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paeds: gastro and growth > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

What is the recent trend in incidence of inflammatory bowel disease?

A

increased markedly in last two decades - complex interplay between genetics, gut microbiome and mucosal immunity

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2
Q

What genetic role is there thought to be in inflammatory bowel disease?

A

number of genes identified that give increased risk, but often in association with increased risk of other autoimmune diseases that don’t always coexist with IBD

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3
Q

What proportion of patients with IBD present in childhood or adolescence?

A

25%

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4
Q

Of Crohn’s disease and ulcerative colitis, which is more common in the young population?

A

Crohn’s disease (unlike in adult population when it is UC)

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5
Q

Which regions of the gastrointestinal system are affected by Crohn’s and UC respectively?

A
  • Crohn’s can affect any part of GI tract from mouth to anus
  • UC confined to colon
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6
Q

What are 3 broad effects of IBD?

A
  1. Poor general health
  2. Restrict growth
  3. Adverse effect on psychological well-being
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7
Q

What are the 3 symptoms considered the classical presentation of crohn’s disease?

A
  1. Abdominal pain
  2. Diarrhoea
  3. Weight loss
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8
Q

In addition to adbominal pain, diarrhoea and weight loss, what are 5 more general features of crohn’s disease in children and adolescents?

A
  1. Growth failure
  2. Puberty delayed
  3. Fever
  4. Lethargy
  5. Weight loss
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9
Q

What are 5 extra-intestinal manifestations of Crohn’s disease?

A
  1. Oral lesions
  2. Perianal skin tags
  3. Uveitis
  4. Arthralgia
  5. Erythema nodosum
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10
Q

What parts of the gastrointestinal system are most commonly affected in Crohn’s disease?

A

Distal ileum and proximal colon

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11
Q

What are 2 types of course that Crohn’s disease can take?

A
  1. Subacute
  2. Chronic inflammatory disease
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12
Q

What 2 words can be used to describe the location of Crohn’s disease where it occurs?

A

Transmural

Focal

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13
Q

How does Crohn’s evolve from an acute to a chronic disease?

A

Initially areas of acutely inflamed, thickened bowel

Then subsequent strictures of the bowel and fistulae may develop between adjacent loops of bowel, between bowel and skin or to other organs e.g. vagina, bladder

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14
Q

What are 4 organs that strictures may develop from bowel to in Crohn’s disease?

A
  1. Between adjacent bowel loops
  2. Bowel to skin
  3. Bowel to vagina
  4. Bowel to bladder
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15
Q

What is diagnosis of Crohn’s disease based on? 3 key things

A

Endoscopic and histological findings on biopsy:

  • upper GI endoscopy
  • ileocolonoscopy
  • small bowel imaging
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16
Q

What is the histological hallmark of Crohn’s disease on biopsy?

A

non-caseating epithelioid call granulomata (only in 70% at presentation)

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17
Q

What are 4 things that may be revealed by small bowel imaging in Crohn’s disease?

A
  1. Narrowing
  2. Fissuring
  3. Mucosal irregularities
  4. Bowel wall thickening
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18
Q

What are 2 forms of treatment that will be received by patients with Crohn’s disease?

A
  1. Remission induction: nutritional therapy
  2. Remission maintenance: immunosuppressants
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19
Q

How is remission induction achieved in patients with Crohn’s disease?

A

nutritional therapy: normal diet replaced by whole protein modular feeds (polymeric diet) for 6-8 weeks

20
Q

How long is a polymeric diet for remission induction required in Crohn’s disease?

A

6-8 weeks

21
Q

In what proportion of cases of Crohn’s disease is a polymeric diet effective to induce remission?

A

75% of cases

22
Q

If a polymeric diet doesn’t work to induce relapse in Crohn’s disease what else can be used?

A

systemic steroids

23
Q

What are 3 examples of immunosuppressant medication that can be used for maintenance of remission in Crohn’s?

A
  1. Azathioprine
  2. Mercaptopurine
  3. Methotrexate
24
Q

If conventional immunosuppressants have failed for remission maintenance in Crohn’s disease, what else can be used?

A

Antitumour necrosis factor (anti-TNF) agents e.g. infliximab or adalimumab

25
Q

What may be used to correct growth failure in Crohn’s disease?

A

Long-term supplemental enteral nutrition, often with overnight nasogastric or gastrostomy feeds

26
Q

What are 4 situations when surgery is used for Crohn’s disease?

A
  1. Obstruction
  2. Fistulae
  3. Abscess formation
  4. Severe localised disease unresponsive to medical treatment - often manifests as growth failure
27
Q

What is the long-term prognosis for patients with Crohn’s disease beginning in childhood?

A

good, most patients lead normal lives despite occasional relapsing disease

28
Q

What is ulcerative colitis?

A

recurrent, inflammatory and ulcerating disease involving mucosa of the colon

29
Q

What are 3 characteristic features of ulcerative colitis?

A
  1. Rectal bleeding
  2. Diarrhoea
  3. Colicky pain
30
Q

Can weight loss and growth failure occur in ulcerative colitis?

A

yes but less frequent than in Crohn’s

31
Q

What are 2 extra-intestinal complications of ulcerative colitis?

A
  1. Erythema nodosum
  2. Arthritis
32
Q

How is a diagnosis made in ulcerative colitis?

A

Endoscopy - upper and ileocolonoscopy, and on histological featurs, after exclusion of infective causes of colitis

33
Q

What can be seen on endoscopy in ulcerative colitis?

A

confluent colitis extending from rectum proximally for a variable length

34
Q

How does the colitis of UC differ in children compared with adults?

A

90% of children have pancolitis but in adults the colitis is usually confined to the distal colon

35
Q

What does histology reveal in ulcerative colitis? 3 key things

A
  1. Mucosal inflammation
  2. Crypt damage
    • cryptitis, architectural distortion, abscesses and crypt loss
  3. Ulceration
36
Q

What are 4 elements of crypt damage in ulcerative colitis?

A
  1. Cryptitis
  2. Architetural distortion
  3. Abscesses
  4. Crypt loss
37
Q

Why is small bowel imaging required in ulcerative colitis?

A

To check extracolonic inflammation suggestive of Crohn’s disease is not present

38
Q

What is the usual treatment for mild ulcerative colitis?

A

Aminosalicylates e.g. mesalazine - induction and maintenance therapy

39
Q

How can ulcerative colitis refined ot hte rectum and sigmoid colon be treated?

A

topical steroids

40
Q

What is the management of aggressive or extensive ulcerative colitis?

A
  • acute exacerbations: systemic steroids
  • Maintenance of remission: immunomodulatory therapy e.g. azathioprine ± low-dose corticosteroid therapy
41
Q

What are the 2 steps of managing resistant ulcerative colitis?

A
  1. Biological therapies e.g. infliximab or ciclosporin
  2. If ineffective, surgery should not be delayed
42
Q

What is the management of severe fulminating disease in ulcerative colitis?

A

medical emergency: requires treatment with IV fluids and steroids

if fails to induce remission, ciclosporin may be used

surgery: colectomy with ileostomy ro ileorectal pouch

43
Q

What are 4 groups of ways to treat ulcerative colitis?

A
  1. Mild: aminosalicylates for induction and maintenance of remission
  2. Rectum + sigmoid: topical steroids
  3. Aggressive/ extensive: systemic steroids + maintennce of remission: immunomodulatory therapy (e.g. azathioprine ± low dose corticosteroids
  4. Severe fulminating: medical emergency, IV fluids and steroids. if fails - ciclosporin. surgery
44
Q

What type of surgery is performed in ulcerative colitis for severe fulminating disease?

A

colectomy ileostomy or ileorectal pouch

45
Q

What are 2 things which may complicate ulcerative colitis making surgery more likely?

A
  1. Toxic megacolon
  2. Chronic poorly controlled disease
46
Q

In which type of IBS is there a particularly increased risk of malignancy, and what kind?

A

UC (but both increase risk), colorectal adenocarcinoma

47
Q

What is performed regularly in patients with UC due to the risk of colorectal adrenocarcinoma?

A

regular colonoscopic screening after 10 years from diagnosis

paeds: gastro and growth (14 decks)

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