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Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is Crohn’s disease?

A

Chronic inflammatory disease affecting any area of the digestive tract

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2
Q

What histiological signs are seen in crohn’s disease?

A

Mucus/increased goblet cells

Cobblestone appearance

Inflammation from mucosa-serosa/transmural

Non-caseating granulomas

Fissures

Fistulas

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3
Q

What age is crohn’s most likely to occur?

A

Onset peaks in early adulthood and over 60s

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4
Q

What sex is crohn’s more common in?

A

F = M

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5
Q

What causes crohn’s?

A

Idiopathic

Genetic Predisposition/FH

  • CARD15

Smoking

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6
Q

How does crohn’s present?

A

Depends on side affected

Diarrhoea

Abdominal pain

  • Right lower quadrant

Weight loss

Malaise

Blood in stool

Malabsorption

  • Iron deficiency anaemia
  • Vitamin deficiencies

Mouth ulcers

Angular stomatitis

Clubbing

Fever

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7
Q

What investigations are used in crohn’s diagnosis?

A

>CRP and >ESR

  • Severe attacks

Calprotectin

FBC

  • >WCC
  • >Platelets/Thrombocythemia
  • Decreased Hb

Colonoscopy/Sigmoidoscopy with biopsy

Barium swallow

Malabsorption Tests

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8
Q

What is calprotectin?

A

Protein biomarker, present in faeces, released by inflammed gut mucosa

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9
Q

What barium signs are seen in crohns?

A

Cobble stone appearance

Rose thorn ulcers

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10
Q

What malabsorption tests are used in crohns monitoring and diagnosis?

A

B12

Folate

Vitamin D

Ca

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11
Q

What is used in the management of crohns?

A

Smoking cessation

Steroids/glucocorticoids

5ASA (Aminosalicylates)

Immunosuppression

Biologics

Enteral feeding/elemental diet

Surgery, although this does not cure disease

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12
Q

Name an example of a 5ASA

A

Mesalazine

Sulphsalazine

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13
Q

Name examples of immunosuppressants used in IBD

A

Azathioprine

Methotrexate

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14
Q

Name examples of biologics used in IBD managament

A

Infliximab

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15
Q

Name the classification that determines crohns severity

A

Montreal classification

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16
Q

What does the Montreal classification take into consideration?

A

Age

Extent of disease

Severity

Disease behaviour, such as trictures and penetration

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17
Q

Name some complications of chrons?

A

Anterior uveitis

Episcleritis

Arthritis

Sacroilitis

Erythema nodosum

Pyroderma gangrenosum

Gallstones and renal stones, more common than in UC

Small and large bowel malignancy

Fistulae and perinanal abscess

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18
Q

What is erythema nodosum?

A

Swollen fat under the skin causing red bumps and patches

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19
Q

What is Pyoderma Gangrenosum?

A

Rare inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow

Single painful irregular deep ulcer on her right shin, with a pustular surface and a blue overhanging edge

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20
Q

What is Ulcertative Colitis?

A

Chronic inflammatory condition affecting the large intestine and rectum, forming ulcers along lumen

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21
Q

What histological signs are seen in UC?

A

Crypt abscesses

Pseudopolyps

Goblet cell mucus depletion

Vascular congestion

Inflammation confined to mucos

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22
Q

What sex is UC most common in?

A

F>M

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23
Q

What age is UC most likely to occur?

A

Peak at 15-25 and 55-65

24
Q

What is the most common inflammatory bowel disease?

A

UC

25
Q

What communities is UC most common in?

A

Caucasians and Jewish community

26
Q

What causes UC?

A

Idiopathic

FH

27
Q

How does UC present?

A

Bloody diarrhoea

Abdominal pain

  • Left lower quadrant

Weight loss

Frequent stools

  • >6 a day, severe attack

Anaemia/malbsorption

Clubbing

Tenesmus/feeling of incomplete evacuation

28
Q

What investigations are used in UC diagnosis?

A

>CRP and >ESR in severe attacks

Calprotectin

FBC

  • >WCC in severe attack
  • >Platelets/Thrombocythemia in severe attack​
  • Decreased Hb

Sigmoidoscopy with biopsy

Barium swallow

pANCA

Stool microscopy/culture

Abdominal X-ray (AXR)

29
Q

In how many UC patients is pANCA +

A

>70%

30
Q

Why is an AXR used in UC?

A

Rule out toxic dilation

31
Q

What is the management of UC?

A

Topical/rectal 5ASA

Oral 5ASA

Corticosteroids

IV steroids

IV Ciclosporin/immunosuppresant

Oral Thiopurines

Surgery

32
Q

Name some chronic complications of UC

A

Fistula

Conjunctivitis and Uveitis

Primary sclerosing cholangitis

Sacroiliitis

Erythema nodosum

Venous thrombosis

Pyoderma gangrenosum

Colorectal carcinoma

Fatty liver

33
Q

Name some acute complications of UC

A

Haemorrhage

Perforation

Toxic megacolon

34
Q

What are the side effecrts of Aminosalicylates (5ASA)?

A

Agranulocytosis

Headache

GI upset

Pancreatitis

35
Q

Name the side effects of Azathioprine

A

Leucopenia

Hepatoxicity

Pancreatitis

Lymphoma

36
Q

Where is the most common site for UC inflammation?

A

Rectum, as inflammation always starts here

37
Q

What is the most common extra-intestinal feature of UC and CD?

A

Arthritis

38
Q

What is used in acute management of CD if steroids fail?

A

Biologic treatment

39
Q

What is first line to induce remission of CD?

A

Glucocorticoids (prednisilone or IV hydrocortisone)

40
Q

What is second line to induce remission of CD?

A

5ASA

41
Q

What is used as an add on to induce remission of CD?

A

Azathioprine or methotrexate

42
Q

What is used for refractory and fistulating CD?

A

Infliximab/biologics

43
Q

What is first line for maintaining remission of CD?

A

Azathioprine

Methotrexate considered in patients where azathioprine is contraindicated

44
Q

What is used for peri-anal CD (abscess)?

A

Metrondiazole + Ceftriaxone

45
Q

What is the management for perianal fistulae?

A

Drainage for high/trans-sphincteric

Fistulotomy for low/sub-mucosal

46
Q

Describe mild UC

A

Less than 4 stools a day

Little blood

47
Q

Describe moderate UC

A

4-6 stools a day

Varying amount of blood

No systemic upset

48
Q

Describe severe UC

A

More than 6 bloody stools a day

Systemic upset

  • Tachycardia
  • Pyrexia
  • Anaemia
  • Raised inflammatory markers
49
Q

What is first line for maintaining remission in mild-moderate UC?

A

Topical/rectal 5ASA

(oral if extensive disease)

50
Q

What is used for maintaining remission in severe UC?

A

Oral thiopurines

51
Q

What are the stages in inducing remission for mild-moderate UC?

A

Topical/Rectal 5ASA

Oral 5ASA

  • Add if remission is not achieved in 4 weeks

Corticosteroid

  • Add if remission is not achieved after rectal and oral 5ASA
52
Q

What are the stages for inducing remission in severe UC?

A

IV Steroids

IV Ciclosporin

  • Add if no improvement in 72 hours
53
Q

What UC sign is seen in bariums swallows?

A

Lead pipe colon

54
Q

What should be assessed in patients before initiating Azathioprine?

A

Thiopurine methyltransferase (TMPT) activity

As this is the enzyme involved in the metabolism of this medication, and so deficiency means the treatment will not work

55
Q

What surgery is used in UC?

A

Proctocolectomy

56
Q

Give differential diagnoses of clubbing

A

CF

Mesothelioma

Bronchiectasis

Lung fibrosis

Lung carcinoma

Lymphoma

Inflammatory bowel disease

Cirrhosis

Coeliac disease

Cyanotic heart disease

Myxoma

Bacterial endocarditis

Gastrointestinal (14 decks)

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