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Inflammatory Bowel Disease Flashcards

1
Q

What is used to help classify IBD?

A

Montreal classification

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2
Q

What is the cause of IBD?

A

Unknown

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3
Q

What is the presentation of ulcerative collitis?

A

–Bloody diarrhoea

–Abdominal pain

–Weight loss

More common in females

Peak incidence is 20-40 years

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4
Q

What is the travel of inflammaiton in UC?

A

Inflammation travels from rectum proximmaly until it stops somewhere

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5
Q

What is the likelihood of surgical removal as a result of UC?

A

•Surgical Removal

–3% first attack

–8% at 5 years

•Mortality

–3% first attack

–23% severe attack

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6
Q

What are markers of a severe attack of ulcerative colitis?

A

•Markers of a severe attack

–Stool frequency: >6 stools/day with blood

–AND

  • Fever: >37.5ºC
  • Tachycardia: >90/min
  • ESR(CRP): raised
  • Anaemia: Hb <10g/dl
  • Albumin: <30g/l
  • Leucocytosis, thrombocytosis
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7
Q

What are the clinical features of Crohn’s disease?

A
  • Diarrhoea
  • Abdominal pain
  • Weight loss.
  • Malaise, lethargy, anorexia, N&V, low-grade fever
  • Malabsorption

–Anaemia, vitamin deficiency

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8
Q

What are complications of Crohn’s disease?

A
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9
Q

What is the foecal calprotectin test?

A

Faecal calprotectin is a biochemical measurement of the protein calprotectin in the stool. Elevated faecal calprotectin indicates the migration of neutrophils to the intestinal mucosa, which occurs during intestinal inflammation, including inflammation caused by inflammatory bowel disease

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10
Q

What are the features of blood in patients with Crohn’s?

A

–High ESR & CRP

–High platelet count

–High WCC

–Low Hb

–Low albumin

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11
Q

What is the difference between histology of Crohn’s and UC?

A

CD = granulomas

Goblet cells are depleted in UC

Crypt abscesses are more common in Ulcerative colitis than crohn’s disease

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12
Q

What are the different features between Crohn’s and Ulcerative colitis?

A

Crohn’s: fistulae and perianal disease

Bloody diarrhoea: UC

Diarrhoea: Crohn’s

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13
Q

What are the extra-intestinal manifestations of IBD?

(EYES)

A

–uveitis, episcleritis, conjunctivitis

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14
Q

What are the extra-intestinal manifestations of IBD?

(JOINTS)

A

–sacroiliitis (inflammation of one or both of your sacroiliac joints) , monoarticular arthritis, ankylosing spondylitis (a form of spinal arthritis) eventually causes ankylosis of vertebral and sacroiliac joints.

Ankylosis abnormal stiffening and immobility of a joint due to fusion of the bones.

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15
Q

What are the IBD manifestations in the Kidney?

A

Crohn’s disease only: Renal calculi: kidney stones

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16
Q

What are the IBD extra intestinal manifestations?

(LIVER AND BILIARY TREE)

A

–Fatty change, pericholangitis, sclerosing cholangitis, gallstones

Pericholangitis: inflammation of the tissues surrounding the bile ducts.

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17
Q

What are the extra-intestinal manifestations of IBD?

(SKIN)

A

–pyoderma gangrenosum, erythema nodosum, vasculitis

Pyoderma gangrenosum: Pyoderma gangrenosum is a condition that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs.

Erythema nodosum: Erythema nodosum is a type of skin inflammation that is located in a part of the fatty layer of skin. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees.

18
Q

What are the IBD differential diagnosis’?

A

•Chronic diarrhoeas

–Malabsorption

–Malnutrition

  • Ileo-caecal TB
  • Colitis must be distinguished from

–infective, amoebic and ischaemic colitis

19
Q

What are the associated liver diseases with IBD?

A

•Sclerosing Cholangitis

–Disease of the bile ducts

–Multiple strictures

–Slowly progressive, can lead to cirrhosis

20
Q

What are Long-term complications of Colitis?

A

•Colonic carcinoma

–Risk Factors

•Extent

–Pancolitis 26 x normal

–Left colitis 8 x normal

–Proctitis minimal

•Duration

–< 10 yrs minimal risk

–- 20 yrs 23 x normal

–- 30 yrs 32 x normal

21
Q

What is surveillance for patients with extensive collitis?

A
22
Q

What is the medical management of IBD for outpatient?

A

–5ASA (aminosalicylates)

–Steroids

–Immunosuppression

  • Azathioprine
  • Mercaptopurine
  • Methotrexate
  • Infliximab
23
Q

What is the therapy for IBD in hospital?

A

–Steroids

–Anticoagulation

–Rest

–Other

  • Cyclosporin
  • Infliximab
  • Surgery
24
Q

Give examples of aminosalicylates

A

Mesalazine

•Pro-drugs

–Balsalazide

–Olzalazine

–Sulfasalazine

Pro-drugs deliver to the distal bowel better

25
Q

What are the effects of 5ASA in UC?

A

First line therapy for induction and maintenance of remission

Reduces risk of CRC

26
Q

What is the effect of 5ASA on Crohn’s?

A
  • Widely used but limited evidence
  • Induction of remission

–Mildly active ileocolonic disease

•Maintenance of remission

Only if medical remission induced by 5ASA

27
Q

Give examples of steroids used to treat IBD?

A

Prednisolone

Budenoside (better side effect profile, ileal and ascending colon disease only)

28
Q

What are the side effects of Azathiopurine / 6 mercaptopurine?

A

–Leucopenia

–Hepatoxicity

•Requires Blood Monitoring

–Weekly for 8 weeks and then every 8 weeks

–Patients must see GP if sore throat/infection

–Pancreatitis

–Possible long term lymphoma risk

–Up to 28% intolerant

29
Q

What type of drugs are

Azathioprine

Mercaptopurine

Methotrexate

A

Immuno-suppressants

30
Q

What are the biologics medications available for IBD patients?

A

•Anti-TNFa antibodies

–Infliximab (Remicade)

•8 weekly IV infusion

–Adulimumab (Humira)

  • 2 weekly SC injections
  • a4b7 Integrin Blockers

–Vedolizumab

  • 8 Weekly IV Infusions
  • IL12/IL23 Blockers

–Ustekinumab

•IV loading followed by SC 8-12 weekly

31
Q

TNF -alpha explanation

A

https://www.youtube.com/watch?v=rBfjfwQ45ZU

32
Q

Elemental feeding

A
  • Exclusive elemental feeding can be as effective as steroids
  • More efficacious in children
  • Compliance difficult
33
Q

What are antibiotics used for?

A

–Crohn’s peri-anal disease

–Small bowel bacterial over growth

34
Q

What can cause failure of medical therapy?

A
  • Relapse prior to or shortly after stopping therapy
  • Failure to control symptoms
  • Unacceptable complications of steroids:

–Diabetes

–Severe osteoporosis

–Psychosis

35
Q

What can result from poor response to medical therapy?

A
  • Fistulas
  • Fibrotic strictures
  • Peri-anal disease
  • Severe fulminating disease
36
Q

What are the surgical options for severe colitis?

A

Total colectomy

37
Q

What are the required surgical procedures after a colectomy?

A

End ileostomy: Illeostomy: a surgical operation in which a damaged part is removed from the ileum and the cut end diverted to an artificial opening in the abdominal wall.

AND

Rectal Stump: The rectal stump is the sack left behind after the colon is diverted surgically to open at the abdominal wall ( a colostomy).

38
Q

What is meant by the pouch procedure?

A

When the colon and rectum are removed (due to ulcerative colitis or familial adenomatous polyposis), another reservoir must be created for bowel contents (stool) to exit the body. Surgically creating a “J” shaped reservoir (called a J-pouch) is an option for selected patients to store and pass stool.

Small bowel is mobilised and lengthened and used to construct a pouch.

Stoma bag still exits in this circumstance - 60% of people chose not to do this

39
Q

Where does Crohn’s affect the GI tract?

A

Small intestine 30%

Ileocaecal area 40%

Colon and rectum 30%

Anus

40
Q

How does crohn’s affect the anus?

A

fissures, abscesses, fistulas, skin tags

(non-ulcerating vs severe ulcerating disease)

41
Q

What are the surgical indications for Crohn’s disease?

A
  • Failure of medical management
  • Relief of obstructive symptoms (small bowel)
  • Management of fistulae - e.g. bowel to bladder
  • Management of intra-abdominal abscess
  • Management anal conditions
  • Failure to thrive

50% need another operation by 10 years

42
Q
A

GI (38 decks)

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