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MD1 GI - EXAM 1 > Maladies inflammatoires intestinales > Flashcards

Maladies inflammatoires intestinales Flashcards

1
Q

What are the two main intestinal inflammatory diseases? (IBD)

A
  1. Ulcerative colitis
  2. Crohn’s disease
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2
Q

What is the most common form of intestinal disease?

A

MII —> 50-250 cases/100 000

Men = women

More prevalent in occidental countries of the Northern Hemisphere

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3
Q

What are the two “pics d’incidence” for MIIs?

A

15-30 and 50-80

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4
Q

Are MIIs genetic?

A

10-25% of the cases are linked to familial history

Twins: heterozygotes —> 6% chance, homozygotes —> 58%

Parent with MII = child 3-20x more likely to have it and if both parents —> 20-30%

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5
Q

Are there any genes associated with MIIs?

A

NOD2 —> predisposition to ileal crohn’s disease

20% of chron’s patients have this mutation

leads to a “defaut de sensing” des bactéries intraluminales

MIIs are polygenic illnesses… > 100 genetic anomalies associated to Chrons and > 40 to UC

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6
Q

What are the auto-immune factors associated with MIIs?

A

Associated to other auto-immune diseases such as Ankylosing Spondylitis, arthritis, and uveitis

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7
Q

Are there any environmental factors associated to MIIs?

A

They’re more common in northern counties

No relation to diet or toxic exposure BUT

Tabacco:

  • decreases risk of UC
  • doubles risk of Crohns and is associated with worse evolution
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8
Q

Are there any infectious factors associated to MIIs?

A

Nothing shown yet.. but one of the theories is a disequilibrium of the intestinal microbiota

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9
Q

What is “la théorie uniciste”?

A

A way to combine different risk factors to see their influence on development and progression of the disease

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10
Q

What would happen if a genetically predisposed pt was exposed to environmental/infectious risk factors?

A

Leads to an inflammatory cascade with lymphocytes and neutrophils —> production of cytokines, IL, TNF —> can set of MII

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11
Q

What is ulcerative colitis?

A

Inflammation de la muqueuse colique —> starts at rectum and the spreads to the rest of the colon

DOES NOT impact the small intestine

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12
Q

Clinical manifestations of UC:

A

Bloody diarrhea sometimes with mucus, nocturnal diarrhea, incontinence

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13
Q

Anorectal sx of UC: (4)

A

Ténesme: cramping rectal pain

Rectorragies: bleeding in the rectum

Urgences fécales

Spasmes

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14
Q

What is the initial presentation of UC? (3 kinds)

A

1/3 —> proctitis

  • Rectum only
  • Sx: fausses envies d’aller à la selle, mucus

1/3 —> colite gauche

  • Rectum —> left colon

1/3 —> colite étendue ou pancolite

  • Passes angle splénique (étendue) or all the way to the caecum (pancolite)
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15
Q

What are some complications of UC? (4)

A
  1. Hémorragie colique (rare)
  2. Colite fulminante
  3. Mégacolon toxique
  4. Cancer
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16
Q

What is colite fulminante?

A

Severe symptoms/atteinte de l’état général:

  • fever, tachycardia, anemia, leucocytosis, hypotension, dehydration, electrolytic imbalance

Requires hospitalization

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17
Q

What is mégacolon toxique?

A

EMERGENCY

Distension of colon with severe colitis and systematic sx

  • extension of severe inflammation: muqueuse —> sous-muqueuse —> musculeuse —> loss of contractility
  • Dilatation colique radiologique

Increased risk of peritonitis and intestinal perforation (50% mortality rate)

  • Can be an indication that surgery is necessary —> total colectomy (removing the entire colon)
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18
Q

How is cancer associated with UC?

A

Increased risk if colite étendue vs if colite gauche, the longer you have the illness (accrus après 10 ans), if associated with other diseases, stronger the inflammatory rxn

Colonoscopy with biopsies every 2-3 years in higher risk pts

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19
Q

Evolution of UC:

A

L’étendue de la colite peut progresser avec le temps —> 20 à 50 % des gens avec une proctite au diagnostic vont avoir une progression de l’atteinte

Illness is characterized by poussées-rémissions (Rx helps prolong remission periods)

Good px —> life expectancy not altered

20
Q

What is Crohn’s Disease?

A

Granulomatous transmural inflammation in the GI tract —> mouth to anus

Inflammation usually discontinuous

21
Q

Where is Crohns usually localized?

A

ileocecal (50%)

Terminal ileon (30%)

Colon (30%)

Anorectal (2-30%)

Stomach/esophagus (5%)

22
Q

Difference between what Crohns and UC look like:

A
23
Q

Normal vs. UC vs. Chrons –> Colon:

A
24
Q

DDx of Crohns:

A

terminal ileitis usually due to Crohns but can also be due to:

Yersinia infection (bacteria in uncooked pork), TB, lymphoma, radiation enteritis (post radiation therapy)

25
Q

What is the typical clinical presentation of Crohns?

A

Abdominal pain

Diarrhea

Other sx depending on localization

26
Q

Clinical presentation Crohns: abdominal pain

A

Chronic pain: atteinte iléale obstructive/inflammation transpariétale

Acute/severe pain: complications such as occlusion, perforations, and abcesses

27
Q

Clinical presentation Crohns: diarrhea

A

Reduction in absorption capacity, bacterial proliferation, choleretic diarrhea (bile acid diarrhea)

28
Q

Clinical presentation Crohns: sx from small intestine

A

Cramps after eating, N/V, subocclusion, intussusception, abdominal masses, malabsorption —> diarrhea, mineral/vitamin defecit, weight loss

29
Q

Clinical presentation Crohns: sx from colon

A

Diarrhea w/ urgency, rectal bleeding (less frequent compared to UC also less often in left colon compared to UC)

30
Q

Clinical presentation Crohns: sx périanal

A

Abcesses, fistules, fissures

31
Q

What are some complications of Crohns?

A

GI tract bleeding, obstruction due to stenosis (inflammatoire —> acute, fibreuse —> chronic), perforation, formation of abcesses, fistules, ulcères aphteux (mouth), dysphagia or odynopagia, risk of colic neoplasia

32
Q

What are the 4 main kinds of fistules?

A

Communication with nearby organ

  • Entéro-entériques ou entérocoliques
  • Entéro ou colo-vésicales : pneumaturie ou infection urinaire
  • Entéro ou colo-vaginales : air ou selles au niveau du vagin, vaginite secondaire
  • Entérocutanées
33
Q

Evolution of Crohns:

A

Variable and unpredictable

  • 2/3 of patients have favourable evolution with prolonged periods of remissions that are easily treatable
  • 1/3 have an agressive evolution
  • Surgery necessary in 50% but does not cure the illness unlike total colectomy in UC
  • Good px —> life expectancy not altered
34
Q

What are some extra-intestinal manifestations of MIIs?

A

20-40% of pts

Musculoskeletal, cutaneous, occular, hepatic…

Dépendantes de l’activité de la maladie

  • Arthrite périphérique
  • Érythème noueux
  • Uvéite

Indépendant de la maladie

  • Cholangite sclérosante
  • Spondylarthrite
35
Q

Musculoskeletal sx of MIIs:

A

Peripheral arthritis, central arthritis (sacro-iléite/spondylarthrite)

36
Q

Cutaneous sx of MIIs:

A

Érythème noueux: inflammation du tissus graisseux sous cutané

Pyoderma gangrenosum: painful pustules or nodules become ulcers that progressively grow (not infectious)

37
Q

Occular sx of MIIs:

A

Uveitis (inflammation of the uvea) and episcleritis (inflammation of the tissue lying between the sclera and the conjunctiva)

38
Q

Hepatic sx of MIIs:

A

Primary sclerosing cholangitis (long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder)

Hépatitie auto-immune

Lithiase vésiculaire (Crohns only)

39
Q

Other sx of MIIs:

A

Cholangite sclérosante, spondylarthrite

40
Q

How are MIIs diagnosed? (3 ways)

A
  1. Examens de laboratoire
  2. Examens radiologiques
  3. Examens endoscopiques

20% of cases —> colite indéterminée… as it evolves we might be able to dx

41
Q

Laboratory testing for MIIs:

A

Useful for monitoring inflammatory response

Des cultures de selles peuvent être demandées pour exclure des infections.

Calprotectine fécale : marqueur inflammatoire intestinal (pas spécifique aux MII)

Des marqueurs plus spécifiques pour la colite ulcéreuse et la maladie de Crohn peuvent aussi être demandés.

  • P-ANCA pour CU
  • ASCA pour Crohn
42
Q

Which marker is used the most for MII lab testing?

A

PCR

43
Q

Radiological testing for MIIs:

A

Allow to investigate small intestines and see MII complications

  • Plaque simple de l’abdomen : permet de noter s’il y a dilatation des anses grêles ou du côlon, des signes d’obstruction ou de mégacôlon
  • Transit grêle (not used), entéro-TDM, entéro-IRM
  • Échographie de surface (ciblée sur l’iléon)
  • Tomodensitométrie : surtout pour les abcès
  • Résonnance magnétique
  • L’échographie et l’entéro-IRM (sans irradiation et de permettre de différencier les caractères inflammatoire et fibreux lors de lésions sténosantes)
44
Q

Endoscopic examinations for MIIs:

A

Gastroscopy

Colonoscopy (#1 choice): allows to distinguish ulcerations (UC vs Crohns), perform biopsies, ileal intubation

Videocapsule

45
Q

Crohns vs UC in endoscopic exams:

A

UC: diffuse, edema, frail, loss of vascularization, erythema, muco-pus, pseudopolyps (chronic), atteinte rectale dans 95%

Crohns: segmentary, edema, frail, loss of vascularization, deeper ulcerations (linear and aphteux), inflammatory stenosis (acute) or due to scarring (chronic)

  • Chez les patients atteints de la maladie de Crohn, en plus de l’atteinte du grêle et du côlon, on peut aussi observer des ulcérations buccales et une atteinte péri-anale (par exemple, fistule) à l’examen physique

MD1 GI - EXAM 1 (15 decks)

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