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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…?

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
Other than adenocarcinoma what other colorectal tumours can occur?
``` Neuroendocrine neoplasms Squamous cell caricnoma Metastatic carcinoma Adenosquamous carcinoma Gastrointestinal stromal tumours Melanoma Lymphoma ```
26
What gene mutations are often seen in colorectal cancer?
``` APC Beta catenin KRAS EGFR COX2 TP53 PIK3CA ```
27
What is a polyp?
An exophytic protuberant growth
28
Give examples of bowel polyps?
Hamartomous Inflammatory Hyperplastic Adenomas
29
What factors of an adenoma influence its potential progression to carcinoma?
Size Number Villi
30
How often should low risk patients with IBD be screened for colorectal cancer?
Every 5 years
31
How often should medium risk patients with IBD be screened for colorectal cancer?
Every 3 years
32
How often should high risk patients with IBD be screened for colorectal cancer?
Every year
33
What is chron's disease?
A chronic inflammatory condition which can affect any part of the GI tract from mouth to anus
34
Smoking increases the. risk of chron's disease. T/F?
True - and stopping smoking reduces relapse rate and need for immunosuppression and surgery
35
What is the peak age of incidence of chron's disease?
15-25 years
36
What are the signs and symptoms of chron's disease?
``` Abdominal pain Diarrhoea (usually watery) Weight loss Fistulae Abscess Episcleritis Uveitis Sarcilitis Inflammatory arthropathy Erythema nodosum ```
37
How should potential chron's disease be investigated?
Faecal calprotectin MR/CT enterography Ileocolonscopy and biopsy Capsule endoscopy
38
What is faecal calprotectin?
A calcium binding protein which is predominantly derived from neutrophils
39
What is considered a normal faecal calprotectin level?
<50-200
40
Why is a faecal calprotectin test useful in the diagnosis of chron's?
It differentiates IBD from IBS
41
What are the acute histological changes in chron's disease?
Acute inflammation Ulceration Loss of goblet cells crypt abscess formation
42
What are the chronic histological changes in chron's disease?
``` Architectural changes Cell metaplasia Chronic inflammatory infiltrates in the lamina propria Neuronal hyperplasia Fibrosis Granulomas ```
43
How can UC and chron's be differentiated pathologically?
Distribution of inflammation, type of inflammation and clinical context/scope findings
44
Azathioprine/6MP can be used to induce remission of chron's disease. T/F?
False - it cannot be used to induce remission but can be used for maintenance of remission
45
Describe the dosing regimen for methotrexate in chron's disease?
25mg/week IM for 16 weeks then 15mg a week
46
What biologics can be. used in the treatment of chron's?
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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