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Core Conditions third year > Inflammatory Bowel disease > Flashcards

Inflammatory Bowel disease Flashcards

1
Q

Which part of the colon does Ulcerative collitis affect

A

Rectum (proctits 50%)

or extend and invlve part of the colon (left-sided colitis 30%)

or the entire colon (pancolitis 20%)

Never spreads proximal to the illoceacal valve.

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2
Q

Causes of UC

A

Idiopathic

genetic

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3
Q

Which gene is associated with UC

A

HLADR103

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4
Q

Risk factors of UC

A

most present aged 15-30

More in non/ex smokers

Appendectomy protects

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5
Q

Risk factors for Crohn’s

A

More common in smokers

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6
Q

Presentation of UC

A

Episodic or chronic diarrohoea (+- blood or mucus)

Crampy abdominal discomfort

urgency/tenesmus - rectal UC

systemic symptoms in attacks: fever, malaise, anorexia, weight loss

higher stool frequency compared to Crohns

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7
Q

A 35 year old male presents with weight loss, diarrohoea, and abdominal pain. On examination he has apthous ulcers in the mouth and a palpable mass in the right illiac fossa.

A

Crohn’s disease

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8
Q

Extraintestinal signs of IBD in the mouth

A

Apthous ulcers in the mouth

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9
Q

Extraintestinal signs of IBDin the eyes

A

conjuctivitis

Iritis

Episcliritis

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10
Q

Extraintestinal signs of IBD in the liver

A

Abscess, fatty change, hepatitis, sclerosing cholangitis

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11
Q

vascular Extraintestinal signs of IBD

A

Mesenteric, portal or deep vein thrombosis

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12
Q

Extraintestinal signs of IBD in the skin

A

Erythema nodosum, pyoderma gangrenosum

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13
Q

Extraintestinal signs of IBD in the boins/joints

A

Metabolic bone disease, sacroiliitis

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14
Q

Mild UC characteristics

A

<4 motions/day

small rectal bleeding

HR <70

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15
Q

Moderate UC characteristics

A

4-6 motions/day

medium rectal bleeding

HR 70-90

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16
Q

Severe UC characteristics

A

> 6 motions/day

severe rectal bleeding

HR >90

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17
Q

Symptoms of crohn’s disease

A

Diarrhoea/urgency “I get up at 4am and go 5-6 times in the next 45 mins”

Abdominal pain, weight loss, fever, malaise, anorexia.

“I can be fine one minute and deathly the other”

18
Q

Signs of Crohn’s

A

Apthous ulcers

Abdominal tenderness/mass

Fistulae

perianal abscess

skin tags

Anal strictures

19
Q

Investigations for inflammatory bowel disease

A

FBC - Anaemia

ESR

CRP

Faecal Calprotectin

Stool sample

Blood cultures

Sigmoidoscopy

Endoscopy/ Colonoscopy for biopsy

Radiology

20
Q

When is ESR elevated

A

In exacebrations or because of abscess in IBD

21
Q

What can we benefit from CRP

A

Helpful in monitoring Crohn’s disease activity

22
Q

Why would you want a stool sample in IBD?

A

Help to exclude superimposed infections in exacebrations

23
Q

What is sigmoidoscopy

A

Looks at rectum and sigmoid colon.

24
Q

What can sigmoidoscopy show in UC

A

Loss of vascular pattern

granularity

Friability

Ulceration

25
Q

What can sigmoidoscopy show in Crohn’s

A

Patchy inflammation with discrete, deep ulcers, perianal disease or rectal sparing occurs

Cobble stone appearance

26
Q

What Radiological investigations can help in IBD investigations

A

Barium enema - can show ulcers or strictures

CT - colongram

MRI - staging

AXR - dilation of colon, mucosal oedema, perforation

USS - thickened small bowel, stricture in Crohn’s disease.

27
Q

Surgical treatment of UC

A

60% of UC will require surgery

Panproctocolectomy with ileostomy or proctocolectomy with ileal–anal pouch anastomosis cures the patient

28
Q

Surgical treatment of Crohn’s

A

Operations are often necessary to deal with fistulae, abscesses and perianal disease, or to relieve small or large bowel obstruction

Surgery is not curative compated to UC, and recurrence is a rule

29
Q

IBD prognosis

A

Now life expectancy is similar to general population and patients can live normal life

30
Q

Medical treatment for mild to moderate subacute proctitis or proctosigmoiditis

A

Topical aminosalicylates (Enema or suppository)

Or

Oral + Topical aminosalicylates

Or Oral alone but must explain that topical or combination is more effective

31
Q

Medical treatment for mild to moderate subacute left-sided and extensive ulcerative colitis

A

Offer high dose oral Aminosalicylates

Can Add topical Aminosalicylates or oral beclometasone dipropionate (corticosteroid i think)

Oral predinosolone if aminosalicylates is contraindicated

32
Q

Inducing remission in acute ulcerative colitis

A

IV corticosteroid to induce remision

Or IV cyclosporine or surgery if IV corticosteroid is containdicated

33
Q

Inducing remission in Crohn’s disease

A

Consider predinosonle or IV hydrocortisone in people with first presentation

Consider budesonide(corticosteroid) if glucocorticoids are contraindicated

If both of above fail/contraindicated consider antisalicylates - explain that it is less effective but has fewer SE

adjunct treatment: azathioprine or mercaptopurine

Influximab and adalimumab

34
Q

When to consider IV cyclosporine in severe acute Ulcerative colitis

A

if IV corticosteroid is containdicated

If no impromvement within 72 hours of starting IV corticosteroids

If symptoms persist after IV corticosteroid therapy

35
Q

When to consider IV cyclosporine in severe acute Ulcerative colitis

A

if IV corticosteroid is containdicated

If no impromvement within 72 hours of starting IV corticosteroids

If symptoms persist after IV corticosteroid therapy

36
Q

In a severe or exacebrations Crohn’s disease presentation which of the following medications you should not offer

A

Budoneside

Antisalicylates

37
Q

Do not offer these drugs as monotherapy for Crohn’s disease

A

Axathiopurine mercaptopurine, methetroxate

38
Q

Maintaining remision in Crohn’s

A

azathioprine or mercaptopurine

Methotrexate if above is contraindicated

39
Q

Maintaining remision in mild to moderate subacute proctitis or proctosigmoiditis

A

same as acute Rx

40
Q

Maintaining remision in mild to moderate subacute left-sided and extensive ulcerative colitis

A

Same as acute but lower dose

Core Conditions third year (78 decks)

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