INFLAMMATORY BOWEL DISEASE Flashcards
If someone presents with bloody diarrhoea what must you rule out? (Other than malignancy)
Infectious cause: much more common cause of bloody diarrhoea than IBD
What layers of the GI tract are involved in ulcerative colitis?
Mucosa and sometimes submucosa, importantly never muscular layer or beyond
When an ulcer heals in ulcerative colitis what is the end result?
Pseudopolyps
What sign can be seen on this x-ray? What is it indicative of and why is it caused?
Lead-pipe appearance on x-ray due to loss of haustra in left-sided colon
Due to chronic inflammation in ulcerative colitis
Crypt cell abscesses on microscopy are associated with which GI condition?
Which cells of the immune system are typically involved?
Ulcerative colitis
→ shows neutrophil infiltration of crypts
You see this in a patient with ulcerative colitis. What is the skin condition?
Pyoderma gangrenosum: deep, necrotic skin alteration
Which Billary condition is strongly associated with ulcerative colitis?
Primary sclerosing cholangitis
Characterised by stricture formation in bile duct – most people who have this condition also have ulcerative colitis
What should you consider in someone with IBD presenting with backpain for 3 months?
Ankylosing spondylitis
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?
Anterior uveitis - inflammation of middle layer of eye
- Constricted, unreactive pupil
- Steroids
♦ Common cause of preventable blindness → refer to ophthalmologist immediately
What happens in toxic megacolon? Which IBD is it associated with?
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
What must you consider in someone with ulcerative colitis who develops abdominal pain and distension and has a fever and symptoms of shock?
Toxic megacolon
Why is screening colonoscopy recommend in people with ulcerative colitis?
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
Elevated levels of which antibody are seen in Ulcerative colitis?
p-ANCA
Which IBD involved transmural inflammation?
Crohn’s disease
What is a common location for Crohn’s disease? What feature will this specifically cause?
Terminal ileum
Malabsorption of B12 and bile salts: may cause non-bloody diarrhoea due to malabsorption
Why is right lower quadrant pain characteristic of Crohn’s disease?
Commonly affects terminal ileum
Which IBD is associated with creeping fat?
Crohn’s disease
If a person presents with abdominal symptoms, diarrhoea and migratory polyarthritis which diagnosis should you consider?
Crohn’s disease
Why do people with CD have an increased rate of calcium oxalate kidney stones?
- Fat malabsorption means that calcium binds to fat in the gut
- This leaves oxalate free in the gut to be absorbed
Briefly explain how sulphasalazine works in IBD and which specific type it is most suitable for
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
Why might some man with IBD be found to have oligospermia?
Reversible side-effect of sulphasalazine
Why is mesalazine normally given as delayed release all with special coating?
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
