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GSS > Pathogenesis CD/UC > Flashcards

Pathogenesis CD/UC Flashcards

1
Q

What is Crohn’s?

A

Chronic progressive patchy inflammation of the gut wall
- Causes transmural patchy inflammation anywhere in the GIT (from mouth to rectum)

Consists of flares and remissions
Fistulae and strictures can occur
Hyperplasia and luminal invasion
RLQ masses occur

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2
Q

What causes Crohn’s?

A

Poor tolerance to bacteria in the gut
Autoimmune response
Genetic predisposition

Often multifactorial and idiopathic
Generally more debilitating than UC due to multiple surgeries being required

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3
Q

What is dysbiosis?

A

Imbalance between the good and the bad bacteria

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4
Q

What genetic factors are thought to be involved in Crohn’s?

A

Variation in

  • CARD15 gene on chromosome 16
  • Increased risk in caucasians
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5
Q

What causes the immune response in IBD?

A

Inappropriate and ongoing activation of the mucosal immune system due to:
- Defective mucosal barrier and microbial clearance

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6
Q

What is ulcerative colitis?

A

Chronic progressive generalised epithelial ulceration

  • Inflammation limited to the colon in the GIT
  • widespread mucosal inflammation (superficial)
  • not commonly associated with fistulae and strictures

Acute condition can occur rapidly and become life threatening

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7
Q

What are crohn’s and ulcerative colitis classified as?

A

Inflammatory bowel disease (IBD)

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8
Q

What age group has the peak onset?

A

20 - 40 years old

but can occur in elderly/children

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9
Q

What genetic factors are thought to be involved in UC?

A

Variations in:

  • IL-10 gene (chromosome 1)
  • ARP2C region (chromosome 2)
  • Increased risk in south asians
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10
Q

What environmental factors affect risk of Crohn’s?

A 
Refrigerators
Western food preparation (not exposed to bacteria, thus when exposed triggers immune response)
Smoking
MAP 
Contraceptive pill
NSAIDs
Stress
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11
Q

What is MAP?

A

Mycobacterium avium subspecies paratuberculosis

  • Last resort treatment is intensive anti-MAP therapy (antibiotics)
  • More evidence needed, but bacteria found in cows/sheep which survives pasteurisation in dairy products
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12
Q

What environmental factors affect risk of UC?

A 
Smoking cessation
Western food prep
NSAIDs
Stress
Pollution
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13
Q

What are RLQ masses and what are they associated with?

A

Right lower quadrant abdominal masses

- Crohn’s disease

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14
Q

Endoscopy image of Crohn’s

A

Mucosal inflammation

  • Redness
  • Oedema
  • Friability, granular appearance
  • Cobblestone-like (indicating deep inflammation)
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15
Q

Endoscopy image of UC

A

Redness
Granular appearance
Friability (looks weak and easily bleeds)

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16
Q

What are the primary complications of Crohn’s disease?

A

Strictures
Fissures

(others include malabsorption- anaemia; small bowel obstruction; abscess; bowel cancer; osteoporosis; lactose intolerance)

17
Q

What are strictures and how are they managed?

A

Narrowing of the bowel lumen causing obstruction and sudden pain

  • can lead to haemorrhages and perforations
  • identified through CT scans

TREATMENT

  • Endoscopic balloon dilatation (remove)
  • Strictureplasty (cut through and reshape)
18
Q

What are fistulae?

A

Abnormal passageway forming between one organ to another, or to the external environment

e.g. Enterocutaneous (bowel to skin); enteroenteric (bowel to bowel)

19
Q

What are the complications of UC?

A
  • Electrolyte imbalance
  • Toxic megacolon (acute swelling- can lead to fever/pain/sepsis)
  • Severe bleeding (anaemia)
  • Risk factor for colorectal cancer
20
Q

What extra intestinal diseases can result from IBD?

A

Uveitis
Osteoporosis
Ankylosing Spondylitis

21
Q

Differences between the clinical features of Crohn’s and uC?

A

Crohn’s

  • Acute or gradual onset
  • Weight loss, fever, malaise
  • Anorexia
  • Malabsorption and hypovitaminosis
  • Frequent perianal disease (fistulae and abscess)
  • Sometimes diarrhoea
  • Abdominal pain and palpable tender masses (lumps in lower abdomen)

UC

  • Abrupt onset
  • Intense diarrhoea (with blood/mucus)
  • Left sided pain (colon)
  • Weightloss and anaemia
  • Nausea and vomiting
  • Dehydration
  • Lower abdominal cramps and pain on defecation
  • Fever
22
Q

Disease activity score used for Crohn’s?

A

Harvey Bradshaw Index

  • Active disease when score is not stable and changes
  • 24h recording factors such as abdominal pain, abdominal mass, wellbeing, number liquid stools
23
Q

Disease activity score used for UC?

A

Simple Clinical Colitis Activity Index (SCCAI)

- 24h recording urgency, blood/mucus in stools, general wellbeing, extracolonic frequency etc.

24
Q

What is used to determine activity and severity of CD/UC?

A

Disease activity scores
Endoscopies
History

25
Q

What else must be considered?

A 
History
Blood Tests
Imaging
Stools culture
Faecal calprotectin

GSS (8 decks)

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