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GI Medicine > Inflammatory Bowel Diseases > Flashcards

Inflammatory Bowel Diseases Flashcards

1
Q

What patients are more likely to have inflammatory bowel diseases

A

20-25 and 50-80 year olds
Crohn’s - male > female
Ulcerative colitis - female > male
White > black

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2
Q

What are common causes of inflammatory bowel diseases

A

Food intolerance
Persisting viral infection/immune activation
Smoking
Genetic

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3
Q

Where does Crohn’s disease affect

A

Can affect any part of the GI tract

Popular site is the ileocaecal region

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4
Q

What area does ulcerative colitis affect

A

Starts at the distal part of the bowel and can move continuously forward through the large intestine
Will always be present in the rectum then extend upwards

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5
Q

Describe the features of ulcerative colitis

A 
Disease continuous
Rectum always involved
Anal fissures in 25% of cases
Ileum involved in 10% of cases
Mucosa granulus with ulcers
Vascular
Serosa not affected
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6
Q

Describe the features of Crohn’s disease

A 
Discontinuous
Rectum involved in 50% of cases
Anal fissures in 75% of cases
Ileum involved in 30% of cases
Mucosa has cobbled appearance with fissures
Non-vascular
Serosa inflammed
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7
Q

Describe the microscopic features of ulcerative colitis

A

Vascular appearance
Inflammatory change in mucosa
Mucosal abscesses present

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8
Q

Describe the microscopic features of Crohn’s disease

A

Transmural
Oedema due to blockage of lymphatics caused by granulomas - giant cells - which are occupying the lymphatic draining channels

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9
Q

How does Crohn’s disease present endoscopically

A

Cobblestone surface

Areas of tissue oedema separated by fibrous bands which are effectively producing a quilted effect

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10
Q

How does Crohn’s disease present on the skin

A

Perianal tissue where there is mucosal tagging, growth of the mucosa and inflammatory changes
Same things around the mouth

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11
Q

How does ulcerative colitis present endoscopically

A

Erythematous inflammatory area present in multiple parts of the bowel, continuous from the rectum

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12
Q

What are the symptoms of ulcerative colitis

A

Diarrhoea
Abdominal pain
PR bleeding

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13
Q

What are the symptoms of Crohn’s disease

A

Same as UC if in the large intestine
Small bowel - pain, malabsorption, obstruction, anal disease
Mouth - orofacial granulomatosis

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14
Q

What investigations are carried out in inflammatory bowel diseases

A

Blood tests - anaemia, CRP, ESR
Faecal Calprotectin
Endoscopy

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15
Q

Why are anaemia tests useful for inflammatory bowel conditions

A

Will tell whether there is much blood loss or bleeding over time

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16
Q

Give examples of inflammatory markers and explain why they are useful for inflammatory bowel diseases

A

C reactive protein and erythrocyte sedimentation rate

Helpful for looking at whether there is a general inflammatory process underway in the body

17
Q

What is faecal calprotectin

A

A test which can be carried out on the stool looking for an inflammatory protein calprotectin
If there is inflammation within the bowel, calprotectin secretion from epithelial cells into the bowel will increase

18
Q

Why is faecal calprotectin used

A

To monitor activity in inflammatory bowel disease as it will often rise before the patient develops symptoms and treatment can be tailored to the patients needs

19
Q

What is the disadvantage of using an endoscope for inflammatory bowel diseases

A

Sometime difficult to get the scope through the bowel

20
Q

What can be carried out instead of an endoscopy

A

Leukocyte scan - leukocytes sent to inflammatory area and then monitored by a detector
Barium meal
Bullet endoscopy - camera will photograph the bowel as it passes through

21
Q

What are the complications with inflammatory bowel diseases

A

Over years of inflammatory change, can develop a carcinoma

22
Q

How is the carcinoma risk of ulcerative colitis dealt with

A

Take surveillance of the bowel and if the patients symptoms are controlled it saves them an operation and a colostomy

23
Q

What different medical treatments are available for inflammatory bowel disease

A

Systemic steroids - prednisolone
Local steroids - rectal administered
Anti inflammatory drugs - 5ASA based drugs
Non steroid immunosuppressants
Anti TNFa therapy - infliximab, adalimumab

24
Q

Give examples of 5ASA drugs

A

Pentasa
Mesalazine
Sulphasalazine

25
Q

What are the surgical treatment options for inflammatory bowel disease

A

Colectomy - cures ulcerative colitis
Crohn’s - remove obstructed bowel segments, drain abscesses, close fistulae
Usually result in a stoma bag

26
Q

Define orofacial granulomatosis

A

No evidence of GI disease other than the mouth

27
Q

What is oral Crohn’s

A

An extension from Crohn’s from a part of the body to the mouth

28
Q

Describe orofacial granulomatosis

A

Oedema of the mouth and changes a such as cobblestoning or fissures in the oral mucosa
May have inflammation through to the surface of the skin form the mouth

GI Medicine (7 decks)

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