
Q

Mesalazine can be given in an oral form that is “pH-dependent” - what does this mean?

A

Only activates at a certain pH; in this case, would only activate in the presence of the pH of the colon

29
Q

What is the advantage of a mesalazine topical enema over a suppository?

A

Enema extends action to sigmoid colon

30
Q

What is the advantage of a mesalazine topical suppository over an enema?

A

Suppository has better mucosal adherence

31
Q

If mesalazine is ineffective/patient continues to experience symptoms, which class of drugs is prescribed? Give an example of the class of drug used

A

Steroids

Oral/topical prednisolone/budesonide

32
Q

Steroids are given for a long course in IBD. True/False?

A

False

33
Q

Is increasing or reducing dosage of steroids given for IBD?

A 
Reducing dose
(start high and reduce over 6-8 weeks)
34
Q

When a more potent suppression of inflammation than steroids is required, which class of drugs is prescribed? Give an example of this class of drug

A

Immunosuppression

Azathioprine, Methotrexate

35
Q

Which class of drug is used after immunosuppression? Give an example of a drug of this class

A

Anti-TNF drugs

IV Infliximab

36
Q

Anti-TNF has become the mainstay of treating Crohn’s disease. When is it mainly used, according to NICE?

A

Long-term management
Refractory/fistulating disease
BUT NOT IN PRESENCE OF TB

37
Q

What are “planned” surgical procedures for IBD in cases of emergency?

A 
Subtotal colectomy (leave rectum) in UC
Resection in Crohn's disease
38
Q

List elective surgery for Crohn’s disease

A

Resection
Stricturoplasty
Fistula repair

39
Q

List elective surgery for UC

A

Proctocolectomy with end ileostomy
Proctocolectomy with ileorectal anastomosis
Proctocolectomy with pouch

40
Q

What is an ileostomy?

A

Small intestine is diverted to an opening in the abdomen and a bag is placed externally to collect waste products

41
Q

What is a pouch? (AKA ileo-anal pouch; J/W/S pouch)

A

Loops of small intestine are folded and stapled on itself to create a reservoir, restoring normal function of the rectum

42
Q

Surgery for UC is well tolerated. True/False?

A

True

Most live well with a stoma

43
Q

Surgery for Crohn’s is well tolerated. True/False?

A

False

GI Rafi Ahmed (23 decks)

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