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gastrointestinal > inflammatory bowel disease > Flashcards

inflammatory bowel disease Flashcards

1
Q

age group for uc or cd

A

any

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2
Q

gender divide uc and cd

A

m=f for uc

f>m for cd

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3
Q

genetic factors for uc and what defect assoc. too

A

HLA-DR103

Colonic epithelial barrier function

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4
Q

genetic factors for CD and what defect assoc. too

A 
HLA locus
NOD2
ATG16L1
IRGM
genetic defect in innate immunity and autophagy
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5
Q

ethnic group ibd

A

ashkenazi jew

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6
Q

risk factors/ protective for UC

A

more common in non or ex smokers

-appendiectomy also proective

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7
Q

risk factors for cd

A

smokers

fhx

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8
Q

presentation of uc

A 
bloody diarrhoea
tenesmus 
abdominal cramps
anorexia
malaise
weight loss
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9
Q

presentation of cd

A

variable pain, diarrhoea and weight loss

often watery diarrhoea and then lethargy
mouth ulcers
peri-anal abscess
perianal skin tags
fistulae
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10
Q

management of uc

A 
5ASA
Steroids 
azathioprine/mercaptopurine 
biologicals 
colectomy
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11
Q

management cd

A 
steroids 
azathioprine
methotrexate
mercaptopurine 
budesonide (ileocaecal)
biological
nutritional
smoke cessation
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12
Q

site of uc

A

rectum +- along colon

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13
Q

site of cd

A

anywhere from mouth to anus

perianal and skin

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14
Q

distribution / image of uc

A

diffuse
continuous
confined to mucosa
(only calcaneal patch ie appendix can be skipped)

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15
Q

distribution/ image of cd

A

patchy

transmural

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16
Q

features of uc

A 
cryptitis
crypt abscess
goblet cell distribution
crypt architecture distorotion
crypt loss
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17
Q

features of cd

A

patchy
lymphoid aggregates
granulomas
crypt stuff preserved

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18
Q

uc ulceration

A

broad based, shallow may undermine mucosa

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19
Q

cd ulceration

A

apthaous ulcers

deep fissuring ulcers

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20
Q

granulomas uc

A

uncommon

assoc. to ruptured ulcers

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21
Q

gramulomas cd

A

common may be transumural and involve lymph nodes

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22
Q

which uc or cd has fistulae and strictures

A

cd

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23
Q

which cd or uc more likely to have inflammatory polyps

A

uc get pseudopolyps

may be larger in cd tho

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24
Q

other features of uc

A

paneth cell metaplasia

pseudopolyps

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25
Q

other features of cd

A

pyloric metaplasia in si

cobblestone mucosa from ulcers

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26
Q

what is pouchitits

A

after a proctocolectomy which removes the colon and rectum
the ileal is joined to anus = ileal pouch anal anasatomosis
this pouch can get inflamed as stores faeces

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27
Q

cd risk of fhx with sibling twin and parent

A

sibling=25-35
twin=45
parent=12-16

28
Q

what is dysbiosis

A

altering of commensal gut microbiota

29
Q

what is proctitis

A

inflammation of the rectum

30
Q

what is pancolitis

A

inflammation of the whole colon

31
Q

complication of UC and presentation

A

toxic megacolon
fever tachycardia
peritoneal inflammation
-distended colon so bacterial toxins pass across diseased mucosa into portal->systemic system

32
Q

factors promoting relapse

A 
emotional stress
intercurrent infection
gastroenteritis
antibiotics
nsaid therapy
33
Q

dx of a acute severe colitis in UC

A 
-diarrhoea >6 with blood 
then plus 1 systemic feature
 -haemoglobin <105 or
 esr >30
-temperature >37.8
-pulse rate >90bpm or 
crp>30
34
Q

extra-intestinal features of IBD (more CD)

A 
A- apthous ulcers
P-pyoderma gangrenosum
I-iritis 
E-erythema nodosum
S-sclerosing cholangitis
A-arthritis
C-clubbing

hepatobiliary

  • psc
  • gallstone
  • fatty liver
  • autoimmune hepatitis

arthritis
-sacroiliitis
-ank spond (HLA)
DVT risk increased

35
Q

investigations ibd

A
  • crp and esr
  • low haem and anaemia
  • low albumin
  • stool microscopy and culture negative
  • clostridium difficile negative
  • faecal calprotectin
  • mrcp of biliary tree if lfts abnormal maybe
36
Q

what test needs to be done before starting azathioprine

A

TMPT enzyme test

- enzyme needed to break down aza toxins

37
Q

cd histology appearance

A 
oedematous
thickened wall
deep ulcers
fisturing ulcers
fistulae and strictures
cobblestone
perforation
lymph node
thickened mesentry
patchy distribution
lymphoid aggregates
granlomatous
38
Q

most common site of getting CD

A
  1. ileocecum- terminl ileum
  2. small bowel
  3. colon
39
Q

what is the window of opportunity for cd

A

ie the window in which anti-inflammatory can be given to prevent strictures
as don’t have anti-fibrosis

40
Q

treatment severe attack of UC

A
  1. methylprednisolone IV 60mg or hydrocortisone
  2. heparin thrombophylaxis
  3. iv fluids resuscitate
  4. invetigations
  5. sigmoidoscopy
41
Q

indication for surgery of UC

A

1.severe attacks failing to respond to treatment
2.toxic megacolon
3.perforation
4.chronic cont disease
dysplasia/malignancy

42
Q

adverse reaction of 5ASA

A

headache
nausea
diarrhoea
blood dyscrasias

43
Q

how do thiopurines work

A

immunomodulation by inducing T cell apoptosis

eg azathioprine and mercaptopurine

44
Q

ciclosporin work by

A

inhibiting t cell activation

45
Q

anti-diarrhoeal drugs for ibd

A

loperamide

co-phenoxylate

46
Q

adverse of budesonide

A

dependency
tolerance
failure
toxicity

47
Q

what treatment is usually good for CD in children

A

polymeric diet

48
Q

when should metronidazole also be given

A

for perianal disease

49
Q

indication for cd surgery

A 
sepsis-fistulae, abscess and perforation
obstruction
haemorrhage
growth retardation
colitis fulminans
cancer
50
Q

azathioprine adverse

A 
minor toxicity (nausea, fever, rash and malaise)
pancreatitis
bone marrow depression
allergy
hepatitis
51
Q

methotrexate adverse

A 
leukopenia
nausea
malaise
fatigue
stomatitis
nephrotoxcitiy
oligospermia
methotrexate pneumonia
52
Q

infliximab safety issues

A

check for tb
malignancy
lupus
immunosuppression

53
Q

where does CD most commonly affect

A

terminal ileum

54
Q

3 main causes of acute severe colitis

A
  1. ibd
  2. infection- gastroenteritis
  3. ischaemic
55
Q

initial medical management for acute severe colitis

A
  • fluids
  • steroids
  • electrolytes
  • dvt prophylaxis
  • dietician
  • consider blood transfusion if Hb <80
  • daily bloods
56
Q

what is tenesmus

A

feeling like need to empty bowels even though colon empty

57
Q

definition of toxic megacolon

A

diameter of >6cm of the transverse or right colon with loss of haustrations in patients with severe UC

58
Q

which has the higher risk of malignancy uc or cd

A

UC

59
Q

indiction for emergency surgery versus elective

A

emergency

  • acute toxic dilation no response 48 hrs
  • perforation
  • severe bleeding
  • failure to respond to med therapy

elective

  • failure to respond to med therapy
  • malignant transformation
60
Q

definition of if medical management of UC is not working

A 
day 3
-stools 3-8
-crp>45
day7
->3 bloody diarrhoea
need to change management
61
Q

surgical managementof UC

A 
-total colectomy with ileostomy and closure of rectal stump/ rectosigmoid mucus fistula
then
-stoma and rectum excision
or
-ileal pouch so rectum and ileum joined 
but cant control stools
62
Q

difference between a ileostomy and colostomy

A

ileostomy=rif and spouted and more liquid

colostomy=lif and flatter more solid for segmental resection

63
Q

what is a proctolectomy

A

removal of both colon and rectum for UC

64
Q

what must patients be counselled for an ileal pouch procedure

A
  • loose bowels
  • fluid
  • incontinence
  • risk sexual dysfunction and risk infertility if nerve damaged
  • pouchitis
65
Q

surgical options for CD

A
  • abscess drainage
  • resection
  • strictureplasty
  • bypass duodenal disease
66
Q

severe UC attack definition

A 
>6 blood stools plus 1 feature of systemic toxicity
- hr>90
hb <105
esr >30
crp >30
temp >37.8
67
Q

toxic megacolon definition

A

diameter of >6cm of transverse or right colon with loss of haustrations in severe UC

gastrointestinal (26 decks)

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