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2ND YEAR SYSTEMS: GI > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

Which 2 diseases fall under the umbrella term Inflammatory bowel disease?

A

ulcerative colitis

Chron’s disease

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2
Q

At what age does IBD usually present?

A

teens and twenties

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3
Q

Define what IBD is?

A

chronic relapsing inflammatory conditions of the bowel

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4
Q

What is microscopic colitis?

A

similar to ulcerative collitis
has 2 main forms:- Collagenous colitis
Lymphocytic colitis

main difference to UC is that the tissue can only be seen under a microscope

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5
Q

3 contributing factors that cause IBD

A

genome - own make up - hereditary conditions?
envirome - smoking, diet, drugs
microbiome ie in the gut

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6
Q

Which genetic alteration is related to IBD?

A

single nucleotide polymorphisms in a particular gene

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7
Q

What functions does the Gut’s microbiota serve?

A

Metabolic - production of viatmins, digestion of dietary carcinogens

Energy source

Immune system and barrier

protective - inflammatory cytokine oversite, colonisation resistance

Antimicrobial secretion

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8
Q

What does dysbiosis of microbiota lead to

A

leaky epithelial barrier

which in turn causes disorded, perpetual innate and adaptive immune response

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9
Q

Ulcerative colitis info

A

can affect any age - peak 20-40 y/o

M=F

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10
Q

symptoms of ulcerative colitis (4)

A

Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue

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11
Q

Investigations for ulcerative colitis?

A

Bloods for markers of inflammation (normocytic anaemia, increased CRP/platelets, low albumin)

Stool culture to rule out infection

Faecal Calprotectin (0-50ug/g stool=normal, 50-200=equivocal, >200 elevated)

Colonoscopy and colon mucosal biopsies

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12
Q

Where does ulcerative colitis begin?

A

begins in the rectum and works proximally - only affects the colon!

variable distribution and severity too

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13
Q

what procedure do patients who are diagnosed with ulcerative colitis usually require within the following 10 years?

A

colectomy

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14
Q

If a patient comes in with acute severe colitis what is the approach for the first 24 hours (6)

A

Specialist GI assessment and early surgical review. Psychological support too.,

Stool chart - 3 cultures for C.dificile

Avoid/stop non steroidal analgesics, opiates, anti-diarrhoeals, anti-cholinergics

IV glucocorticoids

Administer LMWH - anti-inflammatory - 3x increased risk of thromboembolism

abdominal chest xray - looking for toxic dilatation with mucosal oedema, lead pipe (loss of haustral markings - TC), proximal faecal loading

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15
Q

What size does the colon have to be to be conisdered as ‘toxic megacolon’

A

> 5.5cm

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16
Q

Why is Chron’s disease considered a patchy disease?

A

it affects the GI tract from mouth to anus but has skip lesions ie lesions aren’t continuous the whole way through

clinical features depends on regions involved - could be normal, inflammed, strictures, fistula

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17
Q

Clinical features of Chron’s disease (10)

A 
Diarrhoea
Abdominal pain
Weight loss. 
Malaise, lethargy
anorexia
Nausea + vomiting
low-grade fever
Malabsorption
Anaemia
vitamin deficiency
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18
Q

Investigations for Chron’s disease (6)

A

Bloods for markers of inflammation

Stool culture to rule out infection if diarrhoea

Colonoscopy +/- colon/terminal ileum mucosal biopsies

MRI small bowel study

Capsule endoscopy - pill sized camera that can be swallowed

Occasionally CT scan if acutely unwell and want to rule out complication eg abscess

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19
Q

What is perianal Chron’s disease? Common symptoms?

A

inflammation at or near the anus, including tags, fissures, fistulae, abscesses, or stenosis

perianal pain
pus secretion
unable to sit down

20
Q

Investigations for perianal chron’s disease

A

MRI pelvis

examination under anaesthetic

21
Q

Treatment for perianal chron’s disease?

A

Surgery to drain abscess

Medical – antibiotics and biologic therapy (anti-TNF)

22
Q

Differential diagnosis of chronic diarrhoeas?

A

malnutrition

malabsorption

23
Q

What is ileo-caecal tuberculosis

A

tuberculosis infection that spreads to the intestine

very serious, mimicks other abdominal pathologies very well - hard to detect

24
Q

Colitis needs to be distinguished from which 3 types?

A

infective
amoebic
ischaemic

25
Q

Long term complication of colitis

A

colonic carcinoma

26
Q

How is IBD managed nowadays

A

3 specialist IBD nurses

IBD pharmacist - therapeutic drug monitoring

Weekly IBD MDT

Nurse led infusion clinic 3/weeks

dedicated colonoscopy lists for surveillance

Colorectal surgeon with IBD specialist interest

27
Q

Treatment aims through natural course of IBD relapse and remission?

A

Sometimes use top-down approach - start with most potent drug and work down

28
Q

What are the 3 main Aminosalicylates (5-ASA) drugs and what do they do

A

Mesalamine
Olsalazine
Sulfasalazine

work by damping down the inflammatory process, so allowing damaged tissue to heal - block leukotrienes + prostaglandins

usually enteric - not dissolved by gastric acid - released to colon not small bowel

29
Q

What is the 1st line therapy to get a patient into remission after mild- moderate flare up of UC?

A

5- ASA drug treatment

Over time - it reduces chance of colorectal cancer

30
Q

when is rectal 5ASA opted for?

A

for distal and left sided disease (descending colon and below etc)

31
Q

Which disease are 5ASA drugs not effective treatment for?

A

Chron’s disease

32
Q

Discuss steroid use for both ulcerative collitis and Chron’s?

A

it can induce remission for both

prednisolone

  • optimal = 40mg a day
  • reduce over 4-6 weeks
  • give Ca and vit d supplements with it as steroids cause bone thinning

Budenoside

  • Slightly less effective at being absorbed by systemic circ.
  • treats the ascending colon and ileum
33
Q

Why do we need to reduce steroid dose?

A

Need to limit steroid exposure for patients with IBD

Steroids are good for people who are unwell and have active disease but not long term

34
Q

Discuss the use of Thiopurines for maintenance of UC and Chron’s

A

Don’t work for everyone to control their disease

Side effects can be very severe - Drug can dampen down inflammation in the gut. Cap off immune surveillance so dampen down body’s ability to make immune response – increased chance of cancer developing

35
Q

What is Methotrexate

A

type of immunosuppressant

good for Chron’s

takes a long time to work

serious side effects like liver toxicity + pulmonary fibrosis

It is teratogenic

36
Q

If patient has active disease what is usually used first?

A

steroids

37
Q

What type of biologic agents are there?

A

monoclonal antibodies like
anti-TNF alpha
IL12/IL23 blockers
alpha 4b7 integrin blockers

38
Q

what is another treatment option that can be as effective as steroids?

A

elemental feeding - liquid diet - good nutrition in simplest form - nasogastric tube usually as tastes horrible

especially effective in children + is usually 1st line treatment as steroids are potent and can interrupt growth/development

39
Q

When do we know if UC therapy has failed?

A

recurrent courses of steroid - ie >2 courses a year is deemed excessive

relapse (flare up) prior to or shortly after steroid stopping therapy

unacceptable side effects

acute severe colitis not responding to 72 hrs high dose IV steroids +/- anti-TNF biologic

40
Q

So if a patient doesn’t respond to IV steroids for more than 3 days then what do you do?

A

give more potent immunosuppression and then they will need an emergency ileectomy or colectomy

41
Q

Surgery for acute severe colitis

A

Total colectomy
Rectal preservation
Ileostomy

42
Q

After a total colectomy what will a patient be left with?

A

end ileostomy - remove the large colon + ileum is brought out of the abdomen through a smaller cut and stitched on to the skin to form a stoma

rectal stump - sewn or stapled closed and the anus is left intact

43
Q

What is a completion proctectomy?

A

You take out the rectal stump and have a permanent end ileostomy – usually done if people have complications with end ileostomy or elderly with poor anal sphincter muscles

44
Q

what is a pouch procedure?

A

Mobilise and lengthen the small bowel and construct a pouch - so the ileum is joined to anal canal and this forms a pouch where the stool collects before defecation

45
Q

Surgical indications for Chron’s disease (6)

A

Failure of medical management

Relief of obstructive symptoms (small bowel) – ie stricture

Management of fistulae - e.g. bowel to bladder

Management of intra-abdominal abscess – managed with surgery

Management anal conditions – perianal disease

Failure to thrive

2ND YEAR SYSTEMS: GI (38 decks)

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