Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Junior Surgery- GI > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the two major forms of IBD?

A
  • Crohn’s Disease
  • Ulcerative colitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What environmental factors are associated with the development of IBD?

A
  • Smoking
  • NSAID ingestion
  • Hygeine
  • Nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is thought to be the primary cause of IBDs?

A

Inappropriate immune response against the gut flora in a genetically susceptible individual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much does smoking increase the risk of developing IBD?

A

3-4x the risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is ulcerative colitis?

A

Relapsing/Remitting inflammaotyr disorder of the colonic mucosa. It may affect the rectum, or extend to involve part of the colon, or the entire colon. It never spreads proximal to the ileocaecal valve (except for backwash ileitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the main sites the ulcerative colitis occurs?

A
  • Proctitis - rectum
  • Left-sided colitis
  • Pancolitis - whole colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the pathological features of UC?

A
  • Hyperaemic/Haemorrhagic colonic mucosa +/-pseudopolyps
  • Punctate ulceration - extends deep into lamina propria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What distinguishes UC from Crohn’s Pathologically?

A
  • Crohn’s is transmural, whereas UC is primarily mucosal
  • Granulomas are often present in Crohns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the pathological features of Crohn’s Disease?

A
  • Granulomas
  • Fissuring ulceration
  • Focal/Patchy mucosal involvement
  • Neuromuscular hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which IBD does skip lesions occur in?

A

Crohn’s - areas of unaffected bowel between areas of active disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which IBD does backwash ileitis occur in?

A

UC - usually in pancolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the difference in terms of the affected bowel between Crohn’s and UC?

A
  • Crohn’s - Thickened wall + strictures/narrowed lumen
  • UC - Ulcerated wall with dilated lumen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which IBD produces granulomas?

A

Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which type of IBD tends to fistulate more commonly?

A

Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which type of IBD are more at risk of cancer?

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why does the bowel wall thicken in Crohn’s?

A

Due to oedema and fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are symptoms of UC?

A

Episodic attacks

  • Diarrhoea (episode/chronic) +/- blood/mucus
  • Crampy abdominal discomfort
  • Increased frequency
  • Urgency +/- tenesmus
  • Systemic features in attacks - fever, malaise, anorexia, weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What signs may be present in someone with UC?

A

May be none. If presenting during an attack:

  • Fever
  • Tachycardia
  • Tender, distended abdomen

Extraintestinal signs (chronic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What extraintestinal signs may be seen in IBD?

A
  • Clubbing
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Conjunctivitis
  • Uveitis/Episcleritis/Iritis
  • Large joint arthritis
  • Sacroiliitis
  • Ankylosing spondylitis/inflammatory back pain
  • PSC
  • Nutritional defects
  • Venous thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the following seen in?

A

Pyoderma gangrenosum

  • Idiopathic: 25–50% of cases
  • Inflammatory bowel disease: up to 50% of cases
  • Rheumatological disease
  • Paraproteinaemia
  • Haematological malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the following?

A

Erythema nosodum - A skin disorder of acute onset with eruption of red, tender nodules and plaques, predominantly over the lower extremities, especially the extensor surfaces. It is a form of panniculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mechanism behind erythema nodosum?

A

In theory, immune complexes form after exposure to an antigen and are deposited in venules around areas of subcutaneous fat and connective tissue. The subsequent inflammation causes the lesions.

Why the lesions appear so frequently on the shins has not been explained - suggested that a combination of a relatively meagre arterial supply combined with gravitational effects on venous system gravitational favour deposition in that area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are causes of the following?

A
  • Inflammatory bowel disease
  • Infections – streptococcal, tuberculosis, URTIs, yersiniosis
  • Sarcoidosis
  • Rheumatological disorders
  • Drug reactions – usually sulfonamides and the oral contraceptive pill
  • Malignancies
  • Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the following?

A

Clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are causes of the following?

A
  • Cyanotic heart disease/Crohn’s
  • Lung disease - ABCDEF
    • Abscess
    • Bronchiectasis
    • CF
    • DON’T SAY COPD
    • Empyema
    • Fibrosis
  • Ulcerative colitis
  • Biliary cirrhosis
  • Birth defect
  • Infective endocarditis
  • Neoplasm
  • GI malabsorption syndrome (coeliac)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the following?

A

Episcleritis - benign, self-limiting inflammatory disease affecting part of the eye called the episclera.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the following?

A

Scleritis - a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are signs of anterior uveitis?

A
  • Circumcorneal redness - ciliary flush
  • Keratic precipitates on corneal epithelium
  • Cells/flare in anterior chamber
  • Miosis - due to sphincter spasm
  • Hypopyon
  • Posterior/Peripheral anterior Synechaie/Festooned pupil
  • Iris atrophy
  • Fibrinous membrane in the pupillary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are symptoms of crohn’s disease?

A
  • Diarrhoea
  • Abdominal pain
  • Weight loss
  • Failure to thrive
  • Fatigue
  • Fever
  • Malaise
  • Anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are signs of crohn’s disease?

A
  • Abdominal tenderness/mass
  • Perianal abscess/fistulae/skin tags
  • Anal strictures
  • Apthous ulcers
  • Systemic features of IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the following?

A

Apthous ulcer - A painful open lesion anywhere within the oral cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are causes of the following?

A
  • Trauma
  • Stress
  • Toothpaste
  • Iron deficiency/Folate deficiency/Vitamin B12 deficiency
  • Food hypersensitivity
  • Humoural/immunological
  • Inflammatory bowel disease
  • Behçet’s disease
  • SLE
  • HIV/AIDS
  • Nicorandil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How would you approach investigating someone who you suspected had UC?

A
  • Bedside - NEWS score
  • Bloods - FBC, ESR, CRP, U+E’s, LFTs, Blood culture
  • Imaging
    • AXR
    • Flexible sigmoidoscopy - acute attack
    • Colonoscopy once controlled
  • Other - stool culture, faecal calprotectin, biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What might you find on stool studies in someone with UC?

A
  • Negative culture
  • WBC present
  • Elevated faecal calprotectin
37
Q

What might you see on FBC in someone with UC?

A
  • Variable degree of anaemia
  • Leukocytosis
  • Thrombocytosis
38
Q

What might you see on LFTs in someone with UC?

A

Looking for features of PSC:

  • Elevated ALP
  • Elevated Bilirubin
  • Elevated AST/ALT
  • Hypoalbuminaemia
39
Q

What might you see on U+E’s in someone with UC?

A
  • Hypokalaemia metabolic acidosis
  • Hypernatraemia
40
Q

What might you see on AXR in someone with UC?

A
  • Dilated colonic loops - >6cm
  • Mucosal thickening
  • Lead pipe sign
  • Pneumoperitoneum/Rigler’s Sign - If perforated
  • Toxic megacolon
41
Q

What can be seen in the following AXR?

A

Toxic megacolon - colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of ulcerative colitis.

There is evidence of bowel wall oedema with ‘thumbprinting’, and pseudopolyps or ‘mucosal islands

42
Q

What feature of UC can be seen in the following AXR?

A

Lead pipe sign - featureless segment of transverse colon with loss of the normal haustral markings. This ‘lead pipe’ appearance is associated with longstanding ulcerative colitis.

43
Q

What is the feature highlighted in the following AXR?

A

Mucosal thickening + ‘thumbprinting’ - The distance between loops of bowel is increased (arrows) due to thickening of the bowel wall. The haustral folds are very thick (arrowheads), leading to a sign known as ‘thumbprinting.’

44
Q

What investigations would you consider doing in someone you suspected had Crohn’s Disease?

A
  • Bedside - NEWS score
  • Bloods - FBC, U+E’s, LFTs, CRP, ESR, INR, Iron studies, B12, Folate
  • Imaging - AXR, Colonoscopy, Capsule endoscopy, CT/MRI, US, Barium meal
  • Other - stool culture
45
Q

When would you consider limited flexible sigmoidoscopy to investigate UC?

A

During attack

46
Q

When and why would you perform a full colonoscopy in UC?

A

Once symptoms under control - To determine extent of disease

47
Q

How would you assess the severity of a UC attack?

A

Truelove and Witts modified criteria

48
Q

What are the criteria for the truelove and Witts criteria for assessing UC severity?

A
  • Motions/day
  • Rectal bleeding
  • Temp
  • Resting pulse
  • Hb
  • ESR/CRP
49
Q

What is classified as Mild UC as per Truelove and Witts criteria?

A
  • Motions/day - =4
  • Rectal bleeding - small
  • Temp - Apyrexial
  • Resting pulse < 70bpm
  • Hb - > 110g/L
  • ESR - <30
50
Q

What is classified as moderate UC as per Truelove and Witts criteria?

A
  • Motions/day - 5
  • Rectal bleeding - Moderate
  • Temp - 37.1-37.8oC
  • Resting pulse -70-90bpm
  • Hb - 105-110g/L
51
Q

What is classified as severe UC as per Truelove and Witts criteria?

A
  • Motions/day - >/= 6
  • Rectal bleeding - Large
  • Temp - >37.8oC
  • Resting pulse - >90bpm
  • Hb - <105g/L
  • ESR > 30/CRP >45mg/L
52
Q

What are acute complications of UC?

A
  • Toxic megacolon + perforation
  • Venous thromboembolism
  • Hypokalaemia
53
Q

What can be seen in the following AXR?

A

Toxic megacolon of the transverse colon

54
Q

What are chronic complications of Ulcerative colitis?

A

Colonic cancer

55
Q

How would you manage someone with Mild UC?

A

Induction/Maintenance of remission

  • Distal colitis
    • 1st line – topical* 5-ASA (mesalamine)
    • 2nd line – topical* corticosteroids/oral mesalamine
    • 3rd line – oral corticosteroid ± oral tacrolimus
  • Extensive disease
    • 1st line – oral mesalamine
    • 2nd line - oral corticosteroids +/- oral tactrolimus

*Suppository

56
Q

How would you manage someone with Moderate UC?

A
  • Induce remission - Prednisolone 40mg/day for 1 wk, then taper
  • Maintenance - 5-ASA
57
Q

How would you manage severe UC?

A

Admit

  • IV fluids
  • IV Steroids - hydrocortisone 100mg/6h
  • VTE prophylaxis
  • Monitoring - bloods, Stool chart, AXR
  • Consider transfusion
  • Consider rescue therapy - infliximab, ciclosporin
58
Q

What are indications for surgery in ulcerative colitis?

A

Fulminant acute attack

  • Failure of medical treatment
  • Toxic dilatation
  • Haemorrhage
  • Imminent perforation

Chronic disease

  • Incomplete response to medical treatment/steroid dependant
  • Dysplasia on surveillance colonoscopy
59
Q

What would you consider if rescue therapy failed in someone with severe UC?

A

Colectomy - based on disease extent

60
Q

When would you consider rescue/salvage therapy in someone with UC?

A
  • CRP >45 mg/L
  • >8 bowel motions after 3 days IV hydrocortisone
61
Q

What are complications of Crohn’s Disease?

A
  • Small bowel obstruction
  • Toxic megacolon
  • Abscess formation
  • Fistulae
  • Perforation
  • Colon cancer
  • PSC
  • Malnutrition
  • Anal disease - Fissure in ano, Haemorrhoids, SKin tags, Abscess, Anorectal fistula
62
Q

What are the different types of fistulae that can occur in Crohn’s disease?

A
  • Entero-enteric
  • Colovesical
  • Colovaginal
  • Perianal
  • Entercutaneous
63
Q

What are the common sites for Crohn’s disease to occur?

A
  • Duodenum/Ileum/Jejunum
  • Ileocaecal disease
  • Perianal disease/proctitis
  • Colon
64
Q

What might you see on CT/MRI in someone with Crohn’s Disease?

A
  • Skip lesions
  • Stricturing
  • Bowel wall thickening
  • Surrounding inflammation
  • Abscess
  • Fistulae
65
Q

What might you see on biopsy of someone with Crohn’s disease?

A

Transmural involvement with non-caseating granulomas

66
Q

What might you see on Colonosopy in someone with Crohn’s Disease?

A
  • Hyperaemia
  • Oedema
  • Cobblestoning
  • Skip lesions
67
Q

What might you see on oesophagogastroduodenoscopy in someone with crohn’s Disease?

A
  • Aphthous ulcers
  • Mucosal inflammation
68
Q

Why might you do iron studies in someone with Crohn’s?

A

Check for iron deficiecy 2o to GI bleeding

69
Q

Why might you check B12 and folate levels in someone with Crohn’s?

A

Deficiency may be secondary to malabsorption - particularly in ileocaecal CD and post-ileocaecal resection

70
Q

What might you see on AXR with barium meal in someone with crohn’s disease?

A
  • Asymmetrical alteration in the mucosal pattern with deep ulceration
  • Areas of narrowing or stricturing
  • Cobblestoning
71
Q

What are the three major endoscopic findings in crohn’s disease?

A
  • Aphthous ulcers
  • Cobblestoning - normal tissues in between the ulcers give the typical cobblestone appearance.
  • Discontinuous lesions - areas of inflammation are interspersed between normal bowel ‘skip areas’.
72
Q

How would you manage Mild/moderate Crohn’s Disease?

A
  • Dietary modification
  • Stop smoking
  • Prednisolone - 1 wk, then taper
  • Manage extraintestinal manifestations
  • Consider maintenance therapy
73
Q

Which type of IBD are 5-ASA’s not used in?

A

Crohn’s disease

74
Q

How would you manage severe Crohn’s?

A

Admit

  • IV fluids
  • IV Steroids - hydrocortisone 100mg/6h
    • Switch to oral if response
    • Consider biologics if no response
  • VTE prophylaxis
  • Stool screen - Culture etc.
  • Physical examination daily + Bloods
  • Monitor for abdominal sepsis
75
Q

What are the main methods for induction of remission in Crohn’s disease?

A
  • Oral/IV steroids
  • Enteral nutrition
  • ANti-TNF
76
Q

What are the main Medications use to maintain remission in Crohn’s Disease?

A
  • Azathioprine
  • 6MP
  • Methotrexate
  • Mycophenolate mofetil
  • Anti-TNF antibodies
77
Q

What are examples of 5-ASA drugs?

A
  • Mesalazine
  • Sulfasalazine
78
Q

What is the mechanism of action of 5-ASA drugs?

A

The precise mechanism of action of 5-ASA is unknown, but it has both anti-inflammatory and immunosuppressive effects, and appears to act topically on the gut rather than systemically

79
Q

What are important adverse effects of 5-ASA drugs?

A
  • Gastrointestinal upset (e.g. nausea, dyspepsia)
  • Headache
  • Leucopenia
  • Thrombocytopenia
  • Renal impairment
  • Serious hypersensitivity reaction
80
Q

When is Azathioprine used in Crohn’s Disease?

A
  • Refractory to steroids/relapse on steroid taper
  • Requiring > 2 steroid courses per year
81
Q

What are side effects of Azathioprine?

A
  • Abdo pain
  • Nausea
  • Pancreatitis
  • Leucopenia
  • Abnormal LFTs
82
Q

What are indications for surgical intervention in Crohn’s Disease?

A
  • Drug failure
  • GI obstruction fromm stricture
  • Perforation
  • Fistulae
  • Abscess
83
Q

What are poor prognostic factors in Crohn’s Disease?

A
  • Age < 40 yrs
  • Steroids at first presentation
  • Perianal disease
  • Isolated terminal ileitis
  • Smoking
84
Q

How would you manage perianal disease in Crohn’s Disease?

A
  • Oral antibiotics
  • Immunosuppressant therapy - anti-TNF
  • Local surgery +/- seton insertion
85
Q

What mnemonic can you use to remember the extra-colonic features of IBD?

A

A PIE SACK

  • Aphthous ulcers
  • Pyoderma gangrenosum
  • Iritis (uveitis)
  • Erythema nodosum
  • Sclerosing cholangitis
  • Ankylosing spondylitis/arthritis
  • Clubbing
  • Kidney (nephrotic syndrome – unusual)

Junior Surgery- GI (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions