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GI System > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Define inflammatory bowel disease

A

Chronic relapsing inflammatory conditions of the bowel

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2
Q

What classification is used to classify the type of colotis?

A

Montreal

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3
Q

Name two main types of IBD

A

Crohn’s disease and ulcerative colitis

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4
Q

What is the aetiology of IBD?

A

Unknown, but there is definitely an environmental trigger and the genetic susceptibility of patients

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5
Q

What are the alarm symptoms of ulcerative colitis?

A
  • Bloody diarrhoea
  • Abdominal pain
  • Weight loss
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6
Q

What are the features of UC?

A

Continuous inflammation which begins at the rectum and progresses proximally – only in the large bowel (can affect as far as the caecum)

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7
Q

What are the signs of ulcerative colitis?

A 
Markers of sever attack:
• Stool frequency: >6/day with blood
AND:
• Fever >37.5
• Tachycardia >90
• ESR (CRP) –raised 
• Anaemia: Hb <10g/dl
• Albumin <30g/l
• Leucocytosis, thrombcytosis
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8
Q

Describe the features of CD?

A

Patchy disease:
• Mouth to anus
• Skip lesions
• Clinical features depend on regions involved

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9
Q

What are the alarm symptoms of CD?

A
  • Diarrhoea
  • Abdominal pain
  • Weight loss
  • Malaise, lethargy, anorexia, nausea and vomiting, low grade fever
  • Malabsorption: anaemia, vitamin deficiency
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10
Q

What are the markers in the blood of IBD?

A
  • High ESR & CRP
  • High platelet count
  • High WC count
  • Low Hb
  • Low albumin
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11
Q

What are the markers in the stool of IBD?

A

Calprotectin
• <50 normal
• 50-200 equivocal
• >200 elevated

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12
Q

What is CRP?

A

Inflammatory marker

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13
Q

What is the difference in histology between CD and UC?

A
  • Only crohn’s disease contains granulomas
  • Goblet cells are depleted in UC
  • Crypt abscesses: UC > CD
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14
Q

What is the difference in features between CD and UC?

A

Crohn’s can develop fistulas and peri-anal disease

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15
Q

What are extra-intestinal manifestations of IBD?

A
  • Eyes: conjunctivitis
  • Joints: ankylosing spondylitis
  • Renal calculi: only in CD
  • Liver and biliary tree: fatty change, gallstones, sclerosing cholangitis
  • Skin: erythema nodosum, vasculitis
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16
Q

What is sclerosing cholangitis?

A

Disease of the bile ducts which causes multiple strictures and can lead to cirrhosis

17
Q

What screening is available of IBD?

A

Colonoscopy:
• 8-20yrs -> 3yrs colonoscopy
• 30-40yrs -> 2yr
• 40+ yrs -> annually

Quadrantic biopsies every 10cm

18
Q

What is the aim of medical management of IBD?

A

Initially to reduce inflammation in the gut to relieve symptoms. Then once under control, drugs are given to maintain remission and prevent relapse

19
Q

What is the step up approach for treatment of IBD?

A
  1. 5ASA
  2. Steroids
  3. Immunomodulators
  4. Biologic agents
  5. Surgery
20
Q

What is the first line therapy for treatment of IBD?

A

Aminosalicylates (5ASA) - induces remission and then given for maintenance of remission

21
Q

What are two types of 5ASA?

A
  • Mesalaxine

* Ethylcelluose microgranules

22
Q

What types of steroids are used?

A

Prednisolone and budenoside

23
Q

What drugs are used for immunosuppression of IBD?

A

Methotrexate and infliximab

24
Q

What are thiopurine drugs?

A

Class of drug that is used to suppress the normal activity of the body’s immune system (Azathioprine, Mercaptopurine) to prevent autoimmune inflammation

25
Q

What are side effects of thiopurine?

A
  • Leucopenia
  • Hepatoxicity
  • Pancreatitis
26
Q

When is surgery indicated?

A

Failure of medical therapy:
• Relapse
• Failure to control symptoms
• Complications: diabetes, sever osteoporosis, psychosis

27
Q

What surgeries are used to treat severe colitis?

A
  • Total colectomy
  • Rectal preservation
  • Ileostomy
28
Q

What are the indications for surgery for CD?

A
  • Failure of medical management
  • Relief of obstructive symptoms
  • Management of fistulae, intra-abdominal abscess, anal conditions
  • Failure to thrive

GI System (28 decks)

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