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Alimentary System: Pathology SA > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is the two aetiologies of IBD

A

Environmental triggers
(bacteria, diet, vaccinations, social, ethnicy)

and

Genetic susceptibility

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2
Q

What is the two most common forms of Inflammatory bowel disease

A

Crohns disease

Ulcerative colitis

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3
Q

What is the symptoms of Ulcerative colitis

A

Bloody diarrohea

abdominal pain

weight loss

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4
Q

What is the signs of a severe attack of ulcer colitis

A

> 6 stools a day with blood

Fever

Tachycardia

Raised CRP

Anemia

Low Albumin

Leucocytosis

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5
Q

What is the pathology of Ulcerative colitis

A

Continous inflammation starting from the rectum and only affecting the colon

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6
Q

What is variable in Ulcerative colitis

A

Distribution and Severity

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7
Q

What is the management of Ulcerative colitis

A

Surgical removal - colectomy

needs to be controlled within 7 days

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8
Q

Why is Crohns disease called a patchy disease

A

Mouth to anus, called a patchy disease due to skipped lesions

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9
Q

What is the complications of Crohns disease

A

Inflammation
Stricture
Fistula

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10
Q

What does the clinical feature sypmtoms of crohns disease depend upon

A

the regions involved - therefore gives a wide variety of symptoms

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11
Q

What is the symptoms of crowns disease

A 
Diarrhoea 
abdominal pain 
Weight loss 
Malise 
Lethargy 
Anorexia 
Malabsorption: 
 Anemia 
 Vitamine deficiency
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12
Q

What are the blood markers for Crohns disease

A 
High ESR 
High platelet count 
High WBC 
Low Hb
Low Albumin
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13
Q

What is investigated in stool samples for Crohns disease, why?

A

Calcoprotein,

Is a white cell protein found in the bowels, when bowels become inflammation there is an increase in cal protein in stool sample

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14
Q

What differential diagnosis but be checked for crowns disease

A

TB

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15
Q

What are the other causes of Irritable bowel disorder

A

Lymphocytic colitis
Collagenous colitis
Microscopic colitis

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16
Q

Where can extra manifestations occur in IBD

A

Eyes
Inflammation/conjunctivitis

Joint
inflammation/ arthritis

Renal calculi

Liver and Billary tree

Skin

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17
Q

What are the manifestation of IBD that can be seen on the skin

A

Pyroderma gangrenosum

Erythema nosdum

Vasculitis

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18
Q

What are the manifestations of IBD occurring in the liver and biliary tress

A

Fatty change

Pericholangitis

Sclerosing cholangitis

Gallstones

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19
Q

What form of Irritable bowel disease manifest to renal calculi

A

Crohns disease

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20
Q

What is the differential diagnosis of IBD

A

Chronic diarrhoea

  • malabsorption
  • malnutrition

Illeo-caecal TB

Different collitis:

  • infective
  • amoebic
  • ischaemic
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21
Q

What is the long term complication of IBD

A

Colonic carcinoma

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22
Q

What is the risk factors for colonic carcinoma

A

The extent of IBD

and the duration of IBD

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23
Q

How is the potentially development of colonic cancer monitored

A

Surveillance colonoscopy - biopsy

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24
Q

What is the problems of Surveillance colonoscopy

A

Cancers do not always arise from dysplastic mucosa

May be difficult to interpret

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25
Q

What is the steps of medical management in IB

A

5-ASA or sulfasalazine

Steroids:
Predisolone /Budenoside

Immunosuppressants

Biologics

Elemental feeding

antibiotics

Surgery

26
Q

What are aminosalicylates (5ASA) drugs purpose

A

Reduces inflammation of the inning of the intestine

27
Q

When are 5-ASA or sulfasalazine used in the treatment of IBD

A

1st line therapy used in the induction and maintenance of remission

28
Q

How is 5ASA administrated

A

> 3g per day tablet

Rectal 5ASA

29
Q

What is the purpose of rectal 5ASA

A

Treats distal and more extensive disease

30
Q

What is the overall benefit of 5ASA as 1st line therapy

A

Greater and quicker clinical improvement

Reduced number and severity of relapse

Reduced colorectal cancer risk
(>2g per day life long)

Higher mucosal levels gives greater benefit

31
Q

How is Predisolone administrated in IBD

A

Optimal dose 40mg per day with tapering reduction over a minimum of 4 weeks

(longer to reach colon and control inflammation)

32
Q

How does Budenoside steroid treatment compare to prednosiolone steroid treatment

A

Slightly less effective than Prednisolone but better side effect profile

33
Q

What does Budenoside specifically treat

A

Illeal and ascending colon disease

34
Q

What are examples of

immunosuppressants used in the treatment of IBD

A 
Azathioprone 
Methotrexate 
Ciclosporin 
Mycocphenolate 
Tacrolimus
35
Q

When is azathioprine (AZA/6MP) used in the treatment of IBD

A

Induction and maintenance of remission

36
Q

What is the benefit of azathioprine

A

Is steroid sparing

=lower the dose of steroids needed and thus spare some of the undesirable side effects of steroid therapy

37
Q

What is the potential side effect of azathioprine

A 
Leucopenia 
Hepatoxcity 
Pancreatits 
Possible long term lymphoma risk 
Intoleracne
38
Q

What is essential when managing the side effect of azathioprine

A

Blood monitoring for the side effect of hepatoxicity

  • For 8 weeks
  • Then every 8 weeks
  • patients must see GP if throat sore/infection
39
Q

What does methotextrate (MTX) specifically treat, and when is it administrated

A

Unlicensed use to treat Crohns disease

Used in the Induction and maintenance of remission

40
Q

What is methotextrate dependant upon

A

Steriods

41
Q

When is the immunosuppressant ciclosporin used

A

Final option for treating refractory Ulcerative colitis

Or used 3-6months as a bridge to azathioprine treatment

42
Q

What are examples of the biologics used to treat IBD

A

(Anti TNF alpha antibodies)
MONOCLONAL ANTIBODIES
- Infliximab
- Adulimunab

BLOCKERS
Alpha 4B7 integrin blockers
-Vedolizumab

IL12/IL23 Blockers
- Ustekinumab

43
Q

Define Biologic therapy

A

Treatment manufactured in living system

eg monolocalantibodies

44
Q

How is biologics administrated

A

IV infusion - 8 weekly

Subcutaneous Injection - 2 weekly

45
Q

What do biologics increase the risk of

A

Cancer

46
Q

What is elemental feeding just as effective as

A

Steroid treatment

47
Q

Who is elementary feeding more effective in and why?

A

Children as are more complaint to the treatment

tastes disgusting so adults less complaint

48
Q

What is the antibiotic used in IBD

A

Metronidazole

49
Q

What does the antibiotic metronidazole treat specifically in IBD

A

Crohns peri-anal disease

Small bowel bacterial growth

50
Q

What are examples that show the failure of medical therapy in IBD treatment

A

Recurrent courses of steroids

Relapse priori to shortly stopping therapy

Failure to control symptoms

Complications of steroids

51
Q

What are some of the complications of steroids that indicate medial failure in the therapy of iBD

A

Diabetes
severe Osteopororisis
Psychosis

52
Q

What are conditions that have a poor response to medical therapy for IBD

A

Fistulas

Fibrotic strictures

Peri-anal disease

Severe fulminating disease
(new disease)

53
Q

What are the therapies used in the hospital to treat IBD

A 
Steroids 
Anticoagulation 
rest 
surgery 
Cyclosporin - immunosuppressant 
Infliximab - monoclonal antibody
54
Q

What therapies are used for out patients with IBD

A

5ASA
Steroids
Immunosuppression

55
Q

When would emergency surgery rather than elective be performed on a patient with IBD

A

If they have had 5 day of medical treatment with still no improvement

56
Q

What is the surgery option if a patent with severe colitis forms acutely ill

A

total colectomy
Rectal preservation
illeostomy

57
Q

What are the two procedure for rectal preservation

A

Protectomy

or

Pouch procedure

58
Q

Define proctectomy

A

Remove all part of the rectum

59
Q

What happens in a pouch procedure

A

Small bowel is mobilised and lengthened

from Ileum to distal anal canal to construct pouch and stapled together creating a false rectum

60
Q

Define an illeostomy

A

Ileum cut into and diverted to an artificial opening in the abdominal wall
creating a stoma bag

61
Q

What problems arising in the anus due to Crohns may need surgical intervention

A

Fissures
abscesses
Fistulas
Skin tags

62
Q

What is the surgical indication for crohns disease

A

Failure of medical management

Relief of obstructive symptoms (small bowel)

Management of fistulae

Management of intra-abdominal abscess

Management anal conditions

Failure to thrive

Alimentary System: Pathology SA (27 decks)

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