INFLAMMATORY BOWEL DISEASE Flashcards

1
Q

If someone presents with bloody diarrhoea what must you rule out? (Other than malignancy)

A

Infectious cause: much more common cause of bloody diarrhoea than IBD

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2
Q

What layers of the GI tract are involved in ulcerative colitis?

A

Mucosa and sometimes submucosa, importantly never muscular layer or beyond

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3
Q

When an ulcer heals in ulcerative colitis what is the end result?

A

Pseudopolyps

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4
Q

What sign can be seen on this x-ray? What is it indicative of and why is it caused?

A

Lead-pipe appearance on x-ray due to loss of haustra in left-sided colon

Due to chronic inflammation in ulcerative colitis

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5
Q

Crypt cell abscesses on microscopy are associated with which GI condition?

Which cells of the immune system are typically involved?

A

Ulcerative colitis

→ shows neutrophil infiltration of crypts

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6
Q

You see this in a patient with ulcerative colitis. What is the skin condition?

A

Pyoderma gangrenosum: deep, necrotic skin alteration

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7
Q

Which Billary condition is strongly associated with ulcerative colitis?

A

Primary sclerosing cholangitis

Characterised by stricture formation in bile duct – most people who have this condition also have ulcerative colitis

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8
Q

What should you consider in someone with IBD presenting with backpain for 3 months?

A

Ankylosing spondylitis

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9
Q

Patient with inflammatory bowel disease presents with the following eye, acute onset dull pain In the eye, rapidly getting worse and worsening when focusing. He complains of blurred vision.

  • What is your differential diagnosis and how would you treat?
  • What would you expect to see when testing the pupils for reactivity?
A

Anterior uveitis - inflammation of middle layer of eye

  • Constricted, unreactive pupil
  • Steroids

♦ Common cause of preventable blindness → refer to ophthalmologist immediately

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10
Q

What happens in toxic megacolon? Which IBD is it associated with?

A

Rare complication of ulcerative colitis

Cessation of colonic contractions leading to intestinal dilation → rapid distension

Wall thins → becomes prone to rupture may lead to perforation

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11
Q

What must you consider in someone with ulcerative colitis who develops abdominal pain and distension and has a fever and symptoms of shock?

A

Toxic megacolon

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12
Q

Why is screening colonoscopy recommend in people with ulcerative colitis?

A

Significant risk of adenocarcinoma: increases with increasing duration of disease, as well as extent

→ If there is involvement of right side of colon = risk increased

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13
Q

Elevated levels of which antibody are seen in Ulcerative colitis?

A

p-ANCA

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14
Q

Which IBD involved transmural inflammation?

A

Crohn’s disease

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15
Q

What is a common location for Crohn’s disease? What feature will this specifically cause?

A

Terminal ileum

Malabsorption of B12 and bile salts: may cause non-bloody diarrhoea due to malabsorption

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16
Q

Why is right lower quadrant pain characteristic of Crohn’s disease?

A

Commonly affects terminal ileum

17
Q

Which IBD is associated with creeping fat?

A

Crohn’s disease

18
Q

If a person presents with abdominal symptoms, diarrhoea and migratory polyarthritis which diagnosis should you consider?

A

Crohn’s disease

19
Q

Why do people with CD have an increased rate of calcium oxalate kidney stones?

A
  • Fat malabsorption means that calcium binds to fat in the gut
  • This leaves oxalate free in the gut to be absorbed
20
Q

Briefly explain how sulphasalazine works in IBD and which specific type it is most suitable for

A

Metabolised by colonic bacteria into 5-aminosalicylic acid (5-ASA): very similar structure and mechanism of action to aspirin

Not active until reaches colon: perfect for ulcerative colitis

21
Q

Why might some man with IBD be found to have oligospermia?

A

Reversible side-effect of sulphasalazine

22
Q

Why is mesalazine normally given as delayed release all with special coating?

A

Mesalazine is 5-ASA

Fewer side-effects than sulphasalazine but absorbed in jejunum therefore less delivery to colon

Modified compounds resist this absorption e.g. Pentasa, Asacol