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Alimentary System > Lecture 25 Inflammatory Bowel Disease > Flashcards

Lecture 25 Inflammatory Bowel Disease Flashcards

1
Q

What is the definition of IBD

A

• Chronic, relapsing, remitting inflammation of gastrointestinal tract

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2
Q

What are the 2 main IBDs

A

Crohn’s and Ulcerative colitis

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3
Q

What group is microscopic colitis found in and how is it diagnosed

A

Middle aged woman

Histology

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4
Q

What type of inheritance is IBD

A

Multi-factorial
Not-medelian
• Genetic susceptibility – SNPs (single nucleotide polymorphisms)- 1bp switch in genetic sequence- which may affect the function of the gene

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5
Q

What does increase permeability in the epithelium barrier lead to

A

Dysbosis and chronic inflammation

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6
Q

Microbiota metabolic function

A

Production of vitamins
Digestion of dietary carcinogens
Fermentation of non-degradable substrates
Production of SCFAs- energy source

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7
Q

Microbiota structural function

A

sIgA production
Intestinal villi and crypts
Mucous Layer
TJs

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8
Q

Microbiota protective function

A

Colonisation resistance
Innate and adaptive immunity
Inflammatory cytokine oversite

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9
Q

Extra-intestinal manifestation of IBD

A
  • Erythema nodusom
  • Ulcers on leg- PG (Crohn’s disease)
  • Arthritis in large joints
  • Sacroiliitis
  • Associated liver disease- sclerosing cholangitis
  • Gall stones and renal stones
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10
Q

Symptoms of Ulcerative colitis

A

o Bloody diarrhoea
o Abdominal pain
o Weight loss
o Fatigue

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11
Q

Whats a distinctive feature of UC

A

only colon

• Begins rectum and works proximally

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12
Q

Investigations for UC

A
  • Bloods for markers of inflammation (normocytic anaemia, increased CRP/platelets, low albumin)
  • Stool culture to rule out infection
  • Faecal Calprotectin-non-invasive marker of inflammation in GI mucosa
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13
Q

Mild UC

A

Less than 4 stools a day +/-blood
Normal ESR
No signs of toxicity

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14
Q

Moderate UC

A

4-6 stools/day
Occasional blood
Minimal signs od toxicity
CRP<= 30mg/L

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15
Q

Severe UC

A 
More than 6 stills a day and:
Temp over 37.8
Tachycardia
Anaemia 
ESR>30mm/h
CRP>30mg/L
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16
Q

Filmiant UC

A 
10 stools a day, continuous bleeding
Toxicity
Abdominal tenderness or distention
Transfusion requirement
Colonic dilatation (Xray)
17
Q

What is proctitis

A

UC confined to the rectum

18
Q

What are the features of proctitis

A
  • Frequency, urgency, incontinence- constant stimulation of pressure receptors, tenesmus
  • Small volume mucus and blood
  • Proximal faecal stasis (constipation)
19
Q

What is the treatment for proctitis

A

topical therapy via depository

20
Q

Interventions for acute severe colitis

A
  • Stool chart
  • 3-4 serial stool cultures for C. difficile- conditions increases susceptibility to infection
  • IV glucocorticoids- dampen down inflammation
  • LMWH- 3X increased risk of thromboembolism (anticoagulants)
  • Avoid/Stop non-steroidal analgesics, opiates, anti-diarrhoeals, anti-cholinergic
  • IV hydration, careful correction of electrolytes low potassium or magnesium can precipitate toxic megacolon
  • AXR – toxic dilatation, extent of disease – mucosal odema, lead pipe, proximal faecal loading
21
Q

Toxic megacolon

A

Dilated colon filled with air >5.5cm

22
Q

Clinical features of Crohn’s disease

A 
•	Patchy disease  
–	mouth to anus 
–	skip lesions
–	clinical features 
depend on regions involved
23
Q

Clinical Features of CD

A 
•	Diarrhoea
•	Abdominal pain
•	Weight loss. 
•	Malaise, lethargy, anorexia, N&amp;V, low-grade fever
•	Malabsorption
–	Anaemia, vitamin deficiency
24
Q

Investigations for CD

A
  • Bloods for markers of inflammation
  • Stool culture to rule out infection if diarrhoea
  • Faecal Calprotectin (0-50ug/g stool=normal, 50-200=equivocal, >200 elevated) – may not be high if just small bowel disease
  • Colonoscopy with terminal ileum intubation and colon/TI mucosal biopsies
  • MRI small bowel study
  • Capsule endoscopy- tablet with camera within it
  • Occasionally CT scan if acutely unwell and want to rule out complication eg abscess
25
Q

Different in histology of UC and CD

A 
–	CD granulomas
–	Goblet cells depleted in UC
–	Crypt abscesses: UC > CD
–	Transmural inflammation in CD
–	Mucosal in UC
26
Q

Symptoms of perianal Crohn’s disease

A

Perianal pain
Pus secretion
Unable to sit down

27
Q

Investigation of Perianal Crohn’s disease

A

MRI pelvis

Examination under anaesthetic

28
Q

Treatment for perianal Crohn’s disease

A

Surgery to drain abscess

Medical – antibiotics and biologic therapy (anti-TNF)

29
Q

Describe the step up approach for the treatment for UC

A 
Aminosalicylates (5-ASA)
Steroids-Prednisone/Budesonide
Immunomodulators
Biologic agents
Surgery
30
Q

Main Aminosalicylates (5-ASA)

A

Mesalazine
• Work by blocking prostaglandins and leukotrienes
• Topical to colonic mucosa can be taken orally

31
Q

Can Aminosalicylates (5-ASA) work for Crohn’s

A

No

32
Q

What is Immunomodulation

A

– Thiopurines used for maintenance for UC and Crohn’s disease

33
Q

Significant side effects of Immunomodulation

A

– Leucopenia (supress bone marrow function) more susceptible to infection
– Hepatoxicity
• Requires Blood Monitoring
– Pancreatitis
– Possible long-term lymphoma risk and non-melanoma skin cancers

34
Q

Name biologics used

A 
Monoclonal Antibodies
•	Anti-TNF antibodies
–	Infliximab (Remicade)
•	8 weekly IV infusion
–	Adulimumab (Humira)
•	2 weekly SC injections
•	4b7 Integrin Blockers
–	Vedolizumab
•	8 Weekly IV Infusions
•	IL12/IL23 Blockers
–	Ustekinumab
•	IV loading followed by SC 8-12 weekly
35
Q

UC definition of failed medical therapy

A
  • Recurrent courses of steroid (>2 courses a year)
  • Relapse prior to or shortly after stopping therapy
  • Unacceptable side effects
  • Acute severe colitis not responding to 72 hours high dose IV steroids +/- anti-TNF biologic ‘rescue’ therapy
36
Q

Surgery for acute sever colitis

A 
•	Total colectomy 
o	Create a rectal stump 
o	Bring out end of small intestine in iliac fossa (end ileostomy)
•	Rectal preservation 
•	Ileostomy
37
Q

Surgical indicators for Crohn’s disease

A
  • Failure of medical management
  • Relief of obstructive symptoms (small bowel)- if there is development of a stricture
  • Management of fistulae - e.g. bowel to bladder
  • Management of intra-abdominal abscess
  • Management anal conditions
  • Failure to thrive

Alimentary System (39 decks)

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