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Medicine Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Which conditions fall under inflammatory bowel disease?

A

Ulcerative colitis, Crohn’s

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2
Q

Crohn’s disease

A

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

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3
Q

Where is Crohn’s disease most common?

A

Terminal ileum and colon

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4
Q

Which gender is more susceptible to Crohn’s disease?

A

Males

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5
Q

Presentation of Crohn’s disease

A

Abdominal pain, small bowel obstruction, diarrhoea, bleeding PR, anaemia, weight loss, ulcers, swollen lips, angular cheilitis

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6
Q

Investigations for Crohn’s disease

A

Endoscopy and mucosal biopsy

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7
Q

Endoscopy findings in Crohn’s disease

A

Patchy segmental disease with skip lesions

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8
Q

Histological stains for Crohn’s disease

A

Large non-caseating Granuloma formation, increased chronic inflammatory cells in the lamina propria and crypt branching with granulomas

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9
Q

Complications of Crohn’s disease

A

Malabsorption, fistulas, anal disease, intractable disease, bowel obstruction, perforation, malignancy, amyloidosis

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10
Q

Environmental triggers of Crohn’s disease

A

Smoking, infectious agents, vasculitis

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11
Q

Immune response in Crohn’s disease

A

Persistent activation of T-cells and macrophages and excess proinflammatory cytokine production. TH1 mediated

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12
Q

Ulcerative colitis

A

Chronic inflammatory disorder confined to the colon and rectum and nearly always involves the rectum

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13
Q

Clinical presentation of ulcerative colitis

A

Diarrhoea, mucus and blood PR, increased bowel frequency, urgency, tenesmus, incontinence, night rising, lower abdomen, pain

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14
Q

Histological stains in ulcerative colitis

A
  • Massive influx of inflammatory cells
  • Basal lymphoplasmacytic infiltrate with irregular shaped branching crypts
  • Crypt abscesses
  • Severe ulceration with fibrinopurulent exudate
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15
Q

Complications of ulcerative colitis

A

Intractable disease, toxic megacolon, colorectal carcinoma, blood loss, electrolyte disturbance, anal fissures, extra GI manifestations

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16
Q

Toxic megacolon

A

When the colon swells up to a massive size which can rupture if it isn’t removed

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17
Q

Extra GI manifestations of ulcerative colitis

A

Uveitis, primary sclerosing cholangitis, arthritis, ankylosing spondylitis, pyoderma gangrenosum

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18
Q

Immune response in ulcerative colitis

A
  • Persistent activation of T-cells and macrophages
  • Autoantibodies
  • Excess proinflammatory cytokine production and bystander damage due to neutrophilic inflammation
  • Mixed Th1/Th2 mediated disease
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19
Q

Which chromosome is the disease susceptibility gene for IBD?

A

16q12

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20
Q

Which score is used to assess severity of ulcerative colitis

A

Truelove and Witt criteria

21
Q

Severe ulcerative colitis determination

A

> 6 bloody stools in 24 hours and one or more of:

  • Fever
  • Tachycardia
  • Anaemia
  • Elevated ESR
22
Q

Further assessments for ulcerative colitis

A

Bloods - CRP, albumin
AXR - toxic megacolon
Endoscopy
Histology

23
Q

Extra-intestinal manifestations of UC:

  • Skin
  • Joints
  • Eyes
  • Mouth
A

Skin - erythema nodosum, pyoderma gangrenosum
Joints - spondylitis, sacroiliitis, peripheral arthritis
Eyes - epsiscleritis, uveitis
Mouth - stomatitis, aphthous ulcers

24
Q

Primary sclerosing cholangitis

A

Chronic inflammatory disease of the biliary tree

25
Q

Clinical exam in assessment of Crohn’s disease

A

Evidence of weight loss, RIF mass, peri-anal signs

26
Q

Which blood tests do you want in assessment of Crohn’s disease?

A

CRP, albumin, platelets, ferritin, B12

27
Q

Colonoscopy findings in Crohn’s disease and ulcerative colitis

A

Crohn’s disease - cobblestoning

Ulcerative Colitis - psuedopolyps

28
Q

Drug therapy in ulcerative colitis

A

5ASA (mesalazine), steroids, immunosuppressants, anti-TNF therapy

29
Q

Drug therapy in Crohn’s disease

A

Steroids, immunosuppressants, anti-TNF therapy

30
Q

5-aminosalicylic acid side effects

A

Diarrhoea, idiosyncratic nephritis

31
Q

Examples of 5-aminosalicylic acid

A

Sulphasalazine, Balsalazide, Mezavant, Mesalazine

32
Q

Side effects of corticosteroids

A

Avascular necrosis, osteoporosis, acne, thinning of skin, weight gain, diabetes, hypertension, cataracts, growth failure

33
Q

Side effects of azothioprine

A

Pancreatitis, leucopenia, hepatitis

34
Q

Side effects of anti-TNF therapy

A

Infusion reactions, infection, cancer

35
Q

Surgery options for Crohn’s disease

A

Resection, stricuroplasty, fistulas, anal disease

36
Q

Surgery options for ulcerative colitis

A

Proctocolectomy with end ileostomy, proctocolectomy with ileorectal anastomosis

37
Q

Indications for elective surgery in ulcerative colitis

A

Medically unresponsive disease, Intolerability, Dysplasia/malignancy, Growth retardation in children, Attempted resolution of extra-intestinal disease

38
Q

End ileostomy with pouch - how many bowel movements do patients with these have in 24 hours

A

6 on average

39
Q

Complications of end ileostomy with pouch:

  • Immediate
  • Early
  • Late
A

Immediate - local – haemorrhage, enterotomy, systemic – anaphylaxis
Early - local – urinary dysfunction, wound infection, pelvic abscess, anastomotic leak, systemic – atelectasis, ileus, portal vein thrombosis
Late - infertility, pouchitis, systemic – DVT/PE, small bowel obstruction

40
Q

Surgery as an option for ulcerative colitis

A

Patient is ‘cured’

41
Q

Indications for surgery in Crohn’s disease

A
  • Stenosis causing obstruction
  • Enterocutaneous fistulas
  • Intra-abdominal fistulas
  • Abscesses
  • Bleeding
  • Free perforation
42
Q

Colonic surgery for Crohn’s

A
  • Emergency colectomy
  • Segmental colectomy
  • Total colectomy
  • Panproctocolectromy
43
Q

Causes of malnutrition in inflammatory bowel disease

A

Inadequate dietary intake, alterations in energy requirements, malabsorption, side effects of medications

44
Q

Things that can cause inadequate dietary intake in patients with inflammatory bowel disease

A

Reduced appetite secondary to symptoms, taste changes as a result of vitamin and mineral deficiencies and drug interactions, self-restriction of diet to avoid symptoms

45
Q

Factors leading to increased risk of osteoporosis in inflammatory bowel disease

A

Systemic inflammation, age, corticosteroid use, inadequate vitamin D and calcium status

46
Q

Recommended calcium intake for patients with IBD

A

1000mg/day with most coming from diet

47
Q

What is exclusive enteral nutrition?

A

Withdrawal of all food and drink, except water, and replacement with enteral nutrition formula

48
Q

When is exclusive enteral nutrition a primary treatment option in IBD?

A

In children and adolescents

49
Q

How can adherence to enteral nutrition be improved?

A

Prescriptible flavours and ensuring it is cold and taken with a straw from a beaker

Medicine Gastrointestinal (24 decks)

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