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GI > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is the general definition of IBD?

A

Dysregulation of the immune response to foreign proteins and host bacteria is the cause

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2
Q

Which type of IBD has been shown to have a stronger genetic input?

A

Crohn’s

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3
Q

What is a common gene affected in IBD and what is this involved in?

A

NOD2- encodes a protein involved in bacterial recognition

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4
Q

What are 5 common presenting complaints of IBD?

A

Change in bowel habit, PR bleeding, weight loss, anaemia, abdominal pain

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5
Q

What is most likely to be the diagnosis in a child < 12 with IBD symptoms?

A

Crohn’s

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6
Q

Symptoms of bloody diarrhoea, pain in the left lower quadrant and tenesmus are more likely to be what?

A

UC

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7
Q

Symptoms of non-bloody diarrhoea, upper GI symptoms, pain or mass in the right lower quadrant are more likely to be?

A

CD

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8
Q

Per-anal disease is more commonly associated with?

A

CD

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9
Q

Weight loss is more common in?

A

CD

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10
Q

What co-morbidities are more common in UC?

A

Primary sclerosing cholangitis and uveitis

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11
Q

What co-morbidity is more common in CD?

A

Gallstones

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12
Q

Which IBD has a higher risk of colorectal cancer?

A

UC

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13
Q

What are complications of CD?

A

Colorectal cancer, obstruction and fistula

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14
Q

Where in the GI tract does UC affect?

A

From rectum anywhere up to ileocaecal valve- continuously

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15
Q

Where in the GI tract does Crohn’s affect?

A

Anywhere from mouth to anus- usually patchy

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16
Q

Where does inflammation invade in UC?

A

Never beyond the submucosa

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17
Q

Where does inflammation invade in CD?

A

All layers from mucosa to serosa

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18
Q

Which IBD are pseudopolyps associated with?

A

UC

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19
Q

Which IBD is cobble-stoning of mucosa associated with?

A

CD

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20
Q

Which IBD does smoking protect against and which does it affect?

A

Protects- UC

Aggravate- CD

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21
Q

What age range is the peak incidence of UC?

A

20-30

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22
Q

What mediates UC?

A

Th1 and Th2

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23
Q

In UC, there is persistent activation of what?

A

T cells and macrophages

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24
Q

Natural killer cells in UC are mediated by what?

A

IL5 and IL13

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25
Q

Can there ever be a single attack of UC?

A

Yes, but rarely

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26
Q

Where does UC tend to attack first?

A

The rectum, then works proximally

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27
Q

What does proctitis mean?

A

UC affecting only the rectum

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28
Q

What is left-sided colitis?

A

UC affecting rectum and sigmoid/descending colon

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29
Q

What is UC affecting the whole colon known as?

A

Pancolitis

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30
Q

What are 5 common symptoms of UC?

A

Bloody diarrhoea, urgency and tenesmus, increased bowel frequency, incontinence and night rising and lower abdominal pain

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31
Q

What are 5 extra-intestinal manifestations of UC?

A

Skin rashes, joint pain, eye problems, deranged LFTs, renal stones

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32
Q

What are the criteria involved in Truelove and Witt for UC?

A

Number of bowel movements, bloody stool, temp > 37.8, HR > 90bpm, anaemia

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33
Q

A temp > 37.8, HR > 90bpm and anaemia suggests what type of UC?

A

Severe

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34
Q

What distinguishes between mild and moderate UC?

A

Mild: < 4 bowel movements, spots of blood
Moderate: 4-6 bowel movements, mild-severe blood

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35
Q

What tests would be done to assess UC?

A

Bloods, AXR, endoscopy or sigmoidoscopy, biopsy, histology

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36
Q

What would you test blood for in UC?

A

CRP and albumin

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37
Q

What should you look for on an AXR of UC?

A

Bowel dilatation, absent stool distribution, mucosal oedema (thumbprint), toxic megacolon

38
Q

What is Wriggler’s sign?

A

Can see the outside of the bowel wall- suggests perforation

39
Q

What would you look for on histology of UC?

A

Absence of goblet cells and crypt distortion

40
Q

Will there be granulomas on UC histology?

A

No

41
Q

When should UC be monitored for colorectal cancer?

A

Every 10 years if patients have extensive colitis (beyond splenic flexure)

42
Q

What is an electrolyte complication of UC?

A

Hypokalaemia

43
Q

What parts of the GI tract tend to be involved in Crohn’s in older and younger patients?

A

Younger- upper GI

Older- lower GI

44
Q

What is the mediator of CD?

A

Th1

45
Q

CD is driven by the production of what?

A

Interleukins, TNF alpha by dendritic cells and macrophages

46
Q

What are symptoms of Crohn’s in the mouth?

A

Painful ulcers, cobble-stoning of buccal mucosa, angular stomatitis, swollen lips

47
Q

What are symptoms of Crohn’s in the SI?

A

Abdominal cramps, diarrhoea, weight loss

48
Q

What are symptoms of Crohn’s in the LI?

A

Abdominal cramps, bloody diarrhoea, weight loss

49
Q

What are symptoms of Crohn’s in the anus?

A

Peri-anal pain, abscesses

50
Q

What tests are used to assess CD?

A

Bloods, colonoscopy, endoscopy, mucosal biopsy, histology

51
Q

What is looked for in blood tests of CD?

A

CRP, albumin, platelets, vitamin B12, ferritin

52
Q

What will be seen on histology of CD?

A

Large, non-caseating granulomas

53
Q

What can peri-anal disease lead to?

A

Fistula formation

54
Q

What is used to treat peri-anal colitis?

A

Metronidazole

55
Q

What type of effect do all IBD drugs have?

A

Anti-inflammatory

56
Q

What are the drugs used for UC?

A

5ASA, steroids, immunosuppression, anti TNF

57
Q

What are the drugs used for CD?

A

Steroids, immunosuppression, anti TNF

58
Q

What is important to remember about the order of usage of IBD drugs?

A

Often start with strongest first to reduce symptoms and then decrease

59
Q

As well as being an anti-inflammatory, what is another important effect of mesalazine?

A

Decreases risk of colorectal cancer

60
Q

What are side effects of 5ASA?

A

Diarrhoea and nephritis

61
Q

What is a suppository?

A

Solid dose in rectum

62
Q

What is and enema?

A

Fluid dose in rectum

63
Q

How can mesalazine be given?

A

Orally, suppository, enema

64
Q

When should enemas and suppositories be used?

A

Enema- night

Suppository- morning

65
Q

What are the first and second line corticosteroids used?

A

1- prednisolone

2- budesonide (not systemic)

66
Q

What drugs should be co-administered with corticosteroids?

A

Omeprazole

67
Q

Because of unwanted steroid dependence, what drugs are used long term instead?

A

Immunosuppressants

68
Q

What should you avoid co-prescribing with immunosuppressants?

A

Allopurinol

69
Q

What are side effects of immunosuppressants?

A

Pancreatitis, leukopenia, hepatitis, small risk of skin cancer

70
Q

Biological agents work by blocking what?

A

TNF alpha secreted by dendritic cells and macrophages

71
Q

What are side effects of biological agents?

A

Cancers, reactivation of TB, irreversible MS

72
Q

What are some emergency operations for IBD?

A

Subtotal colectomy for UC, resection of Crohn’s

73
Q

What are some elective operations for UC?

A

Proctocolectomy with end ileostomy, ileorectal anastomoses

74
Q

What are some elective operations for CD?

A

Resection, stricturoplasty, fistula surgery, surgery for anal disease

75
Q

Removal of the terminal ileum in Crohn’s is common. This leads to a deficiency of what?

A

Vitamin B12

76
Q

What are some indications for elective surgery of IBD?

A

Medically unresponsive disease, intolerable, dysplasia or malignancy, growth retardation in children

77
Q

What is a proctocolectomy?

A

Removal of some or all of the colon without the rectum

78
Q

What is a panproctocolectomy?

A

Removal of some or all of the colon with the rectum

79
Q

What side is an ileostomy usually on?

A

Right

80
Q

What are the two types of ileostomy and which is preferred?

A

End or loop- loop is preferred

81
Q

Why is it important that ileostomies are spouted?

A

What comes out is toxic and can cause skin reactions

82
Q

Where usually is the spout from a colostomy?

A

Left

83
Q

Who are pouches following a proctocolectomy more common in and what do they create?

A

Younger people- create a reservoir

84
Q

What shapes can pouches be?

A

W, S, J

85
Q

What are the functional outcomes of a pouch?

A

Bad- usually around 6 bowel movements in 24 hours

86
Q

Who are pouches not given to?

A

Crohn’s patients (in UK) and young females without a family

87
Q

What is pouchitis?

A

A common complication of pouch procedures which results in patients being at the toiler around 20-30 times a day with mucus and pain

88
Q

How do you treat pouchitis?

A

Antibiotics and probiotics

89
Q

Surgery for UC is usually what?

A

Curative

90
Q

When is surgery for CD done?

A

Only when necessary- usually they will have it again after 10 years

91
Q

What is a seton?

A

Technique used for fistulas

GI (17 decks)

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