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Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

what is IBD?

A

chronic inflammatory disease of bowel

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2
Q

class of IBD?

A

Crohn’s and UC

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3
Q

epidemiology of IBD?

A

identification in young= severe disease

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4
Q

genetic aetiology of IBD?

A

chromosome 16q12 or NOD2

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5
Q

immunological aetiology of IBD?

A

impaired mucosal immunity

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6
Q

environmental factors that inc risk of IBD?

A

smoking & NSAIDs

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7
Q

site of UC?

A

colon/rectum

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8
Q

site of crohn’s?

A

anywhere in GI tract

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9
Q

so what is Crohn’s?

A

chronic transmural inflammation and ulcerating condition of GI tract that can affect anywhere from mouth anus

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10
Q

what is the handy pneumonic for Crohn’s?

A 
N- no blood in faeces
E- entire GI tract
S- skip lesions on endoscopy 
T- terminal ileum most affected and transmural (full thickness) inflammation 
S- smoking is a risk factor
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11
Q

what else is commonly found with Crohn’s?

A

fistulas, strictures and wt loss

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12
Q

what mutated gene may cause Crohn’s?

A

chromosome 16

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13
Q

true/false…

young males in northern europe have higher chance of having Crohn’s?

A

true

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14
Q

symptoms of Crohn’s affecting small intestine?

A

abdominal cramps, diarrhoea

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15
Q

symptoms of Crohn’s affecting colon?

A

cramps, diarrhoea w blood

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16
Q

symptoms of Crohn’s affecting mouth?

A

ulcers, swollen lips, angular chelitis

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17
Q

symptoms of Crohn’s affecting anus?

A

anal pain, abscess

18
Q

signs of Crohn’s?

A

RIF mass, peri-anal signs e.g. fistula

19
Q

clinical course of crohn’s?

A

chronic OR exacerbations & remission- unpredictable response to therapy

20
Q

ix for Crohn’s

A

endoscopy w mucosal biopsy, Ba imaging, bloods (CRP, albumin, FBCs, B12)

21
Q

what are common findings on endoscopy for Crohn’s?

A

cobblestone appearance, pseudo polyps, fissures, non-caseating granuloma, transmural inflammation, skip areas

22
Q

tx for Crohn’s?

A

lifestyle- no smoking
drugs- steroids, immunosuppressants, anti-TNF therapy
surgery- resection, stricturoplasty, fistula repair (non-curative !!)

23
Q

what drug is given to maintain remission for Crohn’s?

A

azathioprine

24
Q

what emergency surgery is done for Crohn’s?

A

colectomy

25
Q

complications of Crohn’s?

A

fistula*, SBS, anal disease, bowel obstruction, perforation, malabsorption, amyloidosis

26
Q

what is UC?

A

chronic inflammatory disorder confined to colon and rectum which involves inflammation of mucosal and submucosal layers (superficial)

27
Q

what is the acronym for UC?

A 
C- continuous inflammation
L- limited to colon and rectum
O- only affects superficial mucosa
S- smoking is protective
E- excretes blood & mucous
U- use aminosalicyclates as tx
P- primary sclerosis cholangitis
28
Q

is the epidemiology of UC same as that of Crohn’s?

A

yes- young males mostly affected

29
Q

symptoms of UC?

A

diarrhoea w blood/exudate, lower abdominal cramps, inc bowel frequency, tenesmus, incontinence

30
Q

what are the 5Ps of UC?

A 
pyrexia 
pseudopolyps 
lead-piping appearance 
poo 
proctitis
31
Q

systemic signs of UC?

A

uveitis
mouth- stomatitis, ulcers
skin- erythema nodosum

32
Q

ix for UC?

A

endoscopy with mucosal biopsy, bloods (albumin, CRP etc), AXR to rule out toxic megacolon

33
Q

what criteria is used to assess severity of UC?

A

truelove & Witt’s criteria

34
Q

what does Truelove & Witt’s criteria state?

A

> 6 blood stools +

fever/ tachy/anaemia/ elevated ESR (erythrocyte sedimentation ratio)

35
Q

what histological findings on biopsy may be found in a pt with UC?

A

many inflammatory cells, crypt distortion (irregularly shaped), mucosal ulceration with fibrinopurulent exudate, NO GRANULOMA

36
Q

Rx for UC?

A

inducing remission: 1st line= 5-ASAs, 2nd line= steroids, immunosuppressants & anti-TNF therapy
severe: IV corticosteroids, 2nd line= IV cyclosporin (immunosuppressant)

37
Q

what Rx is given to maintain remission in UC?

A

aminosalicyclates

38
Q

what is the non-emergency surgical tx for UC?

A

protocolectomy - pouch given

CURATIVE

39
Q

what is the emergency surgical tx for UC?

A

sub-total colectomy

40
Q

complications for UC?

A

toxic megacolon, intractable disease, colorectal carcinoma, anal fissures

41
Q

recap: Crohn’s…
1. occurs only in colon & rectum
2. has skip lesions on endoscopy
3. transmural inflammation as opposed to superficial
4. non-granulomatous inflammation
5. fistulas present
6. extra GI complications/ symptoms
7. cancer risk low

A
  1. NO- anywhere in GI tract
  2. YES
  3. YES
  4. NO- has granulomatous inflammation
  5. YES
  6. NO- extra GI common in UC
  7. YES
42
Q

cure for fistula?

A

seton or surgery

SNAP: sepsis, nutrition, anatomy, plan

Gastrointestinal (24 decks)

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