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Year 3 GI > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Symptoms (DWARF)

A 
Diarrhoea 
Weight loss 
Abdo pain 
Rectal bleeding/Bloody stools 
Fatigue
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2
Q

Crohn’s pathophysiology

A

Can affect the entire GI tract from mouth to anus

  • skip lesions
  • commonly distal ideal involvement
  • transmural inflammation
  • can cause strictures and fistulas
  • granuloma formation
  • rose thorn ulcers - seen on barium swallow
  • increased goblet cells
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3
Q

Pathophysiology of UC

A
  • Affects rectum and continues proximally
  • Always affects large bowel and can sometimes affect the caecum or ilium
  • Submucosal inflammation
  • Continuous
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4
Q

Risk factors of Crohn’s disease

A

Age 15 - 30
Jewish > white > black
Smoking increases risk
FHx

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5
Q

UC risk factors

A

15 - 30 yo
Jewish > white > black
FHx
HLA- B27

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6
Q

How does smoking effect UC

A

Stopping smoking exacerbates UC

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7
Q

Presentation specific to Crohns

A 
Aphthous ulcers 
Arthritis 
Erythema nodosum 
Pyoderma gangrenosum 
Toxic megacolon - due to fistula/ structure causing obstruction
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8
Q

UC specific presentation

A 
Arthritis 
Ankylosing spondylitis 
Fever 
Erythema nodosum 
Pyoderma gangrenosum 
Episcleritis/ uveitis
Bloody diarrhoea 
Tenesmus
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9
Q

Fistula complications

A

Palpable mass
Increase risk of UTI
Abscess formation
Passage of gas/ faeces through vagina/ skin

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10
Q

Investigations for IBD

A 
Bloods - FBC, Fe, B12, CRP, LFTs, U+Es 
Stool sample testing - faecal calprotectin 
Colonoscopy with biopsy 
Abdo XR with contrast 
CT/MRI of abdo pelvis
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11
Q

Crohns specific investigation

A

Yersinia enterocolitica serology - rule out infection as can cause acute ileitis

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12
Q

Colonoscopy appearance for crohns

A

Cobblestone appearance
Strictures
Fistulas

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13
Q

X-ray appearance

A

Crohns

  • skip lesions
  • Kantor’s string sign

UC:
- lead pipe appearance

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14
Q

Biopsy findings for UC

A 
Ulceration 
Crypt distortion 
Crypt abscesses 
Pseudopolyps 
Infiltration and inflammation
Loss of haustra
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15
Q

Management of Crohn’s disease for remission

A

Supportive:
- smoking cessation

Remission:

  1. prednisolone/ budesonide
  2. aminosalicylate - if prednisolone contraindicated
  3. azathioprine/ mercaptopurine + prednisolone
  4. methotrexate + prednisolone - if ATP not tolerated
  5. monoclonal antibodies - infliximab
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16
Q

Crohns maintenance

A

Maintenance:

  1. Azathioprine/ mercaptopurine
  2. Methotrexate

Surgery:
- if limited to distal ileum

17
Q

When is azathioprine or mercaptopurine used?

A

2+ episodes in 1 year

18
Q

UC remission management

A
  1. Topical aminosalicylate - mesalazine
  2. Oral aminosalicylate (after 4 weeks)
  3. Topical/Oral corticosteroid
  4. Immunomodulative therapies
    - anti TNFalpha - infliximab
    - anti integrin
    - Janus kinase inhibitor
19
Q

UC maintenance management

A
  1. Topical aminosalicylate Or + Oral aminosalicylate

2. Oral azathioprine/ mercaptopurine

20
Q

Acute severe admission management UC

A
  • IV corticosteroid - hydrocortisone
  • cyclosporin 2nd line IV
  • fluid resuscitation if needed
  • Surgical intervention
21
Q

When is surgery indicated

A

If no response to steroids in 24 - 48 hrs or infliximab in 3 days

22
Q

Fulminant colitis presentation

A

Fever
Tachycardia
Abdominal distension
Peritonitis

23
Q

Fulminant colitis endoscopy

A

Should be avoided due to risk of toxic megacolon or perforation

24
Q

Complications of Crohn’s

A
  1. Intestinal obstruction
  2. Sinus tracts (like fistula)
  3. Toxic megacolon (less risk)

Chronic:

  • anaemia
  • short bowel syndrome and malabsorption
  • miscarriage due to methotrexate
  • gallstones
  • colorectal cancer
25
Q

Complications of UC

A
  1. Fulminant colitis
  2. Toxic megacolon

Chronic:

  • colonic adenocarcinoma
  • primary sclerosis group cholangitis
26
Q

Methotrexate side effects

A

Teratogenic
Hepatotoxic
Pulmonary fibrosis

27
Q

Fulminant colitis treatment

A

Emergency

Tx - surgery

28
Q

Toxic megacolon

A

Colon dilates and traps gas or faecal components

Severe build up can lead to perforation

Year 3 GI (21 decks)

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