Inflammatory Bowel Disease Flashcards
What do we know about the causes of IBD?
Complex
Multifactorial
Genetic trend
Influenced by Single Nucleotide Polymorphisms (SNPs)
What are some effects of IBD outside the intestine?
Pyederma ganganosum Erythema nodosum Arthritis Associated liver disease Immune cell production
What are some symptoms of ulcerative colitis?
Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue
What are some findings in blood present in UC?
Increased platelet
Low albumin
What are some useful investigations for UC?
Bloods
Stool culture to rule out infection
Faecal calprotectin
Colonoscopy
How does UC spread?
Starts in rectum and spreads proximally
What is proctitis?
Infalmmation of anus
Responds to topical therapy
What are some signs of CD?
Diarrhoea Abdominal pain Weight loss Malaise Lethargy Anorexia Low grade fever
What are aminosalicylates?
Work by blocking prostaglandins and leukotrines
Topical to colonic mucosa
Used to treat IBD
What is 5asa?
5 aminosalicylic acid
AKA Mesalazine
Effective
Which steroids may be used to treat IBD?
Prednisolone
Budenoside
What are some considerations to take when using Budenoside to treat IBD?
Less effective than prednisolone
Better side effects
Only used for ileal and descending colon
What are some immunomodulation therapies used for IBD?
Thiopurines
Methotrexate
What are some side effects of thiopurines?
Leucopenia
Hepato-toxicity
Pancreatitis
Long term lymphoma risk
What are some drawbacks of using methotrexate to treat Crohn’s?
Unlicensed
Requires specialist follow-up
What are monoclonal antibodies?
Antibodies that are made by identical immune cells that are all clones of a unique parent cell
What are some monoclonal antibodies which may be used to treat IBD?
Infliximab
Adulimumab
Ustekinumab
Vedoluzimab
What does an Aplha-4b7 integrin blocker do?
Blocks integrin
Integrins are transmembrane proteins wihch traffic lymphocytes and aid cell adhesion
What is elemental feeding?
All liquid diet to reduce inflammation
Can be as effective as steroids
More efficacious in children
What is MHC/peptide-TCR?
Major histocompatibility complex (MHC) displays peptides to T cell receptor (TCR)
TCR can discriminate foreign vs self peptides
Determines T cell repsonse
What are some determinants of the T cell response?
MHC/peptide-TCR
CD80 - CD28 (co-stimulatory)
Cytokine (Chemical messengers)
What is vedolizumab?
New biologic
Blocks migration of leukocytes to intestinal mucosa
What is ustekinumab used for?
Psoriasis
What is Coeliac’s Disease?
Inflammatory condition of the small bowel
Intolerance to dietary gluten
What are some signs of CD?
Failure to thrive as a child Iron deficiency anaemia Fatigue Loose stool Abdominal pain
What gene is associated with CD?
HLA-DQ2/8
