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GI/Liver > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is the peak age of incidence for IBD?

A

20-30 years

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2
Q

What factors can cause IBD?

A

Environmental factors
Genetic predisposition
Host immune response
Gut microbiome

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3
Q

What are the differential diagnoses of IBD?

A

Infective colitis

Ischaemic colitis

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4
Q

What is the typical presentation fo infective colitis?

A 
Short history of diarrhoea +/- vomiting
Abrupt onset and resolution of sumptoms
Systemic upset
Predominant fever
Often recent history of travel, unwell contacts or immunosuppressed
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5
Q

How is infective colitis investigated?

A

Stool culture

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6
Q

How is infective colitis treated?

A

Conservative management e.g. fluid replacement and analgesia

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7
Q

In what patients does ischaemic colitis usually occur?

A

Elderly
Cardiovascular diease
Heart failure

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8
Q

Ischaemic colitis is usually due to hypoperfusion rather than embolism. T/F?

A

True

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9
Q

What is the typical presentation of ishcaemic colitis?

A

Abrupt onset of pain and bloody diarrhoea

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10
Q

How is ischaemci colitis diagnosed?

A

CT showing segmental colitis especially in the watershed areas

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11
Q

How is ischaemic colitis treated?

A

Conservative management with IV fluids +/- antibiotics

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12
Q

How is toxic megacolon defined?

A

Megacolon seen on AXR (diameter >5.5cm or caecum >9cm) and signs of systemic toxicity

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13
Q

How is toxic megacolon treated?

A

Emergency colectomy

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14
Q

How should possible IBD be investigated?

A

Flexible sigmoidoscopy with biopsy

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15
Q

Describe the histological features of ulcerative colitis?

A

Crypt architectural changes which are generally very marked
Little or. no fibrosis
No granulomas
Inflammatory infiltrates in the whole. epithelium
Inflammation is mucosa-centric

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16
Q

Which part of the GI tract is typically affected by ulcerative colitis?

A

Extends from the rectum to involve the left side of the bowel
Terminal ileum only involved when whole of large colon including caecum is involved

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17
Q

How is ulcerative colitis treated?

A 
5-ASA/mesalazine
azathioprine/6MP
IV corticosteroids
Infliximab
Surgery
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18
Q

Describe the dosing regimen for 5-ASA/mesesalazine in the treatment of ulcerative colitis?

A

4.8g initially and then 2.4g as daily maintenance

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19
Q

When should. azathioprine/6MP be prescribed for ulcerative colitis?

A

Severe. relpase
Frequently replacing disease
When >2 corticosteroid courses are required in a 12 month period
Disease replaces when steroid dose is reduced <15mg
Relapse within 6 weeks of stopping corticosteroids

20
Q

Many ulcerative colitis patients are intolerant of azathiprine.6MP treatment. This also carries an increased risk of…?

A

Lymphoma

21
Q

What drug is used to induce remission in midl to moderate ulcerative colitis?

A

5-ASA/mesesalazine

22
Q

When should colectomy for ulcerative colitis patients be considered?

A

> 8 stools a day

>3 a day with CRP >45

23
Q

What are the potential complications of ulcerative colitis?

A 
Haemorrhage
Toxic megacolon
Erythema nodosum
Pyoderma grangrenosum
Sclerosing cholangitis
Cholnagiocarcinoma
Iritis
Uveitis
Episcleritis
Ankylosing spondylitis
Malignancy
24
Q

What type of tumour accounts for the majority fo colorectal tumours?

A

Adenocarcinoma

25
Q

Other than adenocarcinoma what other colorectal tumours can occur?

A 
Neuroendocrine neoplasms
Squamous cell caricnoma
Metastatic carcinoma
Adenosquamous carcinoma
Gastrointestinal stromal tumours
Melanoma
Lymphoma
26
Q

What gene mutations are often seen in colorectal cancer?

A 
APC
Beta catenin
KRAS
EGFR
COX2
TP53
PIK3CA
27
Q

What is a polyp?

A

An exophytic protuberant growth

28
Q

Give examples of bowel polyps?

A

Hamartomous
Inflammatory
Hyperplastic
Adenomas

29
Q

What factors of an adenoma influence its potential progression to carcinoma?

A

Size
Number
Villi

30
Q

How often should low risk patients with IBD be screened for colorectal cancer?

A

Every 5 years

31
Q

How often should medium risk patients with IBD be screened for colorectal cancer?

A

Every 3 years

32
Q

How often should high risk patients with IBD be screened for colorectal cancer?

A

Every year

33
Q

What is chron’s disease?

A

A chronic inflammatory condition which can affect any part of the GI tract from mouth to anus

34
Q

Smoking increases the. risk of chron’s disease. T/F?

A

True - and stopping smoking reduces relapse rate and need for immunosuppression and surgery

35
Q

What is the peak age of incidence of chron’s disease?

A

15-25 years

36
Q

What are the signs and symptoms of chron’s disease?

A 
Abdominal pain
Diarrhoea (usually watery)
Weight loss
Fistulae
Abscess
Episcleritis
Uveitis
Sarcilitis
Inflammatory arthropathy
Erythema nodosum
37
Q

How should potential chron’s disease be investigated?

A

Faecal calprotectin
MR/CT enterography
Ileocolonscopy and biopsy
Capsule endoscopy

38
Q

What is faecal calprotectin?

A

A calcium binding protein which is predominantly derived from neutrophils

39
Q

What is considered a normal faecal calprotectin level?

A

<50-200

40
Q

Why is a faecal calprotectin test useful in the diagnosis of chron’s?

A

It differentiates IBD from IBS

41
Q

What are the acute histological changes in chron’s disease?

A

Acute inflammation
Ulceration
Loss of goblet cells
crypt abscess formation

42
Q

What are the chronic histological changes in chron’s disease?

A 
Architectural changes
Cell metaplasia
Chronic inflammatory infiltrates in the lamina propria
Neuronal hyperplasia
Fibrosis
Granulomas
43
Q

How can UC and chron’s be differentiated pathologically?

A

Distribution of inflammation, type of inflammation and clinical context/scope findings

44
Q

Azathioprine/6MP can be used to induce remission of chron’s disease. T/F?

A

False - it cannot be used to induce remission but can be used for maintenance of remission

45
Q

Describe the dosing regimen for methotrexate in chron’s disease?

A

25mg/week IM for 16 weeks then 15mg a week

46
Q

What biologics can be. used in the treatment of chron’s?

A

TNF-alpha antagonists e.g. infliximab, adalimumab
Anti-integrins e.g. vendolizumab
Anti-IL12/23 e.g. ustekinumab

GI/Liver (8 decks)

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