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PHA 223 > PUD 2 > Flashcards

PUD 2 Flashcards

1
Q

what is IBD?

A

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

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2
Q

what are the two main forms of IBD?

A

Chron’s disease and ulcerative colitis

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3
Q

what is the difference between CD and UC?

A

clinical, radiology, history and endoscopic features

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4
Q

what does UC involve?

A

involves the colonic mucosal surface

mostly rectum and sometimes colon

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5
Q

how does UC present?

A

presents with bloody diarrhoea

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

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6
Q

what can UC develop into?

A

procitis, left-sided colitis, or pancolitis

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7
Q

where is CD present?

A

small and large bowel- sometimes limited to small bowel

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8
Q

how does CD present?

A

abscesses, fistulas, strictures

some may have blood loss/ diarrhoea

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9
Q

what are the colonoscopy findings of CD and UC?

A

CD- lesions/ cobble stoning/ ulcerations/ strictures

UC-pseudopolypops

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10
Q

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

A

UC

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11
Q

define incidence and prevlance

A 
incidence= the number of people that are newly diagnosed with a condition
prevlance= newly diagnosed and people previously diagnosed
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12
Q

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

A

CD- may prevent

UC- may cause it

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13
Q

what are the environmental factors that may infleucne IBD?

A

diet-inconclusive evidence

smoking- worsens clinical course and inc risk of relaps

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14
Q

how does the interic microflora influence IBD?

A

bowel commensal microflora- induction and maintenance of chronic inflam process

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15
Q

where are the highest conc of bacterial microflora found?

A

terminal ilieum and colon

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16
Q

how does NSAIDS exacerbate IBD?- diofenac

A

direct inhibiton of prostaglandin synthesis

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17
Q

what drugs aggrevate IBD?

A

nsaids
oral contraceptives
antibiotics

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18
Q

what is an appendectomy?

A

protective in UC

possible inc risk in CD

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19
Q

how does stress aggrevate IBD?

A

triggers relaps

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20
Q

what are the clinical manifestations of CD?

A

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

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21
Q

how is diarrhoea caused?

A

mucosal inflamation

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22
Q

how may small bowel obstruction occur?

A

consequence of fibrosis, inflamation and stricture formation

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23
Q

how is a mid disease characterised?

A

apothous or small superficial ulcerations

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24
Q

how is an active CD characterised?

A

focal information and formation of fistula tracts

25
Q

what happens in active diseases?

A

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

26
Q

what are the typical symptoms of UC?

A

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

27
Q

what symptoms do patients with proctitis have?

A

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

28
Q

what happens when the blood extendeds beyond the rectum?

A

blood was mixed with stool

29
Q

what happens when the disease is severe?

A

liquid stool containing bood stool or fetal matter

30
Q

what are IBD patients at risk of?

A

osteoporosis and anaemia due to malabsorption

31
Q

what are the common deficiencies of IBD?

A

vit b12, d,k , folic acid, calcium

32
Q

when are deficiencies more common?

A

in CD/ in active disease

33
Q

when is calcium absorption reduced?

A

quinsentive and active IBD

34
Q

what are the extratrantestinal complications assoicated with IBD?

A

joints/ bone/ skin/eyes/ liver

35
Q

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

A

peripheral arthritis
axial arthritis
ankylosing spondylitis

36
Q

what are the skin complications associated with IBD?

A
  • Peripheralarthritis
  • Axialarthritis
  • Ankylosingspondylitis
37
Q

how many IBE patients have a lower bone density?

A

30-60%

38
Q

what contributes to lower bone density?

A

prolonged used of cortacosteroids/ vit d/active inflamation

39
Q

what are the eye problems with IBD?

A

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

40
Q

what is the main purpose of the inflam response?

A

localise and eliminate injury that cause injury

protect against further injury

41
Q

how does CD and UC produce an inflam response?

A

CD- IL-12 and -23 inc helper T cells

UC- IL-13 release cytokine T cells

42
Q

what kind of a disease is IBD?

A

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

43
Q

what does the mucosal barrier consists of?

A

epithelial barrier and antimucosal layer

44
Q

what kind of activity is there is IBD?

A

PPARy activity

mediate aminosalicate activities in IBD

45
Q

How do you diagnose IBD?

A

blood tests- inflam medicators and renal and hepatic function tests

46
Q

when should diagnostic testing be done?

A

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

47
Q

what is the gold std diagnosis for IBD?

A

endoscopy

48
Q

what can MRI be used for in diagnosis?

A

eidence of fissulate and absesses

49
Q

how is the severity of UC measured?

A

truelove and witts severity index

50
Q

how do you manage mild to moderate UC?

A

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

51
Q

how do you manage acute severe UC?

A

step 1- IV cortosteroids

step 2- add ciclosporin

52
Q

when is surgery indicated in UC?

A

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

53
Q

how do you manage CD?

A

assess TPMT activity before offering azathioprine
cholonic survealance
bone mineral density

54
Q

how do you induce remission of CD?

A

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

55
Q

what do you NOT offer as monotherapy in CD?

A

Azathioprine, mercaptuprine, or methotrexate as monotherapy

56
Q

what shoud be offered in severe chromes disease?

A

infleximab, adalimuab

57
Q

when do you offer surgery in CD?

A

if disease is limited to distal ileum

58
Q

when do you use a stricture in CD?

A

baloon dialation if single short stricture

PHA 223 (42 decks)

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