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LC Gastroenterology Week 5 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the 2 main IBD?

A

Crohn’s disease

Ulcerative colitis

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2
Q

What do the 2 IBD diseases share (have in common)?

A

Epidemiology

Clinical therapeutic characertisitcs

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3
Q

What do the 2 IBD diseases differ in?

A

Clinical presentation

Pathology

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4
Q

What are the 3 pathogenesis of IBD?

A

Genetic predisposition
Mucosal immune system
Environmental triggers

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5
Q

Describe some evenidence for genetics in IBD?

A

There is a risk in first degree relative of 2.2-16.2%

There is a risk of twins getting CD (36%) and UC (16%)

Postive famiyl history best established risk factor for disease development

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6
Q

What mediated disease is Crohns?

A

Th1 meditated disease

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7
Q

What mediated disease is UC?

A

Mixed Th1/Th2 mediated disease/ NKTC

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8
Q

Describe a rough theory of IBD pathogenesis?

A

Pathogenic bacteria
Abnormal microbial composition
Defective host contaminant of commensal bacteria
Defect host immunoregulation

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9
Q

What does smoking do in Crohns and UC?

A

Crohns - aggravates

UC - protects

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10
Q

What is the aetiology of UC?

A

Inflammation of colon of unknown cause
Peak incidence 20-30s
Relapsing course
Affects rectum extending proximally

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11
Q

Describe the UC disease extent?

A

Just rectum etc - 36%
Left sided colitis - 27%
Pan colitis (whole colon) - 37%

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12
Q

What are the symptoms of UC?

A 
Diarrhoea and bleeding 
Increased bowel frequency 
Urgency
Tenesmus 
Incontinence 
Night rising 
Lower abdo pain (LIF)
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13
Q

What things must you remember to ask in the history?

A 
Recent travel
Antibiotics
NSAID’s
Family history
Smoking
Skin, eyes, joints
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14
Q

How would you determine the severity of UC?

A

Truelove and Witt criteria

Sever UC - 30% of colectomy

> 6 bloody stools/24 hrs

Plus - 1 of more of….

Fever
Tachycardia
Anaemia
Elevated ESR

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15
Q

What other assessments of UC would you do?

A

Bloods - CRP, albumin (negative acute phase reactant)

Plain AXR
Endoscopy
Histology

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16
Q

What might you see on a plain AXR in UC?

A

Stool distribution:
- Absent in inflammed colon

Mucosal oedema / ‘thumb-printing’

Toxic megacolon:
Transverse >5.5cm
Caecum >9cm

17
Q

What might you see on a endoscopy of UC?

A

Confluent inflammation extending proximally from anal margin to a ‘transition zone’:
Loss of vessel pattern
Granular mucosa
Contact bleeding

(UC is restricted to just the mucosa)

18
Q

What might you see histologically in UC?

A

Absence of goblet cells
Crypt distortion and abscess
Affects only mucosal layer

19
Q

What are some longterm complications of UC?

A

Increased risk of colorectal cancer
(determined by, the severity of inflammation, duration of disease, disease extent)

Extensive colitis (to beyond splenic flexure) - at risk and require surveillance after 10 years of disease

20
Q

What are some extra-intestinal manifestation of UC?

A

Skin - erythema nodusum, pyoderma grangroenosum
Joints - spondylitis, sacrolitis, peripheral arthritis
Eyes - uveitis

Deranged LFTs

Oxalate renal stones

21
Q

What is primary sclerosing cholangitis?

A

Chronic inflammatory disease of the biliary tree

(80% have associated IBD)

Most asymptomatic OR itch, riggers
Cholestatic LFTs

22
Q

Describe the aetiology of crohns?

A

diagnose mean age 27

Can affect any region of GI tract from mouth to anus

23
Q

What are some characteristic features of crohns?

A

Skip lesions

Transmural inflammation

24
Q

Describe peri-anal disease?

A

Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters

25
Q

What are some symptoms of crohns diseases?

A 
Small intestine
Abdominal cramps (peri-umbilical)
Diarrhoea, weight loss

Colon
Abdominal cramps (lower abdomen)
Diarrhoea with blood
Wt loss

Mouth
Painful ulcers, swollen lips, angular chielitis

Anus
peri-anal pain, abscess

26
Q

What would you see in crohns vs UC on the mucosa…?

A

Crohns - cobble stoning, thickened wall, fissure

UC - ulceration, surviving mucosa (pseudopolyps), loss of haustra, crypt distortion

LC Gastroenterology Week 5 (10 decks)

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