Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 32 GI and surgery > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

name some common upper GI symptoms?

A
  • Reflux/heartburn
  • Belching
  • Bloating
  • Abdominal pain
  • Vomiting
  • Nausea
  • Difficulty swallowing
  • Problems in the passage of food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

name some common lower GI symptoms?

A
  • Lower abdominal pain
  • Stitch
  • Flatulence
  • Urgency to defecate
  • Diarrhoea
  • Intestinal bleeding
  • Bloating or distension
  • Constipation
  • Accidental stool leakage or incontinence
  • Problems in the passage of food or stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the types of inflammatory bowel disease?

A
  • ulcerative colitis
  • Crohn’s disease
  • (intermediate colitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is faecal calprotectin and what does its presence suggest?

A

substance produced by the intestines in response to inflammation. it is a marker of bowel inflammation which is normal in IBS but raised in IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

where does ulcerative colitis occur?

A

begins in rectum and extends proximally. doesn’t affect anal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe the disease distribution in Ulcerative Colitis?

A

abrupt transition between normal and diseased bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the histological findings in Ulcerative Colitis?

A
  • Most pathological findings limited to mucosa and submucosa
  • Muscularis propria-only affected in fulminant disease
  • Distorted crypt architecture/crypt abscesses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the incidence and prevalence of ulcerative colitis?

A

Incidence: 2-10 per 100 000
Prevalence: 35-100 per 100 000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what groups have an increased incidence of Ulcerative colitis?

A 
Caucasians
Jews
Female
15-25 yrs
55-65 yrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what group has a decreased incidence of ulcerative colitis?

A

less common in smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the symptoms of Ulcerative Colitis?

A

-Diarrhoea
-PR bleeding
-Frequency of small stools with urgency (inflamed rectum loses ability to distend and relax
-Other findings are minimal: fatigue, malaise, weight loss, fever, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what classification system can be used to assess the severity of ulcerative colitis?

A

Truelove and Witts classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what parameters does Truelove and Witts classification take into consideration?

A
  • bowel movements
  • fever
  • heart rate
  • haemoglobin
  • blood in stools
  • erythrocyte sedimentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

where does Crohn’s disease affect?

A

anywhere from mouth to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe the disease distribution of Crohn’s disease?

A

3 major patterns of disease distribution:

  • Ileocaecal disease (40% at presentation)
  • Disease confined to small intestine (30% at presentation)
  • Disease confined to colon (25% at presentation)

Appears in patches in GI tract (skip lesions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the histological findings in Crohn’s disease?

A
  • Transmural inflammation
  • Granulomas (more common in submucosa)

Means more likely to get complications like obstructions, fistulae and have inflamed bowel attached to each other which form masses

17
Q

what is the incidence and prevalence of Crohn’s disease?

A

Incidence: 1-6 per 100 000
Prevalence: 10-100 per 100 000

18
Q

what are the symptoms of Crohn’s disease?

A
  • Diarrhoea
  • Abdominal pain
  • Weight loss/loss of appetite
  • Change in bowel habit
  • Bloody stools
  • Fatigue secondary to anaemia and inflammatory condition
19
Q

what are the signs of Crohn’s disease?

A
  • Clubbing
  • Pallor
  • Nail changes
  • Leukonychia due to hypoalbuminaemia
  • Red eye symptoms
  • Mouth ulcers
  • Soft-non tender abdomen
  • Palpable masses?
20
Q

what groups have an increased risk of Crohn’s disease?

A 
Caucasians
Jews
Female
15-25 yrs
55-65 yrs
Family history
Those with other inflammatory conditions
AND
More common in smokers
21
Q

what classification systems are used to assess Crohn’s disease?

A

Crohn’s disease activity index

Harvey-Bradshaw index

22
Q

when is the Crohn’s disease activity index used and what does scoring indicate?

A

more complex but used in therapeutic trials

  • score <150 = quiescent/in remission
  • score 150-300= active disease
  • score 300 = severe active disease
23
Q

when is the Harvey-Bradshaw index used and what does scoring indicate?

A

simpler than Crohn’s disease activity index

  • score <4=in remission
  • score 5-8=moderate activity
  • score >8=severe active disease
24
Q

what investigations are done for suspected IBD?

A
  • Flexible sigmoidoscopy /colonoscopy and biopsies (upper GI endoscopy occasionally in Crohn’s)
  • Radiology
  • Plain AXR (thumbprinting)
  • CT (including enterography)
  • MR enterography
  • Small bowel follow through/meal
  • Others
  • Faecal calprotectin (useful in monitoring)
  • Wireless capsule endoscopy (camera pill)
  • Labelled white cell scan (rare)
25
Q

what are the features of ischaemic colitis?

A

cramping

abdominal pain

26
Q

what are the risk factors of ischaemic colitis?

A

smoking history

hypertension

27
Q

what area is most likely to be affected in ischaemic colitis?

A

splenic flexure due to it being at the border of regions supplied by different arteries so if there is compromised blood supply it will be there first

28
Q

what may be seen on X-ray in a patient with ischaemic colitis?

A

thumbprinting due to mucosal oedema/haemorrhage

29
Q

Name some classes of drugs that are used in the treatment of IBD?

A
  • aminosalicylates
  • corticosteroids
  • immunomodulators
  • cytokine modulators
30
Q

other than pharmacological methods what other approaches can be used in the treatment of IBD?

A

nutrition

surgery

31
Q

what are aminosalicylates, give some examples and what are the side effects?

A

5-ASA (mesalazine)
olsalazine, balsalazide, sulphasalazine
reduce relapse by 70-80% and prevent colorectal cancer
side effects: rashes, headaches, diarrhea, interstitial nephritis, reversible infertility

32
Q

give examples of corticosteroids and what are the side effects?

A

prednisolone, budesonide, beclomethasone, hydrcortisone

side effects: cushings syndrome, addisons

33
Q

give examples of immunomodulators?

A

azathioprine
methotrexate
mycophenolate
ciclosporin

34
Q

describe the action of azathioprine?

A
  • affects purine synthesis
  • decreases T lymphocytes
  • upto 30% don’t tolerate dangerous neutrophenia
  • (6)-mercaptoprine is an active metabolite of azathiprine
35
Q

describe the action of methotrexate and its administration?

A

antifolate (antimetabolite)
induces pulmonary fibrosis
administration is PO or IM

36
Q

describe the action of mycophenolate?

A

affects guanine synthesis in B and T lymphocytes

37
Q

describe the action of ciclosporin, its effectiveness and when it is used?

A

calcineurin inhibitor and activator of T cells
80% respond but 80% still need colectomy in 6 months
used as rescue therapy in UC

38
Q

describe the action of cytokine modulators, give examples, adverse effects and indications?

A
  • TNF-alpha inhibitors
  • infliximab, adalimumab
  • for severe active disease not responding to conventional drugs eg fistulising Crohn’s
  • concerns about increased risk of lymphoproliferative disorders
39
Q

describe the role of surgery in treatment of IBD?

A

-more common for crohn’s
30% of Crohn’s yet higher rate of disease recurrence after surgery
-last resort
-UC - when toxic megacolon/acute colitis or failure to respond to other therapy. colectomy is curative unless they develop pouchitis
-crohn’s - when there is limited segmental pathology with obstructive symptoms

Block 32 GI and surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions