Small and Large bowel disorders Flashcards
What are the 2 major IBDs
Crohns and Ulcerative Colitis
What gene is linked to the develpment of Crohn’s disease
CARD15/NOD2 gene on chromosome 16
Where is there the greatest prevalence of IBD
Developed countries where there is improved sanitation
Smoking is protective in Ulcerative Colitits. True or False
True
Smoking is protective in Crohn’s disease. True or False
False
What is the incidence of Crohns in the developed world
7 in 100,000
What is the incidence of Ulcerative colitis in the developed world
12 in 100,000
What disease is increasing in prevalence
Crohn’s disease
What is the immune response in Crohn’s disease
Th1 driven
release of TNF alpha and interferon gamma
What is the immune response in Ulcerative colitis
Th2 driven
increased release of proinflammatroy cytokines including IL-5
Give characteristic features of Crohns which are absent in Ulcerative Colitis
Skip lesions (non-continuous fashion) Ileocaecal is the most common area to be affected Full thickness inflammation deep ulcers cobblestone appearance may cause fistula and abscess
Give characteristic features of UC which are absent in Crohn’s
Involves the rectum and extends in a confluent manner to involve the sigmoid colon and rectum
Only colonic mucosa is involved
Inflammation is confined to the mucosa
higher incidence of colorectal carcinoma
What is the histological hallmark of Crohn’s disease
Giant cell granuloma
What is the histological hallmark of UC
Acute and chronic inflammatory cells and abscesses
What are the common presentations of Crohn’s disease
Abdominal pain diarrhoea Weight loss malabsorption anorexia malaise
What is the common presentations of UC
Bloody diarrhoea
tenesmus
abdominal pain
How is the severity of UC determined
By the frequency, degree of blood loss in stools, pule and temperature
What are some complications of IBD
Toxic megacolon
Perforation
Cancer
What could be used to investigate a patient who is too unwell to undergo endoscopy or abdominal CT
Radiolabelled white cells scan
What is the first line treatment of Crohn’s disease
Oral prednisolone for 4-6 weeks
What is the main drug used to treat Ulcerative Colitis
5ASA
What is the main drug used to treat Ulcerative Colitis
5ASA
Why are patients with IBD predisoposed to metabolic bone disease
The use of steroids
What can steroids cause in children
Growth retardation
What percentage of ileal crohn’s patients will have at least one operation
90%
When is surgery for UC most common
In the first 5 years after diagnosis
What is microscopic colitis
Collagenous colitis and lymphocytic colitis
Who is most likely to get microscopic colitis
Patients with coeliac disease, autoimmune disorders and those taking PPIs and NSAIDs
On what side of the colon are changes most commonly seen in microscopic colitis
right
What age do patients present with IBS
Any age
How is the diagnosis of IBS made
Having excluded organic diseases with the same symptoms
What are the 3 categories for IBS
c-IBS - constipation
d-IBS - diarrhoea
m- IBS - mixed
What are the main symptoms of IBS
Cramping abdominal pain
Rectal mucus loss
Incomplete evacuation
What can be used to treat patients with IBS
Antispasmodics
Tricyclic antidepressants in low dose
Occasional patients need hypnotherapy or CBT
What can be used to treat patients with IBS
Antispasmodics
Tricyclic antidepressants in low dose
Occasional patients need hypnotherapy or CBT
What is the least vulnerable vessel to ischaemia
Coeliac vessel
What are 4 causes of gut ischaemia
Arterial thromboembolism
Venous insufficiency
Profound hypotension
Vasculitis
What is acute small bowel ischamia
A rare medical emergency characterised by severe abdominal pain with minimal physical signs
In terms of ABGs, what is common in acute small bowel ischaemia
Metabolic acidosis
What is the management for acute small bowel ischaemia
Aggressive resuscitation
analgesia
correction of acidosis
When does the pain typically start in chronic intestinal ischaemia
30 mins after eating and can last 4 hours
What is the gold standard test for chronic intestinal ischaemia
Angiography
What might be seen on an Abdo X ray in Ischaemic colitis
Thumb printing at the splenic flexure (mucosal oedema)
When does acute radiation enteritis occur
Early weeks after first radiotherapy
What are the symptoms of acute radiation enteritis
Vomiting
Pain
diarrhoea
