Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

G.I. > Inflammatory Bowel Disease (IBD) & Large Bowel > Flashcards

Inflammatory Bowel Disease (IBD) & Large Bowel Flashcards

1
Q

What is a polyp?

A

Protrusion above an epithelial surface

A tumour (swelling)

Pedunculated - has a stalk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Commonest polyp?

A

Adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What must happen to all adenomas?

A

They must be removed.

Potentially pre-malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Different types of polyps

A
  1. Adenoma
  2. Serrated polyp
  3. Polypoid carcinoma
  4. Ohter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a serrated polyp?

A

Sessile (flat) polyp lesion of the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What kind of necrosis is seen in large bowel cancers?

A

Dirty necrosis (looks like it has been flecked with dirt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dukes Staging

A

A: Confined by muscularis propria

B: Through muscularis propria

C: Metastatic to lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Colorectal carcinoma - right and left sided presenting complaint

A

75% Left sided (rectum, signed, descending)

  • blood PR, altered bowel habit
  • obstruction

25% Right sided

  • anaemia, weight loss
  • do not normally obstruct (except at ileocoecal valve)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common metastatic sites in colorectal carcinoma

A

Local - mesorectum, peritoneum

Lymphatic spread - mesenteric nodes

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inherited Cancer Syndromes

HNPCC
FAP

how many polyps in each

A

HNPCC//

Hereditary Non Polyposis Coli

<100 polyps

  • late onset
  • autosomal dominant
  • inherited mutation
  • right sided tumours
  • Crohn’s-like inflammatory response

FAP//

Familial adenomatous Polyposis

> 100 polyps to 1000s
throughout the colon
adenocarcinomas

EARLY onset
autosomal dominant
defect in tumour suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diverticular Disease

what is it
complications

A

True/false diverticula

Out-pouchings of the large intestine

Complications//

inflammation (diverticulitis)
rupture
abscess
fistula
massive bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ischaemic colitis

histopathologically
complications
common in

A

“withering of crypts”
pink smudgy lamina propria
fewer chronic inflammatory ells

Common in: elderly

Complications: massive bleeding, rupture, stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Antibiotic Induced PSEUDOMEMBRANOUS colitis

Common in?
Bacteria responsible?

A

Patchy yellow membranous exudate on mucosal surface (looks like a scabby steak)

Explosive lesions on mucosa

Patients on broad spectrum antibiotics

Clostridium difficile - toxin A and B attack lining

Bloody diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antibiotic induced pseudomembranous colitis - treat with?

A

Vancomycin

or colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Collagenous Colitis

A

Increase in thickness of sub epithelial collagen

Patchy disease

Watery diarrhoea, normal endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lymphocytic colitis

A

Normal mucosa
Watery diarrhoea

MASSIVE increase in intraepithelial lymphocytes

possible coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

RADIATION COLITIS

A

Small ulces
Areas of mucosal haemorrhage

ecstatic mucosa
HISTORY of cervical carcinoma
Telangectasia - spider veins

due to chemo/radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute infective colitis

A

Infection
Cryptitis
Neutrophils

May be onset of IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

IBD - the 2 (main) types

A

Ulcerative colitis
— diarrhoea and bleeding

Crohn’s disease
— abdominal pain and peri-anal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Smoking and IBD

A

Aggravates Crohn’s

Protects against UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ulcerative Colitis - clinical features

A

Inflammation of colon
Affects rectum, extending proximally

affects mucosal layer only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is inflammation of the rectum called?

A

Proctitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pancolitis

A

UC that affects the whole large intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Backwash ileitis

A

Ileocoecal valve is swollen and there is some patchy inflamed tissue in the distal ileum.

due to pancolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

UC - symptoms

A

Diarrhoea + BLEEDING

Mucous and blood PR

Increased bowel frequency

Urgency

Tenesmus - feeling of unfinishedness

Incontinence

Night rising

Lower abdo pain - LIF

Proctitis - constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Who is UC most common in/peak incidence?

A

20s and 30s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Severe UC

How many stools/day
Other symptoms

A

> 6 bloody stools
+ one of

> Fever
Tachycardia
Anaemia
Elevated ESR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mucosal oedema in UC is known as? 👍

A

Thumb printing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is TOXIC MEGACOLON

A

Dilatation of colon

Transverse >5.5cm
Caecum >9cm

30
Q

UC - Ix

A

Bloods
AXR
Endoscopy
Biopsy

31
Q

UC - endoscopy

A

Endoscopy

  • define extent of disease
  • loss of vessel pattern
  • granular mucosa
  • contact bleeding
  • pseudopolyps (surviving mucosa)
  • Loss of haustra
  • Crypt distortion
32
Q

UC - histology

A
  • Absence of goblet cells
  • Crypt distortion
  • Abscess
  • Affects mucosal layer only
33
Q

UC - complications

Extra-intestinal manifestations

A

↑ Risk of colorectal cancer

determined by - severity of inflammation, duration and disease extent.

Toxic megacolon - acute or acute on chronic fulminant colitis, colon swells up to massive size
will RUPTURE unless removed
–> emergency colectomy

Colorectal carcinoma - chronic inflammation leads to epithelial dysplasia and then carcinoma

Blood loss
Electrolyte disturbance
Anal fissures

Intractable disease - continuous diarrhoea, total colectomy, flare ups

Extra-intestinal//

deranged LFTs
Oxalate renal stones

PSC - stricture within bile duct
–>Chronic inflammatory disease of biliary tree –> cholangiocarcinoma

Uveitis 
Stomatitis 
Steatosis
Erythema nodosum 
arthritis
ankylosing spondylitis
Pyoderma gangrenous, erythema nodosum
34
Q

Crohn’s affects everywhere from…

A

Bum to gum

35
Q

What kind of lesions are present in Crohn’s

A

Skip lesions

Discontinuous inflammation (unlike UC)

Granulomatous

36
Q

Crohns has mucosal/transmural inflammation?

A

Transmural

37
Q

Does Crohn’s have exacerbations?

A

Yes (as does UC)

38
Q

Perianal crohn’s disease

A

Recurrent abscess formation
Pain
Fistulae - persistent leakage
Damaged sphincters

39
Q

Crohn’s disease phenotypes

A

Stenosis of oleo-coecal valve

Inflammation

Fistuale within the intestine (from ileum to sigmoid)

Strictures causing distension of the proximal bowel

40
Q

Crohn’s symptoms are determined by…?

A

The site of the disease

41
Q

Crohn’s - symptoms

A

S.I.//

Abdo cramps (peri-umbilical)
Diarrhoea
Weight loss

Colon//

Abdo cramps (lower abdo)
Diarrhoea (sometimes w/blood)
Weight loss

Mouth//

Painful ulcers
Swollen lips
Angular cheilitis

Anus//

Peri-anal pain
abscess
fistulae

42
Q

Crohn’s - on examination

Clinical
Bloods
Colonoscopy
Histology

A

Clinical//

Evidence of weight loss
RIF mass (inflamed bowel/abscess)
Peri-anal signs

Bloods//

CRP
Albumin
Platelets
B12
Ferritin

Colonoscopy//

Crohn’s has “fat wrapping” and cobblestoned appearance of mucosa

“Fat creeping”

Thickened wall

Histology//

Patchy
Granuloma (non caseating)
43
Q

Most common site of Crohn’s?

A

Ileocoecal region

44
Q

Small bowel assessment

A

Barium follow through
Small bowel MRI
Technetium-labelled white cell scan

45
Q

Typical Patient

22 years old
Male
Abdo pain
Bloody diarrhoea for 3/12 
Tender abdomen

Patchy, segmental disease with “skip” areas, anywhere in GI tract

A

Crohn’s disease

46
Q

What kind of granuloma is crohn’s associated with?

A

Non-caseating granuloma

47
Q

Typical endoscopic signs in Crohn’s

A

Fissuring (ulceration destroys the mucosa)

Stricturing of terminal ileum

Thickening of bowel wall

Cobblestoning

Pseuodpolyps

TRANSMURAL inflammation

Cryptitis

Crypt abscesses

48
Q

Complications of Crohn’s

A

Malabsorption

  • – short bowel syndrome
  • – Hypoproteinaemia
  • – vitamin deficiency
  • – anaemia
  • – gallstones

Fistulae

Anal disease

    • sinuses
    • fissures
    • skin tags
    • abscesses
    • skin tags
Intractable disease
Bowel obstruction
Perforation
Malignancy
Amyloidosis
Toxic megacolon
extra-GI conditions are rare
49
Q

What can repeated resections lead to?

A

Short bowel syndrome

50
Q

Pathogenesis of Crohn’s

A

Genetics

Environmental triggers/

  • smoking
  • infectious agents
  • vasculitis
  • sterile environment theory
  • NSAIDs

Abberant immune response

  • persistent activation of T cells and macrophages
  • excess pro-inflammatory cytokines
51
Q

Is Toxic megacolon more likely in Crohn’s or UC?

A

UC

52
Q

32 yo
Female
Bloody diarrhoea and mucous
Goes to toilet 25 times a day

diffuse, continuous disease involving rectum

A

Ulcerative colitis

53
Q

Histology - UC

A

Irregular-shaped branching crypts
— acute cryptitis

Crypt abscesses

Ulceration

  • – fibrinopurulent exudate
  • – broad base
54
Q

What are aphthous ulcers most commonly associated with

A

Coeliac disease and Crohn’s disease

55
Q

Ulcers in Crohn’s and UC

A

Crohn’s - fissure like ulcers

UC -horizontal, box like, undermining ulcers

56
Q

Lifestyle advice for IBD

A

Avoid smoking

Diet (can influence symptoms)

57
Q

Drug therapy for Crohn’s

A

Steroids
Immunosuppressants
Anti-TNF therapy

58
Q

Drug therapy for UC

A

5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy

59
Q

5ASA mechanism & side effects

A

Topical effect
Anti-inflammatory
Reduces risk of colon cancer

side effects: diarrhoea, idiosyncratic nephritis

can be taken as:

Prodrug
pH dependent release
Delayed release

Suppositories
Enema

60
Q

Corticosteroids in IBD

A

Anti-inflammatory
Prednisolone/Budenoside

Induce remission

Short course

61
Q

Immunosuppression IBD

A

When most potent suppression of inflammation required (if steroids are not working)

Azathioprine
Methotrexate
Mercatopurine

62
Q

Azathioprine

what drug should be avoided when prescribing this one?

A

Immunosuppressant

TPMT activity –> toxicity

Avoid ALLOPURINOL

Side effects//

pancreatitis
leukopoenia
hepatitis
lymphoma (small risk)

63
Q

Anti TNF-alpha therapy

A

Proinflammatory cytokine

Anti TNF promotes the apoptosis of activated/effector T lymphocytes

rapid mucosal healing in responders

64
Q

TNF antibodies

A

Infliximab

Adalimumab

65
Q

Infliximab

A

TNF antibody

66
Q

Adalimumab

A

TNF antibody

67
Q

When to use anti TNF

A

Part of long term strategy - including immune suppression; surgery (Crohn’s) supportive

Refractory/fistulising disease

Exclude current infection (like TB)

68
Q

What disease is 5ASA used for?

A

Ulcerative colitis

69
Q

Surgery in IBD

A

Emergency//

  • failure to respond to medical therapy
  • small bowel obstruction
  • abscess, fistula

Elective//

  • failure to respond to medical therapy
  • dysplasia of colonic mucosa
  • best scenario
    (patient prepped for outcome)
70
Q

Crohn’s - surgery

A

Minimise amount of bowel resected

NOT curative

Repeated resection can lead to small bowel syndrome and lifelong parenteral nutrition

71
Q

Surgery for UC

A

CURATIVE

Option of permanent ileostomy

Restorative proctocoloectomy and pouch

G.I. (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions