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Gastrointestinal System > Lecture 6.1: Inflammatory Bowel Disease (IBD) > Flashcards

Lecture 6.1: Inflammatory Bowel Disease (IBD) Flashcards

1
Q

What are the 2 Types of Inflammatory Bowel Disease?

A

Ulcerative Colitis and Crohn’s

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2
Q

Causes of Bowel Inflammation: INVITED MD

A
  • Infection
  • Neoplasia
  • Vascular
  • Inflammatory
  • Trauma
  • Endocrine
  • Drugs
  • Metabolic
  • Degenerative
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3
Q

Types of Colitis (4)

A
  • IBD
  • Microscopic Colitis
  • Radiation Colitis
  • Infectious Colitis
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4
Q

Types of Microscopic Colitis (2)

A
  • Lymphocytic Colitis
  • Collagenous Colitis
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5
Q

Causes of Microscopic Colitis

A
  • Medication- e.g. PPIs/ NSAIDs, statins, SSRIs
  • Autoimmune disease- e.g Rheumatoid Arthritis, coeliac
    disease, psoriasis
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6
Q

When does Radiation Colitis develop?

A

Develops 6 months to 5 years post regional radiotherapy

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7
Q

What can cause Infectious Colitis?

A
  • Viral, parasitic or bacterial infection
  • E Coli and Salmonella are common causes
  • C Difficile – often antibiotic induced
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8
Q

Histological Features found in Crohn’s but not in UC (5)

A
  • Granulomas
  • Deep Fissuring Ulcers
  • Transmural Lymphoid Aggregates
  • Small Intestine Involvement
  • Crypt Abscesses
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9
Q

What is the Cardinal Symptom of UC?

A

Bloody diarrhoea

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10
Q

What part of the GI is involved in UC?

A

Affects mucosa of colon and rectum only

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11
Q

What part of the GI is involved in Crohn’s?

A
  • May involve any part of the GI tract from mouth to
    anus
  • Perianal disease – abscess, fistula
  • May be transmural
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12
Q

Extra-Intestinal Manifestations (EIMs) of IBD: CLUECLUE

A
  • Clubbing
  • Large joint arthritis
  • Ulcers (pyoderma gangrenosum)
  • Erythema nodosum
  • Cholangitis (primary sclerosing cholangitis)
  • Lower back arthritis
  • Ulcers (aphthous ulcers in mouth)
  • Eye signs e.g. acute uveitis
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13
Q

What IBD is more common?

A

UC is up to 2-fold more common than Crohn’s disease

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14
Q

What is seen at Colonoscopy for UC?

A

Continuous inflammation from the rectum

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15
Q

What is seen at Colonoscopy for Crohn’s? (2)

A

‘Cobble-Stoning’
‘Skip Lesions’

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16
Q

What is the name for inflammation of the lining of the rectum?

A

Procitis

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17
Q

What is the name for inflammation of the entire colon?

A

Pancolitis

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18
Q

What imaging is done to help diagnose IBD?

A
  • CT/MRI enterography can be used to visualise the
    small bowel
  • MRI Pelvis to assess known/ suspected peri-anal
    Crohn’s disease
  • AXR (historically)
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19
Q

CD vs UC: Mucosal Involvement

A

CD: Discontinuous
UC: Continuous

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20
Q

CD vs UC: Aphthous Ulcers

A

CD: Common
UC: Rare

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21
Q

CD vs UC: Surrounding Mucosa

A

CD: Relatively Normal
UC: Abnormal

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22
Q

CD vs UC: Longitudinal Ulcer

A

CD: Common
UC: Rare

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23
Q

CD vs UC: Cobble Stoning

A

CD: In severe cases
UC: No

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24
Q

CD vs UC: Mucosal Friability

A

CD: Uncommon
UC: Common

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25
Q

CD vs UC: Vascular Pattern

A

CD: Normal
UC: Disorted

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26
Q

CD vs UC: Transmural Inflammation

A

CD: Yes
UC: Uncommon

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27
Q

What factors are involved in the Pathophysiology of IBD?

A
  • Genetics
  • Environment
  • Diet
  • Smoking
  • Stress
  • Microbial Factors
  • Immune Factors
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28
Q

What are pANCA autoantibodies?

A

Antibodies that stain the material around the nucleus of a neutrophil

29
Q

In what IBD are pANCA autoantibodies seen?

A

UC

30
Q

Management of IBD (7)

A
  • Amino Salicylates
  • Corticosteroids
  • Antibiotics
  • Immunosuppressants
  • Biological Therapy
  • Surgery
  • Avoid NSAIDs
31
Q

Examples of Amino Salicylates (2)

A
  • Mesalazine
  • Sulfasalazine
32
Q

What IBD are Amino Salicylates used to treat?

A

To induce remission or to maintain remission of mild to moderate UC

33
Q

How do Amino Salicylates help manage IBD?

A

MOA is unclear butut believed to act by activating a class of nuclear receptors involved in the control of inflammation, cell proliferation, apoptosis and metabolic function

34
Q

When should Amino Salicylates be avoided?

A

If aspirin allergy

35
Q

Side-Effects of Amino Salicylates (3)

A
  • Renal Impairment
  • Diarrhoea
  • Hepatitis
36
Q

Examples of Corticosteroids (2)

A
  • Prednisolone
  • Budesonide
37
Q

What IBD are Corticosteroids used to treat?

A

To induce remission of active disease in both UC and CD

38
Q

How do Corticosteroids help manage IBD?

A

Potent anti-inflammatories through transcription modulation of genes involved in inflammation

39
Q

Side-Effects of Corticosteroids (6)

A
  • Significant so ideally not used long term
  • Weight Gain
  • Hypertension
  • Glucose Impairment
  • Osteoporosis
  • Adrenal Suppression
  • Mood Disturbance
40
Q

When are Antibiotics used to help manage IBD?

A

Treatment of septic complications and can reduce perianal fistula symptoms

41
Q

Which antibiotics are shown to have effect in colonic CD? (2)

A

Metronidazole +/- Ciprofloxacin

42
Q

Examples of Immunosuppressants or DMARDs (3)

A

Thiopurines:
* Azathioprine
* Mercaptopurine
* Methotrexate

43
Q

What IBD are Immunosuppressants or DMARDs used to treat?

A

To treat refractory or chronic active IBD both UC and CD

44
Q

How do Immunosuppressants or DMARDs help manage IBD?

A
  • Not really understood but reduce inflammation
  • Used as steroid-sparing agents to maintain remission
45
Q

Side-Effects of Immunosuppressants or DMARDs (2)

A
  • Hepatoxic
  • Bone Marrow Toxicity
46
Q

What are the Types of Biological Therapies to help manage IBD? (4)

A
  • Anti-TNF Therapy
  • Ustekinumab
  • Vedolizumab
  • JAK Inhibitors
47
Q

What IBD is Anti-TNF Therapy used to treat?

A

To induce remission in moderate to severe UC and
maintenance of remission for UC and CD

48
Q

Examples of Anti-TNF Therapy Drugs? (2)

A
  • Infliximab
  • Adalimumab
49
Q

What is the MOA of Anti-TNF Therapy Drugs?

A
  • TNF-α is a chemical messenger (cytokine) and a key
    player in the inflammatory process involved in IBD
  • Infliximab and Adalimumab are monoclonal antibodies
    targeting TNF-α
  • They block the interaction of TNF α with its receptors
  • They bind to TNF-α and preventing it from binding to
    receptors involved in the inflammatory process
50
Q

Side-Effects of Anti-TNF Therapy Drugs (2)

A
  • Opportunistic infections
  • Anaphylaxis
51
Q

What IBD is Ustekinumab used to treat?

A

Maintenance of remission in UC and CD

52
Q

What is the MOA of Ustekinumab?

A

Blocks interleukin IL-12 and IL-23 which activate certain
T-cells

53
Q

Side-Effects of Ustekinumab (6)

A
  • Dizziness
  • Sore Throat
  • Arthralgia
  • Headaches
  • Nausea
  • Soreness around injection site
54
Q

What IBD is Vedolizumab used to treat?

A

Maintenance of remission in CD and UC

55
Q

What is the MOA of Vedolizumab?

A
  • Binds to ɑ4β7 integrin, a mediator of GI.
    inflammation
  • Decreasing inflammation in the GI tract by blocking
    the entry of inflammation- stimulating lymphocytes
56
Q

Side-Effects of Vedolizumab (6)

A
  • Nasopharyngitis
  • Upper Respiratory Tract Infections
  • Arthralgia
  • Headache
  • Fatigue
  • Pyrexia
57
Q

What IBD are JAK Inhibitors used to treat?

A

To induce remission in moderate to severe UC and
maintain remission in UC

58
Q

Examples of JAK Inhibitors (2)

A
  • Tofacitinib
  • Upadacitinib
59
Q

What is the MOA of JAK Inhibitors?

A
  • Limit the action of Janus kinase enzymes
  • Block cytokines from attaching to receptors in the JAK-
    STAT pathway
  • This reduces the amount of inflammation the immune
    system produces
60
Q

Side-Effects of JAK Inhibitors (6)

A
  • Nausea
  • Indigestion
  • Diarrhoea
  • Headaches
  • Upper Respiratory Tract Infection
  • Increased Cholesterol Levels
61
Q

What should be avoided when taking JAK Inhibitors?

A

Avoid grapefruit juice as it may enhance the therapeutic
effect and increase risk of side effects

62
Q

What Surgeries can be done to manage CD? (4)

A
  • Colectomy
  • Segmental resection
  • Stricturoplasty
  • Perianal abscess or fistulae
63
Q

What Surgeries can be done to manage UC? (2)

A
  • Colectomy
  • Proctocolectomy
64
Q

What percentage of UC patients will need surgery in their lives?

A

20%

65
Q

What percentage of CD patients will need surgery in their lives?

A

80%

66
Q

Complications of IBD (5)

A
  • Primary Sclerosing Cholangitis (PSC)
  • Colorectal Cancer
  • Strictures in CD
  • Fistulae in CD
  • Toxic Megacolon
67
Q

What gene is strongly associated with a big family of rheumatic diseases called spondyloarthropathies?

A

HLA-B27

68
Q

What diseases are associated with HLA-B27? (6)

A
  • Inflammatory Bowel Disease (IBD)
  • Eye Inflammation Uveitis
  • Ankylosing Spondylitis (AS)
  • Axial Spondyloarthritis
  • Axial Psoriatic Arthritis
  • Reactive Arthritis

Gastrointestinal System (22 decks)

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