PUD 2 Flashcards
what is IBD?
it is a group of inflammatory conditions that are characterised by chronic inflammation in the GIT
what are the two main forms of IBD?
Chron’s disease and ulcerative colitis
what is the difference between CD and UC?
clinical, radiology, history and endoscopic features
what does UC involve?
involves the colonic mucosal surface
mostly rectum and sometimes colon
how does UC present?
presents with bloody diarrhoea
may be associated with abdominal pain/ need to empty bladder but nothing coming out (tenesmus)
what can UC develop into?
procitis, left-sided colitis, or pancolitis
where is CD present?
small and large bowel- sometimes limited to small bowel
how does CD present?
abscesses, fistulas, strictures
some may have blood loss/ diarrhoea
what are the colonoscopy findings of CD and UC?
CD- lesions/ cobble stoning/ ulcerations/ strictures
UC-pseudopolypops
which IBD has more of a risk of developing colon cancer?
UC
define incidence and prevlance
incidence= the number of people that are newly diagnosed with a condition prevlance= newly diagnosed and people previously diagnosed
which form of IBD does smoking : help prevent disease or may cause it?
CD- may prevent
UC- may cause it
what are the environmental factors that may infleucne IBD?
diet-inconclusive evidence
smoking- worsens clinical course and inc risk of relaps
how does the interic microflora influence IBD?
bowel commensal microflora- induction and maintenance of chronic inflam process
where are the highest conc of bacterial microflora found?
terminal ilieum and colon
how does NSAIDS exacerbate IBD?- diofenac
direct inhibiton of prostaglandin synthesis
what drugs aggrevate IBD?
nsaids
oral contraceptives
antibiotics
what is an appendectomy?
protective in UC
possible inc risk in CD
how does stress aggrevate IBD?
triggers relaps
what are the clinical manifestations of CD?
present with weight loss/ pain or tender mass/ and diarrhoea with no blood
how is diarrhoea caused?
mucosal inflamation
how may small bowel obstruction occur?
consequence of fibrosis, inflamation and stricture formation
how is a mid disease characterised?
apothous or small superficial ulcerations
how is an active CD characterised?
focal information and formation of fistula tracts
what happens in active diseases?
bowel wall thickens and becomes narrowed and fibrotic leading to recurrent , bowel obstruction
what are the typical symptoms of UC?
bloody diarrhoea with mucus
abdominal pain with fever
weight loss in severe cases
what symptoms do patients with proctitis have?
blood or blood stained mucus mixed with stool or streaked onto it
what happens when the blood extendeds beyond the rectum?
blood was mixed with stool
what happens when the disease is severe?
liquid stool containing bood stool or fetal matter
what are IBD patients at risk of?
osteoporosis and anaemia due to malabsorption
what are the common deficiencies of IBD?
vit b12, d,k , folic acid, calcium
when are deficiencies more common?
in CD/ in active disease
when is calcium absorption reduced?
quinsentive and active IBD
what are the extratrantestinal complications assoicated with IBD?
joints/ bone/ skin/eyes/ liver
what are the common types of arthritis experienced by patients with IBD?
peripheral arthritis
axial arthritis
ankylosing spondylitis
what are the skin complications associated with IBD?
- Peripheralarthritis
- Axialarthritis
- Ankylosingspondylitis
how many IBE patients have a lower bone density?
30-60%
what contributes to lower bone density?
prolonged used of cortacosteroids/ vit d/active inflamation
what are the eye problems with IBD?
uveitis/keropathy (abnormality of cornea)/ episcleritis(inflam of outer coating of white eye)/ dry eyes (vit a def)
what is the main purpose of the inflam response?
localise and eliminate injury that cause injury
protect against further injury
how does CD and UC produce an inflam response?
CD- IL-12 and -23 inc helper T cells
UC- IL-13 release cytokine T cells
what kind of a disease is IBD?
auto immune disease- it is associated with gut barrier disorders/ dysbyosis
what does the mucosal barrier consists of?
epithelial barrier and antimucosal layer
what kind of activity is there is IBD?
PPARy activity
mediate aminosalicate activities in IBD
How do you diagnose IBD?
blood tests- inflam medicators and renal and hepatic function tests
when should diagnostic testing be done?
done periodically when methotrexate, thiopurines and biological agents are used for treatment
what is the gold std diagnosis for IBD?
endoscopy
what can MRI be used for in diagnosis?
eidence of fissulate and absesses
how is the severity of UC measured?
truelove and witts severity index
how do you manage mild to moderate UC?
step 1-proctitis and sigmoiditis
left sideded or extensive CD
step 2- if no improvement add prinosimolone to amino-salicate
stop beclametazone
how do you manage acute severe UC?
step 1- IV cortosteroids
step 2- add ciclosporin
when is surgery indicated in UC?
stool freq more than 8 times a day
rise in body temp
tachycardia
x ray showing colonic diation
how do you manage CD?
assess TPMT activity before offering azathioprine
cholonic survealance
bone mineral density
how do you induce remission of CD?
monotherapy- in first presentation of single exacerbation in 12 months
enternal nutrition alternative to steroid
right-sided- budisamide
what do you NOT offer as monotherapy in CD?
Azathioprine, mercaptuprine, or methotrexate as monotherapy
what shoud be offered in severe chromes disease?
infleximab, adalimuab
when do you offer surgery in CD?
if disease is limited to distal ileum
when do you use a stricture in CD?
baloon dialation if single short stricture
