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Gastrointestinal > Inflammatory Bowel Disease (IBD) > Flashcards

Inflammatory Bowel Disease (IBD) Flashcards

1
Q

What are the two forms of IBD. (2)

A

Crohn’s disease.

Ulcerative colitis.

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2
Q

What are the characteristics of Crohn’s disease. (9)

A 
Affects any part of the GIT from mouth to anus. 
Segmental. 
Transmural process. 
Ulceration. 
Cobblestone appearance. 
Pseudopolyps. 
Non-caseating granulomas. 
Fissures. 
Fistulae.
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3
Q

What contributes to the development of Crohn’s disease. (3)

A

Genetic predisposition (NOD2/CARD15).
Smoking.
NSAIDs may exacerbate disease.

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4
Q

What are the symptoms of Crohn’s disease dependent on.

A

Depends on the site affected.

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5
Q

What are the typical symptoms associated with Crohn’s disease. (5)

A 
Abdominal pain. 
Diarrhoea/urgency. 
Weight loss/failure to thrive. 
PR mucus/pus. 
Arthritis.
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6
Q

What are the clinical signs of Crohn’s disease. (12)

A 
Fever. 
Malaise. 
Anorexia.
Anaemia. 
Palpable inflammatory mass. 
Perianal abscess/fistulae/skin tags.
Anal strictures.  
Aphthous ulcerations. 
Abdominal tenderness/mass. 
Erythema nodosum. 
Clubbing. 
Pyoderma gangrenosum.
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7
Q

What is seen on the blood tests of a patient with Crohn’s disease. (4)

A

Raised CRP.
Raised ESR.
Low Hb.
Low albumin.

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8
Q

What tests should be conducted in a patient suspected of having Crohn’s disease. (7)

A

Stool microscopy/culture.
Blood tests (CRP, ESR, albumin, WCC, Hb, FBC, UandEs, LFTs, INR, ferritin, TIBC, B12, folate).
Sigmoidoscopy/colonoscopy with biopsies.
Small bowel enema detects ileal disease.
White cell scan.
BaFT.
MRI (can assess pelvic disease and fistulae).

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9
Q

What malabsorption tests should be performed in a patient with Crohn’s. (4)

A

Vitamin B12.
Folate.
Vitamin D.
Calcium.

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10
Q

What are the complications of Crohn’s disease. (16)

A 
Stricturing. 
Small bowel obstruction. 
Perforation. 
Toxic dilatation (rarer than in UC). 
Abscess formation.
Fistulae. 
Rectal haemorrhage. 
Colon cancer. 
PSC. 
Cholangiocarcinoma. 
Renal stones. 
Osteomalacia. 
Malnutrition. 
Amyloidosis. 
Cholelithiasis. 
Fatty liver.
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11
Q

What is the treatment for Crohn’s. (9)

A

Mild attacks: prednisolone 30mg/d PO for 1 week, then 20mg/d for 4 weeks.

Severe attacks: IV steroids, NBM, IVI, hydrocortisone 100mg/6h IV.

Other treatments include:
5-aminosalicylic acid (5-ASA) eg. mesalazine. 
Antibiotics. 
Azathioprine/6-mercaptopurine. 
Methotrexate. 
Infliximab (anti-TNF alpha). 
Enteral therapies (elemental diet, TPN).
Surgery.
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12
Q

What are the characteristics of UC. (7)

A

Involves the rectum and extends proximally.
Inflammation confined to mucosa and submucosa.
Distorted crypt architecture.
Cryptitis.
Crypt abscesses.
Inflammatory cell infiltrate.
Vascular congestion.

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13
Q

What contributes to the development of UC. (2)

A

Genetic predisposition.

Non-smokers.

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14
Q

What are the symptoms of UC. (7)

A

Episodic or chronic diarrhoea.
PR bleeding and mucus.
Crampy abdominal discomfort.

Systemic symptoms in attacks:
Weight loss. 
Fever. 
Malaise. 
Anorexia.
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15
Q

What are the physical signs of UC. (19)

A 
There may be none.
In acute, severe UC, there may be: 
Fever. 
Tachycardia. 
Tender distended abdomen. 
Extraintestinal signs include:
Clubbing. 
Aphthous oral ulcers. 
Conjunctivitis. 
Episcleritis. 
Iritis. 
Large joint arthritis. 
Sacroilitis. 
Ankylosing spndylitis. 
Fatty liver. 
PSC. 
Cholangiocarcinoma. 
Nutritional deficits. 
Amyloidosis. 
Erythema nodosum. 
Pyoderma gangrenosum.
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16
Q

What is seen on the blood tests of a patient with UC. (5)

A 
Raised CRP. 
Raised ESR. 
Raised platelets. 
Low albumin. 
Low Hb.
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17
Q

What are the investigations carried out in a patient suspected of UC. (8)

A

Blood tests (CRP, ESR, albumin, platelets, Hb, FBC, UandEs, LFTs).
Blood cultures.
Stool microscopy/culture.
AbdoXray (need to rule out toxic dilatation).
Colonoscopy with biopsies.
Erect CXR (to look for perforation).
Barium enema (never do during severe attacks or for diagnosis).
pANCA test.

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18
Q

What percentage of UC patients test positive for pANCA.

A

70%.

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19
Q

How do you induce remission in UC. (3)

A

Mild UC: 5-ASA (eg sulfasalazine/mesalazine).
Steroids (prednisolone 20mg/d PO, helps remission induction).

Moderate UC (if 4-6BO/day): prednisolone 40mg/d for 1 week, then 30mg/d for 1 week, then 20mg for 4 more weeks and 5-ASA.

Severe UC (if unwell and >6BO.day): NBM, IV hydration, hydrocortisone 100mg/6h IV, rectal steroids, daily blood tests and physical examinations.

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20
Q

What are the complications of UC. (7)

A 
Haemorrhage. 
Perforation.
Venous thrombosis. 
Toxic megacolon. 
Colorectal carcinoma. 
Fatty liver. 
Primary sclerosing cholangitis.
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21
Q

What part of the GIT does Crohn’s disease affect.

A

Any part from mouth to anus.

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22
Q

What part of the GIT does UC affect.

A

Affects large bowel only.

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23
Q

What are the typical endoscopic findings in Crohn’s disease. (3)

A

Rectum frequently spared.
Some areas of healthy bowel between diseased segments (skip lesions).
Bowel wall is thickened and has a cobblestone’ appearance due to deep ulceration.

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24
Q

What are the typical endoscopic findings in UC.

A

Bowel wall is thin and featureless in severe disease.

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25
Q

What are the typical histological findings in Crohn’s disease. (2)

A 
Granuloma is the characteristic finding. 
Transmural inflammation (extends all the way through the bowel wall).
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26
Q

What are the typical histological findings in UC.

A

Inflammation usually confined to mucosa.

27
Q

What are the common radiological findings in Crohn’s disease. (4)

A

Strictures, fissures and fistulae are common.

Asymmetrical inflammation.

28
Q

What are the common radiological findings in UC. (2)

A

Symmetrical inflammation.

Uncommon to find strictures, fissures and fistulae.

29
Q

Which IBD is commonly associated with smokers.

A

Crohn’s disease.
Predicts a worse course of disease.
Increases risk of surgery and future surgery.

30
Q

Which IBD is commonly associated with non-smokers or ex-smokers.

A

UC.

31
Q

What is Crohn’s disease.

A

A chronic inflammatory GI disease characterized by transmural granulomatous inflammation affecting any part of the gut from mouth to anus.

32
Q

What part of the GIT is most often affected in Crohn’s. (2)

A

Terminal ileum is affected in 70% of cases.

Proximal colon.

33
Q

What are ‘skip lesions’. (2)

A

Areas of unaffected bowel between areas of active disease.

Seen in Crohn’s disease.

34
Q

What is the prevalence of Crohn’s disease.

A

0.5-1/100,000.

35
Q

What is the incidence of Crohn’s disease.

A

5-10/100,000/year.

36
Q

What is the typical age of presentation of Crohn’s disease.

A

Peaks 20-30 and 60-70.

37
Q

Where might abscesses form in Crohn’s. (3)

A

Abdominal.
Pelvic.
Ischio-rectal.

38
Q

What percentage of patient’s with Crohn’s have fistulae.

A

10%.

39
Q

What is seen on a barium enema of a patient with Crohn’s. (3)

A

Cobblestoning.
‘Rose thorn’ ulcers.
Colon strictures.

40
Q

What is the preferred investigation to assess disease extent.

A

Colonoscopy.

41
Q

What percentage of patient’s with Crohn’s develop perianal disease.

A

50%.

42
Q

What indicates a poor prognosis in patients with Crohn’s. (4)

A

Age

43
Q

What are some other causes of erythema nodosum. (5)

A 
Crohn's disease. 
Streptococci. 
TB. 
Sarcoidosis. 
Drugs.
44
Q

What is the prevalence of UC.

A

100-200/100,000.

45
Q

What is the incidence of UC.

A

10-20/100,000.

46
Q

What is the male:female ratio for UC.

A

1:1.

47
Q

What is the typical age of presentation of UC.

A

15-30.

48
Q

What is UC.

A

UC is a relapsing and remitting inflammatory disorder of the colonic mucosa.

49
Q

What parts of the GIT does UC most commonly affect. (3)

A

Just the rectum (proctitis in 50%).
Extends to involve parts of the colon (left sided colitis in 30%).
It may involve the entire colon (pancolitis in 20%).

50
Q

Where does UC not spread beyond.

A

UC never spreads proximal to the ileocaecal valve.

51
Q

What are the pathological features of UC. (4)

A

Hyperaemic/haemorrhagic granular colonic mucosa.
There may be pesudopolyps formed by inflammation.
Punctate ulcers may extend deep into the lamina propria - inflammation is normally not transmural.

52
Q

What differentiates Crohn’s from UC.

A

Mucosal extent of the disease.

53
Q

What are the extraintestinal signs of UC. (15)

A 
Clubbing. 
Aphthous oral ulcers. 
Conjunctivitis. 
Episcleritis. 
Iritis. 
Large joint arthritis. 
Sacroilitis. 
Ankylosing spndylitis. 
Fatty liver. 
PSC. 
Cholangiocarcinoma. 
Nutritional deficits. 
Amyloidosis. 
Erythema nodosum. 
Pyoderma gangrenosum.
54
Q

What are the topical therapies that can be used for UC (proctitis). (3)

A

Suppositories: prednisolone 5mg or mesalazine).

5-ASAs work better than topical steroids.

55
Q

What are the indications for surgery in UC. (4)

A

Perforation.
Massive haemorrhage.
Toxic dilatation.
Failed medical therapy.

56
Q

What percentage of UC cases will eventually need surgery.

A

20%.

57
Q

What is the indication for immunomodulation in UC.

A

If there is no remission on steroids.

58
Q

What can you use for immunomodulation in UC.

A

Azathioprine/6-mercaptopurine.

59
Q

What is the relapse rate for UC once remission has been achieved.

A

All 5-ASAs reduce relapse rate from 80% to 20% at 1 year.

60
Q

What may be seen on AXR in UC. (3)

A

No faecal shadows.
Mucosal thickening/islands.
Colonic dilatation.

61
Q

What should you look for in colonoscopy in UC. (5)

A 
Inflammatory infiltrate. 
Goblet cell depletion. 
Glandular distortion. 
Mucosal ulcers. 
Crypt abscesses.
62
Q

Summarise the treatment options available for UC. (5)

A 
5-ASA. 
Corticosteroids. 
Azathioprine. 
Biological therapy (anti-TNF). 
Colectomy is curative.
63
Q

Summarise the treatment options for Crohn’s disease. (7)

A 
Corticosteroids. 
Azathioprine. 
Methotrexate. 
Biological therapy (anti-TNF). 
Nutritional therapy. 
Surgery for complications is not curative. 
5-ASA is not effective.

Gastrointestinal (35 decks)

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