PUD 2

Question 1

what is IBD?

Answer 1

it is a group of inflammatory conditions that are characterised by chronic inflammation in the GIT

Question 2

what are the two main forms of IBD?

Answer 2

Chron’s disease and ulcerative colitis

Question 3

what is the difference between CD and UC?

Answer 3

clinical, radiology, history and endoscopic features

Question 4

what does UC involve?

Answer 4

involves the colonic mucosal surface

mostly rectum and sometimes colon

Question 5

how does UC present?

Answer 5

presents with bloody diarrhoea

may be associated with abdominal pain/ need to empty bladder but nothing coming out (tenesmus)

Question 6

what can UC develop into?

Answer 6

procitis, left-sided colitis, or pancolitis

Question 7

where is CD present?

Answer 7

small and large bowel- sometimes limited to small bowel

Question 8

how does CD present?

Answer 8

abscesses, fistulas, strictures

some may have blood loss/ diarrhoea

Question 9

what are the colonoscopy findings of CD and UC?

Answer 9

CD- lesions/ cobble stoning/ ulcerations/ strictures

UC-pseudopolypops

Question 10

which IBD has more of a risk of developing colon cancer?

Answer 10

UC

Question 11

define incidence and prevlance

Answer 11

incidence= the number of people that are newly diagnosed with a condition
prevlance= newly diagnosed and people previously diagnosed

Question 12

which form of IBD does smoking : help prevent disease or may cause it?

Answer 12

CD- may prevent

UC- may cause it

Question 13

what are the environmental factors that may infleucne IBD?

Answer 13

diet-inconclusive evidence

smoking- worsens clinical course and inc risk of relaps

Question 14

how does the interic microflora influence IBD?

Answer 14

bowel commensal microflora- induction and maintenance of chronic inflam process

Question 15

where are the highest conc of bacterial microflora found?

Answer 15

terminal ilieum and colon

Question 16

how does NSAIDS exacerbate IBD?- diofenac

Answer 16

direct inhibiton of prostaglandin synthesis

Question 17

what drugs aggrevate IBD?

Answer 17

nsaids
oral contraceptives
antibiotics

Question 18

what is an appendectomy?

Answer 18

protective in UC

possible inc risk in CD

Question 19

how does stress aggrevate IBD?

Answer 19

triggers relaps

Question 20

what are the clinical manifestations of CD?

Answer 20

present with weight loss/ pain or tender mass/ and diarrhoea with no blood

Question 21

how is diarrhoea caused?

Answer 21

mucosal inflamation

Question 22

how may small bowel obstruction occur?

Answer 22

consequence of fibrosis, inflamation and stricture formation

Question 23

how is a mid disease characterised?

Answer 23

apothous or small superficial ulcerations

Question 24

how is an active CD characterised?

Answer 24

focal information and formation of fistula tracts

Question 25

what happens in active diseases?

Answer 25

bowel wall thickens and becomes narrowed and fibrotic leading to recurrent , bowel obstruction

Question 26

what are the typical symptoms of UC?

Answer 26

bloody diarrhoea with mucus abdominal pain with fever weight loss in severe cases

Question 27

what symptoms do patients with proctitis have?

Answer 27

blood or blood stained mucus mixed with stool or streaked onto it

Question 28

what happens when the blood extendeds beyond the rectum?

Answer 28

blood was mixed with stool

Question 29

what happens when the disease is severe?

Answer 29

liquid stool containing bood stool or fetal matter

Question 30

what are IBD patients at risk of?

Answer 30

osteoporosis and anaemia due to malabsorption

Question 31

what are the common deficiencies of IBD?

Answer 31

vit b12, d,k , folic acid, calcium

Question 32

when are deficiencies more common?

Answer 32

in CD/ in active disease

Question 33

when is calcium absorption reduced?

Answer 33

quinsentive and active IBD

Question 34

what are the extratrantestinal complications assoicated with IBD?

Answer 34

joints/ bone/ skin/eyes/ liver

Question 35

what are the common types of arthritis experienced by patients with IBD?

Answer 35

peripheral arthritis axial arthritis ankylosing spondylitis

Question 36

what are the skin complications associated with IBD?

Answer 36

* Peripheralarthritis * Axialarthritis * Ankylosingspondylitis

Question 37

how many IBE patients have a lower bone density?

Answer 37

30-60%

Question 38

what contributes to lower bone density?

Answer 38

prolonged used of cortacosteroids/ vit d/active inflamation

Question 39

what are the eye problems with IBD?

Answer 39

uveitis/keropathy (abnormality of cornea)/ episcleritis(inflam of outer coating of white eye)/ dry eyes (vit a def)

Question 40

what is the main purpose of the inflam response?

Answer 40

localise and eliminate injury that cause injury | protect against further injury

Question 41

how does CD and UC produce an inflam response?

Answer 41

CD- IL-12 and -23 inc helper T cells | UC- IL-13 release cytokine T cells

Question 42

what kind of a disease is IBD?

Answer 42

auto immune disease- it is associated with gut barrier disorders/ dysbyosis

Question 43

what does the mucosal barrier consists of?

Answer 43

epithelial barrier and antimucosal layer

Question 44

what kind of activity is there is IBD?

Answer 44

PPARy activity | mediate aminosalicate activities in IBD

Question 45

How do you diagnose IBD?

Answer 45

blood tests- inflam medicators and renal and hepatic function tests

Question 46

when should diagnostic testing be done?

Answer 46

done periodically when methotrexate, thiopurines and biological agents are used for treatment

Question 47

what is the gold std diagnosis for IBD?

Answer 47

endoscopy

Question 48

what can MRI be used for in diagnosis?

Answer 48

eidence of fissulate and absesses

Question 49

how is the severity of UC measured?

Answer 49

truelove and witts severity index

Question 50

how do you manage mild to moderate UC?

Answer 50

step 1-proctitis and sigmoiditis left sideded or extensive CD step 2- if no improvement add prinosimolone to amino-salicate stop beclametazone

Question 51

how do you manage acute severe UC?

Answer 51

step 1- IV cortosteroids | step 2- add ciclosporin

Question 52

when is surgery indicated in UC?

Answer 52

stool freq more than 8 times a day rise in body temp tachycardia x ray showing colonic diation

Question 53

how do you manage CD?

Answer 53

assess TPMT activity before offering azathioprine cholonic survealance bone mineral density

Question 54

how do you induce remission of CD?

Answer 54

monotherapy- in first presentation of single exacerbation in 12 months enternal nutrition alternative to steroid right-sided- budisamide

Question 55

what do you NOT offer as monotherapy in CD?

Answer 55

Azathioprine, mercaptuprine, or methotrexate as monotherapy

Question 56

what shoud be offered in severe chromes disease?

Answer 56

infleximab, adalimuab

Question 57

when do you offer surgery in CD?

Answer 57

if disease is limited to distal ileum

Question 58

when do you use a stricture in CD?

Answer 58

baloon dialation if single short stricture