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Systems: Alimentary AB > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is included in IBD?

A
  • Crohn’s
  • Ulcerative colitis
  • Microscopic colitis
  • Collagenous colitis
  • Lymphocytic colitis
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2
Q

Inflammatory bowel disease

A

Chronic relapsing inflammatory conditions of the bowel

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3
Q

What classification system is used in IBD?

A

Montreal classification

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4
Q

What is the aetiology of IBD?

A
  • Unknown
  • Environmental trigger?
  • Genetically susceptible people?
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5
Q

What environmental factors are believed to trigger IBD?

A
  • Role of bacteria
  • Diet
  • Vaccination history
  • Social factors
  • Ethnicity
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6
Q

When does peak incidence occur for UC?

A

20-40 years

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7
Q

What does UC present with?

A
  • Bloody diarrhoea
  • Abdominal pain
  • Weight loss
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8
Q

What are the characteristics of UC?

A
  • Continuous inflammation only affecting the colon
  • Variable distribution
  • Variable severity
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9
Q

What are the markers of a sever attack of UC?

A 
Stool frequency >6 stools/day with blood
AND
-Fever >37.5
-Tachycardia >90
-ESR (CRP) raised
-Anaemia: Hb <10g/dl
-Albumin <30g/l
-Leucocytosis
-Thrombocytosis
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10
Q

What is the prevalence of Crohn’s ?

A

M=F

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11
Q

When are the 2 peaks of incidence of CD?

A
  • 20-40 years

- 60+

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12
Q

What are the characteristics of CD?

A

-Patchy disease
-Can affects mouth to anus
-Skip lesions
-Clinical features depend on regions involved
-

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13
Q

What are the clinical features of CD?

A
  • Diarrhoea
  • Abdominal pain
  • Weight loss
  • Malaise
  • Lethargy
  • Anorexia
  • Nausea and vomiting
  • Low grade fever
  • Malabsoprtion
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14
Q

What are the possible complications of CD?

A
  • Inflammation
  • Strictures
  • Fistulas
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15
Q

What are the blood results of someone with IBD like?

A
  • High ESR and CRP
  • High platelet count
  • High WCC
  • Low Hb
  • Low albumin
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16
Q

What are the categories of calprotectin results?

A
  • <50 normal
  • 50-200 equivocal
  • > 200 elevated
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17
Q

How does the histology of CD and UC differ?

A
  • CD has granulomas
  • Goblet cells are depleted in UC
  • Crypt abscess UC>CD
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18
Q

What features are present in CD but not in UC?

A
  • Fistulae

- Peri-anal disease

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19
Q

What extra-intestinal manifestations of IBD can occur in the eyes?

A
  • Uveitis
  • Episcleritis
  • Conjunctivitis
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20
Q

What extra-intestinal manifestations of IBD can occur in the joints?

A
  • Sacroilitis
  • Monoarticular arthritis
  • Ankylosing spondylitis
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21
Q

What extra-intestinal manifestations of IBD can occur in the liver and biliary tree?

A
  • Fatty change
  • Pericholangitis
  • Sclerosing cholangitis
  • Gallstones
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22
Q

What extra-intestinal manifestations of IBD can occur in the skin?

A
  • Pyoderma gangrenosum
  • Erythema nodosum
  • Vasculitis
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23
Q

Which IBD can present with renal calculi?

A

CD

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24
Q

What are the differential diagnoses for IBD?

A
  • Chronic diarrhoeas (malabsorption/ malnutrition)

- Ileo-caecal TB

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25
Q

What must colitis be distinguisged from?

A

Infective, amoebic and ischaemic colitis

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26
Q

What is sclerosing cholangitis?

A
  • Slow progressive disease of the bile ducts
  • Involves multiple strictures
  • Can lead to cirrhosis
27
Q

What is a long term complication of colitis?

A

Colonic carcinoma

28
Q

What is surveillance colonoscopy?

A

Annual, biannual etc colonoscopies with quadrantic biopsies every 10cm in patients with extensive colitis in order to detect any colonic cancers early

29
Q

How can people with IBD be managed as outpatients?

A
  • 5ASA
  • Steroids
  • Immunosuppression
30
Q

How can people with IBD be managed in hospital?

A
  • Steroids
  • Anticoagulation
  • Rest
  • Antibiotics
  • Surgery
31
Q

What are the tiers in the IBD management pyramid from the bottom up?

A
  • 5ASA or sulfasalazine
  • Prednisolone or budesonide
  • Immunomodulators (AZA, 6MP, MTX)
  • Biological agents
  • Surgery
32
Q

What is 5ASA?

A
  • 5 amino salicylic acid otherwise known as mesalazine

- Is an aminosalicylate

33
Q

When are antibiotics indicated for IBD?

A
  • CD peri-anal

- Small bowel bacterial over growth

34
Q

In what ways may medial therapies fail?

A
  • Relapse prior to or shortly after stopping therapy
  • Failure to control symptoms
  • Unacceptable complications of steroids
35
Q

What unacceptable complications from steroids are there?

A
  • Diabetes
  • Severe osteoporosis
  • Psychosis
36
Q

What may show poor response to medical therapy?

A
  • Fistulas
  • Fibrotic strictures
  • Peri-anal disease
  • Severe fulminating disease
37
Q

What 2 categories of surgery are ther for IBD?

A
  • Emergency

- Elective

38
Q

For someone who is acutely ill with severe colitis , what is the best surgical option?

A

Subtotal colectomy with rectal preservation and an ileostomy

39
Q

What surgical options are there for chronic UC?

A
  • Pouch procedure (no ileostomy)

- Proctocolectomy (ileostomy)

40
Q

What are the surgical options for site with CD?

A
  • Small intestine
  • Ileocaecal area
  • Colon and rectum
  • Anus (fissures, abscesses, fistulas, skin tags)
41
Q

What are the surgical indications fro CD?

A
  • Failure of medical management
  • Relief of obstructive symptoms
  • Management of fistulas
  • Management of intra-abdominal masses
  • Management of anal conditions
  • Failure to thrive
42
Q

Why is CD surgery not considered curative?

A

50% need further surgery by 10 year mark

43
Q

What different forms of mesalazine are there?

A
  • Acrylic resin

- Ethylcellulose microgranules

44
Q

What aminsalicylate pro drugs are there?

A
  • Balsalazide
  • Olzalazine
  • Sulfasalazine
45
Q

When is 5ASA given in mild- moderate UC?

A

-For distal and more extensive disease as they are superior to rectal steroids

46
Q

When 5ASA is used in mild-moderate UC to induce remission what has >3g per day shown?

A
  • No significant improvement in remission rate
  • Greater and quicker clinical improvement
  • No increase in adverse events
47
Q

When 5ASA is used in mild-moderate UC for maintenance of remission what has it shown?

A
  • Reduced number and severity of relapses

- Reduced CRC risk

48
Q

When can 5ASA induce remission in CD?

A

Mildly active ileocolonic disease

49
Q

When can 5ASA be used to maintain remission in CD?

A
  • Only if medical remission had been induced by 5ASA

- Post small bowel resection

50
Q

What steroids are used in IBD?

A
  • Prednisolone

- Budenoside

51
Q

How is prednisolone used in IBD?

A
  • Optimal dose is 40mg per day

- Tapering reduction over 4 weeks

52
Q

When are the only times that budenoside can be used in IBD?

A

-Ileal and ascending colon disease

53
Q

What immunosuppressant’s are used in IBD?

A
  • Azathioprine
  • Methotrexate
  • Ciclosporin
  • Mycophenolate
  • Tacrolimus
54
Q

What can azathioprine be used for?

A

Induction and maintenance of remission

55
Q

What are the significant side effects of azathioprine?

A
  • Leucopenia
  • Hepatotoxicity (requires regular blood monitoring)
  • Pancreatitis
  • Long term lymphoma risk
  • Intolerance
56
Q

Describe the use of methotrexate in CD.

A
  • Induction and maintenance of remission
  • Steroid dependen
  • 10-18% intolerance
  • Requires specialist follow up
57
Q

What is ciclosporin used for?

A
  • Salvage therapy for refractory UC

- 3-6 months as bridge to azathioprine

58
Q

Why is mycophenolate rarely used?

A

No evidence

59
Q

How effective is elemental feeding?

A
  • Exclusive elemental feeding can be as effective as steroids
  • More efficacious in children
  • Compliance is difficult though
60
Q

What biological agents are used in IBD?

A
  • Anti-TNFa antibodies
  • a4b7 integrin blockers
  • IL12/IL23 blockers
61
Q

What anti-TNFa antibodies are used in IBD?

A
  • Infliximab (remicade): 8 weekly IV infusion

- Adulimumab (Humira): 2 weekly SC injections

62
Q

What a4b7 integrin blockers are used in IBD?

A

-Vedolizumab: 8 weekly IV infusion

63
Q

What IL12/IL23 blockers are used in IBD?

A

-Ustekinumab : IV loading followed by SC 8-12 weekly

Systems: Alimentary AB (37 decks)

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