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Charis & Ellie vs GI > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Two types of extra-intestinal manifestations of IBD?

A

Type 1: pauciarticular(4 or less joints involved)

Type 2: polyarticular

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2
Q

Describe Type 1 of extra-intestinal manifestations of IBD?

A

Attacks are acute and self-limiting (<10 weeks), associated with other extra-intestinal manifestations of IBD activity

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3
Q

Describe type 2 of extra-intestinal manifestations of IBD?

A

Arthropathy lasts longer (months to years), is independent of IBD activity and usually associated with uveitis

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4
Q

Eye manifestations of IBD?

A

Uveitis

Episcleritis, conjunctivitis

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5
Q

Joint manifestations of IBD?

A

Arthritis

Seronegative arthropathy

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6
Q

Skin manifestations of IBD?

A

Erythema nodosum
Pyoderma gangrenosum
Clubbing

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7
Q

Liver and biliary tree manifestations of IBD?

A 
Primary sclerosing cholangitis 
Fatty liver 
Chronic hepatitis 
Cirrhosis 
Gallstones
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8
Q

What is Crohn’s disease?

A

Chronic inflammatory condition which may affect the whole git but tends to affect the terminal ileum and ascending colon.
Can involve 1 small area of gut or have skip lesions or whole colon

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9
Q

Histology of bowel involved in Crohn’s disease?

A

Bowel normally thickened and narrowed
Cobblestone appearance
Inflammation is transmural: extends all area of the bowel

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10
Q

Who gets Crohn’s disease?

A
  • Jewish people
  • White people
  • Young people
  • 1/4 diagnosed are kids
  • People with family history
  • Smokers
  • NSAIDs
  • Appendectomy increases risk
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11
Q

How does Crohn’s generally present?

A

Diarrhoea (containing blood if colonic disease)
Abdominal pain
Perianal disease

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12
Q

How does Crohn’s of small intestine present?

A
  • Abdominal cramps
  • Diarrhoea
  • Wt loss
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13
Q

How does Crohn’s in the colon present?

A

Abdominal cramps
Diarrhoea with blood
Wt loss

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14
Q

Mouth crohn’s presents as?

A

Painful ulcers
Swollen lips
Angular chellitis

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15
Q

Anus Crohn’s presents as?

A

Peri-anal pain and abscesses

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16
Q

When should Crohn’s be considered?

A

Should be considered in all individuals with evidence of vitamin malabsorption and children with reduced growth velocity and diarrhoea

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17
Q

Clinical evidence for Crohns?

A

Evidence of weight loss
RIF mass
Peri-anal signs

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18
Q

Blood tests for Crohn’s?

A 
Anaemia 
Raised ESR and CRP 
Hypoalbuminaemia 
Liver biochem 
Blood cultures (suspected septicaemia)
Serological tests
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19
Q

Stool tests for Crohn’s?

A

Diarrhoea- C. Difficile toxin assay should be done
Microscopy for parasites in patients with travel
Faecal calprotectin and lactoferrin

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20
Q

Imaging tests for Crohn’s?

A
  • Colonoscopy
  • Upper GI endoscopy (to exclude oesophageal and gastroduodenal disease) define extent
  • Small bowel imaging (mandatory)
  • US scanning
  • Perianal MRI
  • Capsule endoscopy
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21
Q

Severity of CD can be assessed with?

A

Haemoglobin
WCC
Inflammatory markers (ESR, CRP, platelets)
Serum albumin

22
Q

lifestyle Treatment of CD?

A

Lifestyle
STOP SMOKING it aggravates
Diet

23
Q

Medical treatment of CD?

A

Oral or IV glucocorticosteroids (pred, budesonide)
Enteral nutrition
Immunosuppressants
Anti tumour necrosis factor (TNF) antibodies: promote apoptosis of activated T lymphocytes
IV fluids

24
Q

Examples of anti tumour necrosis factor (TNF) antibodies?

A

Infliximab IV
Adalimumab SC
Certolizamub pegol

25
Q

Maintenance of remission of CD?

A

Azathioprine
Mercaotopurine (all immunosuppressants)
Methotrexate
Anti- TNF antibodies

26
Q

Perianal disease management?

A

Surgical drainage of sepsis
Ciprofloxacin & metronidazole
Azathioprine

27
Q

Surgical treatment of Crohn’s?

A 
Should be avoided as not curative 
Indications for surgery:
-Failure of medical therapy 
-Failure to grow in children 
-peri-anal sepsis
28
Q

Type of surgeries for CD?

A

Stricturoplasty- widening of strictures
Resection
Anastamosis
Ileocolonoscopy to prevent disease recurrence

29
Q

Problems with ileostomy?

A 
Mechanical problems 
Dehydration 
Psychosexual problems 
Erectile dysfunction 
Recurrence of CD
30
Q

Risk of CD?

A

Gallstones
Malabsorption
Bowel obstruction
Increased risk of colorectal cancer & oestoporosis

31
Q

Anal and peri-anal complications of CD?

A 
Fissure in ano
Haemorrhoids 
Skin tags
Perianal abscess 
Ischiorectal abscess 
Fistula in ano 
Anorectal fistulae
32
Q

What is Ulcerative Collitis?

A

IBD which affects the colon, can affect the rectum alone or can extend proximally to involve the different parts of the colon up to the whole colon + possible terminal ileum

33
Q

Histology of UC?

A

Inflammation is superficial, limited to the mucosa, including chronic inflammatory cell infiltrate in the lamina propria
NO SKIP LESIONS
Granulomas are very rare in UC

34
Q

What is UC inflammation mediated by?

A

TH1/TH2 natural killer cells

35
Q

Who gets UC?

A 
People with Fam history 
NSAIDs 
Appendectomy decreases risk 
Young people
NON SMOKERS
36
Q

How does UC present?

A 
DIARRHOEA WITH BLOOD + MUCOUS 
Lower abdo pain 
Malaise/fatigue 
Lethargy 
Anorexia 
Wt loss 
Aphthous ulceration 
Less severe symptoms than CD 
Slightly distended abdomen 
Tachycardia &amp; pyrexia (if severe)
Rectal exam shows blood
37
Q

How is UC diagnosed?

A

Severe: 6 stools with a lot of blood, fever>37.5, >90bpm, erythrocyte sedimentation rate >30mm/h, <100g/L haemoglobin and <30g/L albumin

38
Q

Blood tests for UC?

A

WCC & platelet counts
ESR and CRP- raised, liver biochemistry abnormal, hypoalbuniaemia
pANCA- positive contrary to CD
Albumin

39
Q

Gold standard for UC?

A

Endoscopy with mucosal biopsy

40
Q

How is severe UC treated?

A 
Exclude enteric infection 
Admit to hospital 
Confirm diagnosis sigmoidoscopy 
Assess fluid status
Prophylactic anticoagulation (LMWH)
IV hydrocortisone 
Monitor daily
41
Q

Treating general UC?

A 
Corticosteroids for acute attacks 
Aminosalicylates 
IV Fluids 
Immunosuppressants 
Anti-TNF therapy
42
Q

Treating proctitis?

A

Rectal 5-ASA suppositories = first line
Topical steroids
Oral 5-ASA prednisalone
Oral pred for those who don’t respond

43
Q

Surgical management of UC?

A

Can be curative
Laproscopic surgery
Permanent ileostomy & ileo-anal pouch

44
Q

Risk factor of severe colitis?

A

Toxic Megacolon
- abdominal x ray will show dilated thin-walled colon with a diameter >6m, which is gas filled and has mucosal islands
HIGH RISK OF PERFORATION AND DEATH

45
Q

Other risks of UC?

A

Primary sclerosing cholangitis

46
Q

Prognosis?

A

1/3 patients will undergo colectomy within 20 years of diagnosis

47
Q

Mouth manifestations of IBD?

A

Ulcers

Stomatitis

48
Q

Where can Crohn’s affect?

A

Anywhere from mouth to anus

49
Q

What is different about treatment of UC and CD?

A

CD you do not use 5 ASA in

50
Q

IV steroids are used to?

A

Reduce severe flares

51
Q

General medications for IBD?

A

Corticosteroids
Immunosuppression
Anti-TNF
Surgery

Charis & Ellie vs GI (120 decks)

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