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Block 32- GI/surgery > inflammatory bowel disease > Flashcards

inflammatory bowel disease Flashcards

1
Q

IBD=

A

crohn’s and ulcerative colitis

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2
Q

Where can crohn’s affect

A

anywhere in the GI tract - mouth to anus

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3
Q

most common places of Crohn’s (2)

A

terminal ileum

ascending colon

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4
Q

3 things increasing risk of Crohns

A
  • cigarette smoking
  • microvascular infarction (contraceptive pill)
  • infective agents
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5
Q

symptom of crohns in colon

A

blood diarrhoea

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6
Q

symptom od crohns in upper GI/ small intestine

A
  • severe abdo pain
  • vomiting
  • weight loss
  • small intestine obstruction
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7
Q

perianal crohns symptoms

A

ulcers
fissures
perianal abscess
fistula

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8
Q

examination feature of Crohns

A

aphthous ulceration in mouth

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9
Q

blood tests for Crohns (6)

A
  • haemoglobin
  • ESR, CRP
  • albumin
  • LFTs
  • blood cultures
  • serological test
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10
Q

anaemia in Crohns (2)

A
  • normocytic normochromic anaemia of chronic disease

- deficiency of iron and/or folate

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11
Q

non-blood investigation for Crohns (6)

A
  • stool testing
  • colonoscopy
  • upper GI endoscopy
  • small bowel imaging
  • MRI/ ultrasound
  • capsule endoscopy
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12
Q

what endoscopic assessment in crucial in patients with suspected CD

A

terminal ileum

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13
Q

macroscopic changes to the small bowel in crohns (3)

A
  • thickened and narrowed
  • deep ulcer and fissures in mucosa -cobblestone
  • fistulae and abscesses
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14
Q

microscopic crohns disease on biopsy

A
  • flat surface
  • crypt architecture preserved
  • ulcer patchy activity
  • plasma cell infiltrate
  • chronic inflammatory cells
  • granuloma 6/10 patients
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15
Q

type of granulomas in crohns

A

non-caseating epithelioid cell aggregates with langhans giant cells

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16
Q

which part of the wall does crohns affect

A

all layers- transmural

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17
Q

granuloma=

A

collection of macrophages

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18
Q

why might diarrhoea occur in long-standing inactive crohns disease or after ileal resection

A

bile acid malabsorption

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19
Q

how is diarrhoea as a consequence of bile acid malabsorption treated

A

bile salt sequestrants

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20
Q

agents to reduce remission in crohns (3)

A
  • glucocorticosteroids
  • anti-TNF antibodies
  • enteral nutrition
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21
Q

agents to maintain remission in crohns (5)

A 
azathioprine 
methotrexate 
6MP 
mycophenolate mofetil 
anti-TNF antibodies
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22
Q

treatment of perianal crohns disease (4)

A
  • ciprofloxacin and metronidazole
  • azathoprine
  • anti-TNF antibodies
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23
Q

indication for surgery in crohns

A

complications of disease -fistula, strictures, abscess, perforation

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24
Q

2 protective factors for UC

A

appendicectomy

smoking

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25
Q

drug that can initiate UC

A

NSAIDS

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26
Q

where does UC always start

A

rectum

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27
Q

whats it called when UC only affects the rectum

A

proctitis

28
Q

name of UC when it extends proximately to the sigmoid and descending colon

A

left-sided colitis

29
Q

name of UC extending proximately to variable length or entire large bowel

A

pancolitis/ extensive colitis

30
Q

what is inflammation of the terminal ileum in UC called

A

backwash ileitis

31
Q

where is UC always more severe

A

distally

32
Q

layer UC usually affects

A

mucosa

33
Q

what are pseudopolyps

A

islands of oedematous mucosa

34
Q

which IBD has pseudopolyps and polyps form more

A

UC

35
Q

macroscopic UC

A

mucosa looks reddened, inflamed and bleeds easily

36
Q

microscopic UC (2)

A
  • chronic inflammatory cell infiltrate in lamina propria

- crypt abscesses and goblet cell depletion

37
Q

what is it called when the IBD can’t be differentiated

A

Colitis of undetermined type and aetiology (CUTE)

38
Q

ANCA in

A

UC

39
Q

ANCA=

A

anti-neutrophil cytoplasmic antibodies

40
Q

major UC symptoms

A
  • diarrhoea with blood and mucus

- abdominal discomfort

41
Q

less major UC symptoms

A

malaise
lethargy
anorexia
weight loss

42
Q

proctitis is characterised clinically by

A
  • passage of blood and mucus
  • urgency
  • tenesmus
43
Q

when is diarrhoea common in UC

A

acute attack of left-sided or extensive UC

44
Q

toxic megacolon =

A

severe complication associated with severe UC

45
Q

X-ray of toxic megacolon

A

dilated thin-walled colon >6cm diameter -gas filled with mucosal islands

46
Q

investigations of UC

A

blood tests
stool cultures
colonoscopy
abdo X-ray

47
Q

blood tests for UC (4)

A
  • anaemia - iron deficiency
  • ESR, CRP
  • LFTs
  • pANCA positive
48
Q

gold standard diagnosis of UC

A

endoscopy with mucosal biopsy

49
Q

main treatment for mild-moderate UC

A

aminosalicylate

50
Q

indications for surgery in UC

A
  • resistant to medical therapy
  • severe disease
  • complications- dysplasia/ carcinoma
51
Q

dysplasia=

A

unregulated cell proliferation due to chronic inflammatory stimulus

52
Q

lesions in crohns

A

continual

53
Q

lesions in UC

A

skip lesions

54
Q

which IBD has cobblestone ulcers and granulomas

A

Crohns

55
Q

lymphoid hyperplasia and muscular hypertrophy in

A

Crohns

56
Q

Crypt disorganisation and loss of haustra in

A

UC

57
Q

which has a dilated lumen

A

UC

58
Q

extraintestinal system that can be affected by IBD

A 
liver pathology 
biliary tree 
skin 
eyes
joints
59
Q

primary sclerosing cholangitis =

A

disease of biliary tract

60
Q

primary sclerosing cholangitis most commonly seen with

A

pancolitis

61
Q

5 treatments for IBD

A 
azathioprine 
mesalazine 
prednisolone 
cyclosporine 
infliximab
62
Q

azathioprine=

A

immunsuppresant antimetabolite pro-drug

-blocks pruine metabolism and DNA synthesis

63
Q

mesalazine=

A

aminosalicylate inhibiting COX enzymes in colon

64
Q

prednisolone=

A

corticosteroid

inhibit steroid receptor -increased gene expression of anti-inflammatory genes

65
Q

symptoms of cushings relate to

A

increased cortisol in body

66
Q

cyclosporine=

A

immunosuppressant drug acting on T-cells to dampen immune response

67
Q

infliximab=

A

tumour necrosis factor (TNF) blocker

Block 32- GI/surgery (9 decks)

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