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Y2 NnD > Inflammatory disorders > Flashcards

Inflammatory disorders Flashcards

1
Q

How can ischaemia cause mucosal injury in the gut

A
  • Systemic hypotension- affects intestinal mucosa
  • Atherosclerotic disease
  • Volvulus- colon twists on part of mesolcolon, obstructs veins
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2
Q

What drugs can cause mucosal injury of gut

A

NSAIDs,(Ibuprofen and diclofenac can cause ulceration, peptic ulcers) antibiotics, steroids
Chemotherapy e.g. 5-fluorouracil ⇒ Affects stem cells at bottom of pits

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3
Q

What classificiation system is used for gastritis and how is it classified

A

The Sydney System uses a combination of endoscopic features, histology and aetiology to classify gastritis

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4
Q

Main types of gastritis and their causes

A

Acute erosive / haemorrhagic gastritis ⇒ Ingestion of irritant chemicals causes damage to the surface of mucosa
Acute H. pylori infection usually no or minor symptoms, so seldom seen in biopsies

Chronic:
non atrophic like Hp
atrophic like autoimmune or chronic hp also
Special forms

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5
Q

What are the obvious hallmarks of non-atrophic gastritis ( chronic and active)

A

chronic -Lymphocytes and plasma cells in lamina propria
Active- neutrophils infiltrating epithelium of gastric pits

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6
Q

What is atrophic gastritis characterised by and what are the causes

A

characterised by loss of parietal (acid secreting) and peptic (pepsin secreting) cells in gastric body ( usually occurs in mucosa)
- Autoimmune gastritis ⇒ Need serology for anti parietal cell antibodies which affect fundus.
- Chronic H. pylori infection

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7
Q

Causes of Non-infectious granulomatous gastritis

A

e.g. Crohn’s disease, sarcoidosis

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8
Q

What is coeliac disease histology characterized by

A
  • Chronic mucosal inflammation
  • Variable Villous atrophy ⇒ flat surface
  • Crypt hyperplasia ( as compensation) ⇒ longer crypts

May also have Increased CD8+ T- Lymphocytes in epithelium ⇒ Epithelial damage ⇒ Leads to malabsorption
Increase in lamina propria lymphocytes and plasma cells as well

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9
Q

Waht is coeliac disease diagnosed by

A
  1. Histology ( biopsy changes)
  2. Serology
  3. Response to gluten - free diet
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10
Q

How is coeliacs often picked up

A

routine haematology (iron deficiency anaemia) => presents as tiredness

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11
Q

What genes predispose for coeliac’s

A

HLA DQ2, DQ8

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12
Q

Pathophysiology of coeliacs

A
  • Exposure to gluten (gliaden) in wheat, barley, rye or other glutamine- rich proteins (hordeins and secalins) results in:
    • Gliaden-reactive T lymphocytes
    • Tissue transglutaminase antibodies
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13
Q

What may be the presenting complain in some coeliac patients

A

Dermatitis herpetiformis ⇒ Blistering skin condition, CAN be presenting complain in some coeliac patients!!

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14
Q

Common presentations of coeliac

A
  • Diarrhoea
  • Abd pain, bloating, general sense of unease in stomach
  • Anaemia ⇒ From iron or folate deficiency
  • Dyspepsia
  • Weight loss
  • Recirring mouth ulcers may be common
  • Fatigue
  • Neuropsychiatric symptoms
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15
Q

Classical presentation of coeliacs

A
  • Childhood
  • FTT / Weight loss
  • Short stature
  • Malnutrition
  • Steatorrhoea
  • Delayed puberty
  • Osteomalacia
  • Myopathy
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16
Q

Investigations of coeliacs
what deficiencies are more common

A
  • Anaemia (microcytic, macrocytic)
  • Iron, folate deficiency
  • Macrocytosis without anaemia
  • Hyposplenic blood film due to splenic atrophy
  • Low calcium, elevated Alk Phos due to met. bone disease
  • Raised transaminases ⇒ liver enzymes, reasons not clear
  • Hypoalbuminaemia
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17
Q

Testing for coeliacs

A
  • Serological markers
    • Anti-tissue transglutaminase antibody (IgA) (TTG) Sensitivity and specificity >95% ⇒ Usually can be used simply for diagnosis now in paeds w/o biopsy
      • Anti-endomysial antibody (IgA)
      • Anti-gliadin antibody (IgA, IgG)
  • Small intestinal biopsy ⇒ Definitive test- show pathological features
    • Scalloping, Loss of Kerking’s folds, mosaic pattern
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18
Q

What infection is common after broad spectrum antibiotics

A

C diff

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19
Q

What infection is more common in immune suppressed individuals, and what is the common histology

A

CMV -treatment of ulcerative in crohns
- Intranuclear and cytoplasmic inclusions are typical ⇒ accumulation of viral proteins in cytoplasm and nucleus

Intranuclear and cytoplasmic inclusions are typical ⇒ accumulation of viral proteins in cytoplasm and nucleus

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20
Q

In which part of the intestine is giardia infection more common

A

duodenum

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21
Q

where does ischaemic colitis often occur in

A

Mimics Crohn’s, most common in region of splenic flexure and descending colon

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22
Q

What is divericular disease and which group is it most common in . What is a complication

A
  • In elderly, has chronic complications ⇒ stricture and fistulas
    • Most common in sigmoid colon

Ulceration may eventually result in fistula

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23
Q

What drug is more likely to cause colitis and where does it affect most often

A

NSAIDs, TI

24
Q

How does distribution of UC and CD differ

A

UC - inflammation is confined to mucosa, diffuse in distribution, while Crohn’s has skip lesions and is transmural

25
Q

Typical microscopic features of UC and CD

A

UC has cryptitis, crypt abscesses, mucin depletion
vs patchy inflammation and transmural lymphoid aggregrates

26
Q

How do ulceration patterns vary in UC and CD

A

UC has broad-based ulceration which may undermine mucosa while CD has apthous ulcers and deep fissuring ulcers leading to fistula formation

27
Q

Are granulomas more common in UC or CD

A

Common in CD, may be transmural and in lymph nodes

28
Q

Are polyps more common in UC or CD

A

More common in UC, fewer in numbers in CD but often larger

29
Q

What is the greatest risk factor for IBD, does this vary in CD and UC

A

Having family member with IBD, but greater concordance in MZ twin studies for CD than UC
NOD2 gene in Crohn’s

30
Q

How does smoking affect IBD risk

A

Aggravates CD but decreases UC risk

31
Q

Main investigation for IBD

A

Biopsies- can distinguish between Crohn’s and UC, exclude other aetiologies. Should biopsy colon and TI

32
Q

What is cryptiitis and crypt absecces

A

Refers to neutrophil infiltration, basically shows active disease
Hallmark of active disease in UC

33
Q

What is the main presentation of ulcerative colitis

A

Rectal bleeding

34
Q

Which part of colon is commonly involved in UC

A

Left colon

35
Q

What is a pseudopolyps and what does it show. UC or CD

A

UC. Due to mucosa around it being destroyed and inflamed/ulcerated.
Very broad based ulceration, flat. NO inflammation going into muscularis propria . Ulceration mainly of mucosa

36
Q

What is the main sign of chronic UC

A

Irregular, shortened crypts which won’t reach muscularis mucosae and increased inflammatory

37
Q

What is a skip lesion in UC

A

Caecum and appendix may be involved- caecal patch lesion

38
Q

Most common involvement of crohn’s

A

Anus

39
Q

Are granulomas more common in right or left colon

A

left colon

40
Q

What causes strictures in CD

A

Due to transmural thickening

41
Q

is neoplasia risk higher in UC or CD

A

UC

42
Q

Most common carcinoma from UC

A

colorectal

43
Q

What does microscopic colitis usually present as and who in

A

Chronic watery diarrhoea and in middle aged, esp women

44
Q

Appearance in endoscopy and histology of microscopic colitis

A

Normal appearance of mucosa at endoscopy but increase in chronic inflammatory cells identified in histology

45
Q

Causes of mucroscopic colitis

A

Drugs like lansoprazole and NSAIDs
Steroids like budesonide

46
Q

Two patterns of microscopic colitis

A

Collagenous colitis and lymphocytic colitis

47
Q

What is lymphocytic colitis closely associated with

A

coeliacs

48
Q

Causes of strictures

A
  • Crohn’s disease
  • Ischaemic colitis
  • Diverticular disease
  • Diaphragm disease ⇒ complication of NSAIDs, forms thin membrane- like structure
  • Neoplasia
49
Q

granulomas are mediated by which cells?

A

T cells

50
Q

what macrophages are present in granulomas and what are they intermixed with

A

Histocytes with lymphoid follicles

51
Q

clinicl\al manifestations of UC and CD

A

Rectal bleeding more common in UC, both likely to have diarrhoea ( more severe in UC). pain in both but more in CD, may have rashes and joint pain in both, weight loss in both (more in CD)

52
Q

Is there stenosi/ dilatation of bowel in UC or CD

A

CD mainly

53
Q

is malabsorption common in CD or UC

A

CD

54
Q

Is neoplasia risk higher in UC or CD

A

UC

55
Q

Which part of the GI tract is CD the most common

A

anus/ perianal region

56
Q

Are these symptoms more common in UC or CD?

  • MSK
  • Hepatobillary
A
  • CD
  • UC

Y2 NnD (10 decks)

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