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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
drug that can initiate UC
NSAIDS
26
where does UC always start
rectum
27
whats it called when UC only affects the rectum
proctitis
28
name of UC when it extends proximately to the sigmoid and descending colon
left-sided colitis
29
name of UC extending proximately to variable length or entire large bowel
pancolitis/ extensive colitis
30
what is inflammation of the terminal ileum in UC called
backwash ileitis
31
where is UC always more severe
distally
32
layer UC usually affects
mucosa
33
what are pseudopolyps
islands of oedematous mucosa
34
which IBD has pseudopolyps and polyps form more
UC
35
macroscopic UC
mucosa looks reddened, inflamed and bleeds easily
36
microscopic UC (2)
- chronic inflammatory cell infiltrate in lamina propria | - crypt abscesses and goblet cell depletion
37
what is it called when the IBD can't be differentiated
Colitis of undetermined type and aetiology (CUTE)
38
ANCA in
UC
39
ANCA=
anti-neutrophil cytoplasmic antibodies
40
major UC symptoms
- diarrhoea with blood and mucus | - abdominal discomfort
41
less major UC symptoms
malaise lethargy anorexia weight loss
42
proctitis is characterised clinically by
- passage of blood and mucus - urgency - tenesmus
43
when is diarrhoea common in UC
acute attack of left-sided or extensive UC
44
toxic megacolon =
severe complication associated with severe UC
45
X-ray of toxic megacolon
dilated thin-walled colon >6cm diameter -gas filled with mucosal islands
46
investigations of UC
blood tests stool cultures colonoscopy abdo X-ray
47
blood tests for UC (4)
- anaemia - iron deficiency - ESR, CRP - LFTs - pANCA positive
48
gold standard diagnosis of UC
endoscopy with mucosal biopsy
49
main treatment for mild-moderate UC
aminosalicylate
50
indications for surgery in UC
- resistant to medical therapy - severe disease - complications- dysplasia/ carcinoma
51
dysplasia=
unregulated cell proliferation due to chronic inflammatory stimulus
52
lesions in crohns
continual
53
lesions in UC
skip lesions
54
which IBD has cobblestone ulcers and granulomas
Crohns
55
lymphoid hyperplasia and muscular hypertrophy in
Crohns
56
Crypt disorganisation and loss of haustra in
UC
57
which has a dilated lumen
UC
58
extraintestinal system that can be affected by IBD
``` liver pathology biliary tree skin eyes joints ```
59
primary sclerosing cholangitis =
disease of biliary tract
60
primary sclerosing cholangitis most commonly seen with
pancolitis
61
5 treatments for IBD
``` azathioprine mesalazine prednisolone cyclosporine infliximab ```
62
azathioprine=
immunsuppresant antimetabolite pro-drug | -blocks pruine metabolism and DNA synthesis
63
mesalazine=
aminosalicylate inhibiting COX enzymes in colon
64
prednisolone=
corticosteroid | inhibit steroid receptor -increased gene expression of anti-inflammatory genes
65
symptoms of cushings relate to
increased cortisol in body
66
cyclosporine=
immunosuppressant drug acting on T-cells to dampen immune response
67
infliximab=
tumour necrosis factor (TNF) blocker

Block 32- GI/surgery (9 decks)

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