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Colorectal Surgery > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What two disease are encompassed by inflammatory bowel disease?

A

Ulcerative colitis

Crohn’s disease

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2
Q

What is the peak age incidence of inflammatory bowel disease?

A

15-30 years

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3
Q

How does smoking affect the risk of inflammatory bowel disease?

A

Crohn’s disease - increased risk in smokers

UC - decreased risk in smokers

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4
Q

What are the possible presenting signs and symptoms of inflammatory bowel disease?

A

Diarrhoea - can be bloody or chronic
Abdominal pain, distension, masses
Urgency or tenesmus
Proctitis
Perianal abscess and anal fissures / fistulae
Systemic upset during. an acute flare
Poor growth, delayed puberty and malnutrition in children

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5
Q

What are the extra-intestinal manifestations of inflammatory bowel disease?

A 
Mouth ulcers
Clubbing
Pyoderma gangrenous
Erythema nodosum
Conjunctivitis / iritis / episcleritis
Arthritis
Ankylosing spondylitis 
Sacroilitis
Fatty. liver
Primary sclerosing cholangitis
Cholangiocarcinoma
Renal stones
Osteomalacia
Amyloid
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6
Q

What is pyoderma gangrenosum?

A

A condition which causes tissue to become necrotic, causing deep ulcers which usually occur on the legs
Ulcers usually initially look like small bug bites/papules and can progress to larger ulcers
They can cause pain and scarring

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7
Q

What is erythema nodosum?

A

An inflammatory condition characterised by inflammation of the fat cells under the skin. Results in tender red nodules or lumps that are usually seen on both shins

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8
Q

What are the differential diagnoses of inflammatory bowel disease?

A 
Gastroenteritis
Infective colitis
Diverticulitis
Coeliac disease
Colorectal carcinoma
Ischaemic colitis
Radiation or drug induced colitis
Irritable bowel syndrome 
Acute appendicitis
Carcinoid syndrome
Amyloidosis
Intestinal lymphoma
Bechet's disease
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9
Q

What blood tests should be used to investigate possible inflammatory bowel disease?

A 
FBC
Haematinics
U&Es
LFTs
ESR and CRP
Faecal calprotectin
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10
Q

What tests should be used to rule out infection in possible inflammatory bowel disease?

A

Stool culture and microscopy

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11
Q

What blood test can be used to differentiate inflammatory bowel disease from irritable bowel syndrome?

A

Faecal calprotectin

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12
Q

What is the gold standard diagnostic test for inflammatory bowel disease?

A

Colonoscopy with biopsy

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13
Q

When would AXR. be used to investigate inflammatory bowel disease?

A

In severe colitis to look for possible signs of toxic megacolon

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14
Q

What investigative test can be used in place of colonoscopy in inflammatory bowel disease?

A

Flexible sigmoidoscopy

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15
Q

Define Crohn’s disease?

A

A disorder of unknown aetiology characterised by transmural inflammation of the GI tract which can affect any/all parts of the GI tract from mouth the anus

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16
Q

Which part of the GI tract is most commonly affected by Crohn’s disease?

A

Terminal ileum

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17
Q

Which type of inflammatory bowel disease is characterised by skip lesions?

A

Crohn’s disease

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18
Q

Why is it common for fibrosis and fistula formation to occur in Crohn’s disease?

A

Inflammation is transmural

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19
Q

What environmental factors are implicated in the pathogenesis of Crohn’s disease?

A

Smoking
Oral contraceptive pill
Infectious agents
Nutritional deficiencies

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20
Q

What endoscopic findings would you expect to see in Crohn’s disease?

A

Erythema
Oedema
Friability of the mucosa
Identification of fistula tract openings

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21
Q

What histological features of Crohn’s disease can help distinguish it from UC?

A

Presence of non-caveating granulomas
Architectural change
Distribution of disease

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22
Q

Explain how autoantibodies can help distinguish Crohn’s from UC?

A

In Crohn’s it is likely that ASCA will be positive and p-ANCA will be negative
The opposite is true of UC

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23
Q

What scoring system is used to measure the severity of Crohn’s disease?

A

Crohn’s disease activity index

24
Q

What is the main factor involved in lifestyle modification for Crohn’s disease?

A

Smoking cessation

25
Q

What are the first line drugs for inducing remission of Crohn’s disease?

A

Glucocorticoid

If this is not tolerated or is contraindicated, 5-ASA can be used

26
Q

What add-on therapies can be used to induce remission of Crohn’s disease?

A

Azathioprine / mercaptopurine

If TPMT activity deficient or if azathioprine not tolerated methotrexate can be used

27
Q

What additional drugs can be induce remission of Crohn’s disease?

A

Anti-TNF drugs - infliximab, adalimumab

If this fails or there are contraindications vedolizumab and ustekinumab can be used

28
Q

What drugs can be used to maintain remission in Crohn’s disease?

A

Azathioprine

IM methotrexate

29
Q

Why should glucocorticoids not be used for maintenance therapy in Crohn’s disease?

A

Glucocorticoids are not effective for maintaining remission and can cause unwanted adverse effects

30
Q

After surgery for Crohn’s disease, what drugs should be used?

A

Azathioprine plus metronidazole for 3 months

31
Q

What are the possible complications fo Crohn’s disease?

A 
Colorectal cancer
Strictures
Fistulae
Perforation
Haemorrhage
Osteoporosis
Renal disease
Anaemia
Delay growth and puberty in children
Miscarriages, stillbirths and IBD exacerbation in pregnancy
32
Q

What is the term from ulcerative colitis which only involves the rectum?

A

Ulcerative proctitis

33
Q

What is the term from ulcerative colitis which only involves the rectum and sigmoid colon?

A

Ulcerative proctosigmoiditis

34
Q

What is the term from ulcerative colitis which affects the rectum, sigmoid colon and colon up to the splenic flexure?

A

Distal ulcerative colitis

35
Q

What is the term from ulcerative colitis which affects the rectum, sigmoid colon and colon up to but not including the caecum?

A

Extensive colitis

36
Q

What is the term from ulcerative colitis which affects the entire colon including the caecum?

A

Pancolitis

37
Q

What scale is used to measure the severity of disease in ulcerative colitis in adults?

A

Truelove and Witt’s index

38
Q

What scale is used to measure the severity of disease in ulcerative colitis in children?

A

PUCAI severity index

39
Q

In the Truelove and Witt’s index for severity of ulcerative colitis, what are the criteria for mild UC?

A 
<4 stools/day
No more than a small amount of blood in stools
No anaemia
HR <90
No fever
Normal ESR and CRP
40
Q

In the Truelove and Witt’s index for severity of ulcerative colitis, what are the criteria for moderate UC?

A 
4-6 stools/day
More blood in stools
No anaemia
HR <90
No fever
Normal ESR and CRP
41
Q

In the Truelove and Witt’s index for severity of ulcerative colitis, what are the criteria for severe UC?

A

> 6 stools/day
Visible blood in stools

\+ one of:
>37.8 degrees C
HR >90
Anaemia
ESR >30
42
Q

Which patients with ulcerative colitis require urgent hospital referral?

A

Severe colitis or moderate disease which doesn’t respond to steroids within 2 weeks

43
Q

How is medication administered for ulcerative proctitis?

A

Suppositories

44
Q

How is medication administered for ulcerative proctosigmoiditis?

A

Foams

45
Q

How is medication administered for distal ulcerative colitis?

A

Enemas

46
Q

How is medication administered for extensive UC / pancolitis?

A

Oral medications

47
Q

When can mesalazine (5-ASA) be used to treat ulcerative colitis?

A

For induce and maintenance of remission in mild to moderate UC

48
Q

When can corticosteroids be used in ulcerative colitis?

A

To induce remission

49
Q

When should azathioprine be used in ulcerative colitis?

A

Patients who are intolerant of corticosteroids
Patients who need >2 corticosteroids a year
Patients who have disease relapses when corticosteroids are reduced or within 6 weeks of stopping steroids

50
Q

Levels of which enzyme need to be checked before starting azathioprine?

A

TPNT enzyme

51
Q

Anti-TNF drugs can be used for patients with ulcerative colitis who have failed therapy with conventional agents. Give examples of these agents?

A

Infliximab
Adalimumab
Golimumab

52
Q

Colectomy is curative in ulcerative colitis. T/F?

A

True

53
Q

Which patients with ulcerative colitis are at an increased likelihood of requiring surgery?

A

Stool frequency >8 a day
Pyrexia
Tachycardia
Colonic dilatation on AXR

54
Q

What are the complications of ulcerative colitis?

A 
Colorectal cancer
Other bowel complications - toxic megacolon, perforation, haemorrhage, polyps, pouchitis, post-IPAA leakage and pelvic abscess
Osteoporosis
Anaemia
Psychosocial and sexual problems
55
Q

Given than patients with inflammatory bowel disease are at increased risk of colorectal cancer, what precautions should be taken?

A

Regular colonoscopy for colorectal cancer screening

56
Q

Why is toxic megacolon (a possible complication of inflammatory bowel disease) particularly dangerous?

A

It can lead to perforation and peritonitis

57
Q

Toxic megacolon is characterised by a dilated colon. What diameter is required for diagnosis?

A

> 5.5cm

Colorectal Surgery (1 decks)

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