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Surgery > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

What is the difference in distribution between Crohn’s and ulcerative colitis?

A

Crohns can effect mouth to anus

Ulcerative colitis is exclusively colon and rectum

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2
Q

Disease continuity in Crohn’s vs UC?

A

Crohns- discontinuous (skip lesions)

UC- continuous

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3
Q

Depth of inflammation in Crohn’s vs UC?

A

Crohns- transmural

UC- mucosal

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4
Q

Biggest risk factor for Crohn’s development?

A

Smoking

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5
Q

Macroscopic appearance of Crohn’s disease?

A

Cobblestoning appearing- oedematous islands of mucosa separated by fissures

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6
Q

What consequences can the transmural inflammation in Crohn’s have? (3)

A

Adhesions to neighbouring structures, sinus formation, fistula formation

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7
Q

Microscopic features of Crohn’s? (2)

A

Deep fissuring ulcers

Inflammatory cell infiltrates (lymphocytes, non-caseating granulomas)

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8
Q

Disease course of Crohn’s disease?

A

Chronic with relapses/remissions

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9
Q

Main clinical features of Crohn’s colitis? (5)

A 
Continuous/episodic diarrhoea
Abdominal pain
Weight loss and malabsorption
Features of obstruction
Peri-anal disease
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10
Q

Peri-anal disease features in Crohn’s? (6)

A 
Abscess
Fistulae
Fissures
Uleration
Strictures
Skin tags
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11
Q

Systemic manifestations/associations of Crohn’s? (6)

A 
Anterior uveitis/iritis
Ankylosing spondylitis
Erythema nodosum
Gallstones
Primary sclerosis cholangitis
Megaloblastic anaemia (if involvement of terminal ileum)
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12
Q

Investigation of suspected Crohn’s?

A

Full blood count (?anaemia)
CRP
Stool culture
Ileocolonoscopy and biopsy

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13
Q

Medical management of Crohn’s disease?

A

Induction of remission (prednisolone, 5-ASA e.g. mesalazine)

Maintenance of remission (azathioprine, mercaptopurine)

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14
Q

What should be assessed before offering AZT/mercaptopurine for Crohn’s?

A

TPMT level

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15
Q

Which antibiotic is sometimes used for isolated peri-anal disease?

A

Metronidazole

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16
Q

What is the basic principle of surgery for Crohn’s?

A

Maintenance of bowel length

17
Q

Bowel complications of Crohn’s? (5)

A 
Strictures causing obstruction
Fistulae
Perforation
Acute dilatation
Increased risk of colonic carcinoma
18
Q

Treatment of perianal fistula?

A

Seton suture- allows fistula to drain and heal itself

19
Q

Clinical features of ulcerative colitis?

A

Diarrhoea + blood/mucus
Abdominal pain
Pyrexia
Increased faecal frequency and urgency

20
Q

Key investigation in the diagnosis of ulcerative colitis?

A

Sigmoidoscopy showing red, friable mucosa

21
Q

What might abdominal X ray show in ulcerative colitis?

A

Dilated gas filled colon

22
Q

Mainstays of UC treatment?

A

Fluid and electrolyte replacement
Nutritional support
Systemic steroids to induce remission

23
Q

What is Truelove and Witt’s criteria?

A

System used to identify a severe acute episode of UC

24
Q

Maintenance therapy for UC?

A

Aminosalicylates e.g. mesalazine

AZT and mercaptopurine

25
Q

Treatment of acute distal colitis?

A

Topical rectal mesalazine

26
Q

How are UC flares graded?

a) mild
b) moderate
c) severe

A

a) fewer than 4 stools
b) four to six stools
c) more than 6 stools, evidence of systemic disturbance

27
Q

Criteria for toxic megacolon?

A

Transverse colon diameter greater than 6cm

28
Q

Why is colectomy not a curative procedure for Crohn’s?

A

Crohn’s can affect any segment of the GI tract

29
Q

Extra-intestinal manifestations:

Eyes (3)

A

Uveitis (more in UC), episcleritis (more in CD), conjunctivitis

30
Q

Extra-intestinal manifestations:

Joints (3)

A

Arthralgia, ank spond (more UC), sacroiliitis

31
Q

Extra-intestinal manifestations:

Skin (3)

A

Erythema nodosum, pyoderma gangrenosum, enterocutaneous fistulae

32
Q

Extra-intestinal manifestations:

Hepatobiliary (5)

A

PSC and cholangiocarcinoma (more in UC), gallstones (more in CD), fatty liver, chronic hepatitis, cirrhosis

Surgery (21 decks)

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