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The Alimentary Canal > Inflammatory Bowel Diseases > Flashcards

Inflammatory Bowel Diseases Flashcards

1
Q

What is inflammatory bowel disease?

A

Chronic, relapsing, remitting inflammation of GIT
Chron’s disease and ulcerative colitis
Present mainly in teens and tweens

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2
Q

Where is Chron’s disease located?

A

Can be anywhere from mouth to anus
Is patchy

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3
Q

Where is Ulcerative Colitis located?

A

Starts at rectum then moves proximally
Only in colon

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4
Q

What are microscopic colitis?

A

Collagenous colitis - thickness of sub-epithelial collagen band increases
Lymphocytic colitis - increased lymphocytes

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5
Q

What is IBD-U?

A

IBD-unclassified
Mix of UC and CD

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6
Q

What causes for IBD?

A

Genomes, microbiota, medication, environment, smoking, diet and history of gastroenteritis

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7
Q

Explain genes and IBD

A

Is not Mendelian inherited
Genetic susceptibility - SNPs
Family trend
Offspring have 10% chance of developing
Genes effect epithelial barrier, immune responses and bacterial handling

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8
Q

How does host genetic and environmental factors affect the gut?

A

Altered microbiota - dysbiosis
Damages epithelial barrier and increased bacterial adherence
Chronic inflammation

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9
Q

What are the symptoms of ulcerative colitis?

A

Bloody diarrhoea, abdominal pain, weight loss and fatigue

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10
Q

Who does UC mainly affect?

A

Peak incidence at 20-40 years
More males over females

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11
Q

Explain Ulcerative Colitis

A

Continuous inflammation - only colon
Begins rectum and works proximally
Variable severity and distribution

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12
Q

What is proctitis?

A

Confined to rectum only
There is increased frequency, urgency, incontinence and tenesmus
Small volume mucus and blood
Constipation

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13
Q

What does proctitis respond to?

A

Topical therapy

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14
Q

What is acute severe colitis?

A

Life threatening medical emergency = appreciable mortality
Risk of colectomy
Patients often look well
Infection is main differential

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15
Q

How is ulcerative colitis scored?

A

Truelove and Witt’s criteria
Scores to put into categories - mild, moderate, severe and fulminant (continuous bleeding, toxicity..)

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16
Q

What investigations are used for ulcerative colitis?

A

Bloods for markers of inflammation - microcytic anaemia
Increased CRP/WCC/platelets
Decreased albumin
Stool culture, faecal calprotectin and colonoscopy

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17
Q

Explain faecal calprotectin

A

If activation of immune system then calprotectin released from epithelial cells, monocytes and neutrophils
High conc. does not equal IBD but shows inflammation

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18
Q

What is the name of the stool chart used?

A

Bristol stool chart

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19
Q

What should be done in the first 24hrs of acute severe colitis?

A

Blood tests, stool charts, 4 stool cultures, avoid/stop some drugs, IV hydration and glucocorticoids, LMWH, AXR

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20
Q

What drugs should be avoided or stopped for acute severe colitis?

A

Non steroidal analgesics
Opiates
Anti-diarrhoeas
Anti-cholinergic

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21
Q

What can be some features of UC on AXR?

A

Colon more than 5.5
Toxic megacolon
Mucosal thickening
Gaseous small bowel loops
Lead pipe appearance

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22
Q

What are the symptoms of Chron’s Disease?

A

Diarrhoea, abdominal pain, weight loss, malaise, lethargy, anorexia, malabsorption

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23
Q

What investigations are used for Chron’s Disease?

A

Bloods, stool culture, faecal calprotectin, colonoscopy, MRI small bowel study, capsule endoscopy and occasionally CT

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24
Q

How is Chron’s Disease different to ulcerative colitis?

A

Different histology
CD granulomas, transmural inflammation in CD
Goblet cells depleted in UC and more crypt abscesses

25
Q

What are the complications of Chron’s Disease?

A

Inflammation, Stricture, Fistula, Abscess
Due to transmural inflammation and can cause connection to other organ

26
Q

What are the symptoms for peri-anal Chron’s Disease?

A

Perianal pain, pus secretion and unable to sit down

27
Q

What investigations are used for perianal Chron’s disease?

A

MRI pelvis
Examination under anaesthetic (EUA)

28
Q

What is the treatment for perianal Chron’s disease?

A

Surgery to drain abscess and place seton stitch
Medical - antibiotics and biologic therapy (anti-TNF)

29
Q

What are some extra-intestinal manifestations of IBD?

A

Mouth ulcers, skin rashes/lesions (erythema nodosum), musculoskeletal, eye, primary sclerosing cholangitis

30
Q

What are some differential diagnoses of IBD?

A

Other causes of chronic diarrhoea - malabsorption, IBS and overflow diarrhoea
Ileo-caecal TB and colitis type

31
Q

What is the long term complications of colitis?

A

Colonic carcinoma

32
Q

What are the risk factors for developing colonic carcinoma from colitis?

A

Pancolitis 26x, left colitis 8x and proctitis minimal
Over 10years is minimal risk then 20 and 30 years gets to 30x normal

33
Q

Describe colitis surveillance

A

If have colitis then need observation
Screening at 10 years then after can be low risk, intermediate and higher risk
Low - 5years
Intermediate - 3 years
High - 1year

34
Q

Who is involved in IBD management?

A

OP clinics, IBD nurses, pharmacist, nurse led infusion clinic, colorectal surgeon, GP, MDT meetings

35
Q

What are the aims of treatment for IBD?

A

Maintenance
Steroids needed at flares
Can have periods of remission

36
Q

What approach is used for IBD?

A

Step up vs top down approach
5ASA then prednisolone/ budesonide then immunomodulators then biologic agents then surgery

37
Q

Explain amino-salicylates

A

Work by blocking prostaglandins and leukotrienes
Topical to colonic mucosa
Release mechanisms lead to colonic delivery ex pH responsive

38
Q

What are the two types of 5-ASAs

A

Mesalazine - pentasa
Prodrugs - balsalazide, olzalazine

39
Q

What is 5-ASAs used for?

A

Induction of remission - 1st line treatment
Used in UC not in CD
Can be given orally or rectal

40
Q

Describe 5ASAs and mild moderate UC

A

Maintenance of remission
Reduced number and severity of relapses
Reduced colorectal risk

41
Q

What are steroids used for?

A

Induce remission UC and CD
Not for long term use as have adverse side effects

42
Q

What steroids are used for treatment?

A

Prednisolone - calcium/ vit D supplementation
Budesonide - slightly less effective but has better side effect profile

43
Q

When are Thiopurines -immunomodulation used for treatment?

A

Used for maintenance in UC and CD
Azathioprine
Has significant side effects

44
Q

What are some side effects of Azathioprine?

A

Leukopenia
Hepatoxicity
Pancreatitis
Possible lymphoma risk and non melanoma skin cancers
Check TPMT to access

45
Q

When is Methotrexate - immunomodulation used for treatment?

A

Unlicensed use
For Chron’s only - induction and maintenance of remission
Require specialist follow up

46
Q

What are some biologics - monoclonal antibodies used for treatment?

A

Anti-TNF alpha antibodies
Alpha 4b7 integrin blockers
IL12/IL23 blockers

47
Q

What are some Anti-TNF alpha antibodies?

A

Infliximab - 8 weekly IV infusion
Adalimumab - 2 weekly SC injection

48
Q

What is a alpha 4b7 integrin blocker used?

A

Vedolizumab - 8 weekly IV infusion

49
Q

What is a IL12/IL23 blocker used?

A

Ustekinumab - IV loading then SC 8-12 weekly

50
Q

What is a newer treatment?

A

Tofacitinib
Small molecule
Pan JAK inhibitor and oral

51
Q

Describe elemental feeding

A

Liquid food and no other oral diet
More efficacious in children
Compliance difficult but can be as effective as steroids

52
Q

When is it an emergency to operate?

A

Acute severe colitis not responding to high dose IV steroids and maybe anti-TNF biologics
Complications like perforation, obstruction and abscess

53
Q

What are some elective reasons to operate?

A

Frequent relapses despite medical therapy
Not able to tolerate medical therapy
Steroid dependant
Patient choice

54
Q

What is the surgery for acute severe colitis?

A

Subtotal colectomy
Rectal preservation
Ileostomy

55
Q

What is left after subtotal colectomy?

A

End ileostomy and rectal stump

56
Q

Describe pouch surgery

A

Mobilise and lengthen small bowel
Construct pouch then staple
Recommended in UC

57
Q

What are surgical indication for surgery in Chron’s disease?

A

Failure of medical management
Relief of obstructive symptoms
Management of fistulae, intra-abdominal abscess and anal conditions
Failure to thrive

58
Q

Is surgery in Chron’s disease curative?

A

No - half need further surgery in 10 years

The Alimentary Canal (33 decks)

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