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Week 10 -GI > Small bowel disease > Flashcards

Small bowel disease Flashcards

1
Q

What are the causes of inflammatory bowel disease?

A
  • Environmental factors: diet, sanitation, medication
  • Genetic predisposition
  • Host immune response: related to psoriasis, ankylosing spondylitis
  • Gut microbiota
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2
Q

What kind of bowel opening is almost always pathological?

A

Nocturnal

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3
Q

What is the classical presentation of infective colitis?

A
  • Short history of diarrhoea +/- vomiting
  • Abrupt onset +/- resolution of symptoms
  • Systemic upset and fevers prominent
  • Travel
  • Unwell contacts
  • Immunocompromised
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4
Q

What is the investigation for suspected infective colitis?

A

Stool culture - need at least 4 for 90% sensitivity

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5
Q

What is the treatment for infective colitis?

A

Normally conservative if immunocompetent

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6
Q

What is the classical presentation of ischaemic colitis?

A
  • Abrupt onset of pain

* bloody diarrhoea +/- SIRS

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7
Q

What are the risk factors for ischaemic colitis?

A
  • Elderly
  • Cardiovascular disease
  • Heart failure
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8
Q

What may be seen on a CT scan in someone with ischaemic colitis?

A

May show segmental colitis in watershed areas

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9
Q

What is the treatment of ischaemic colitis?

A
  • IV fluids

* Consider antibiotics if systemic features

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10
Q

Above what number of bloody stools a day should you admit a patient, regardless of other symptoms?

A

> 6

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11
Q

What are the signs of ulcerative colitis on an abdominal X-ray?

A

Thumb printing due to extensive bowel wall thickening

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12
Q

What can be evaluated/seen in an abdominal X-ray which you should be worried about in someone with ulcerative colitis?

A
  • Megacolon

* toxic megacolon

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13
Q

What is the difference between megacolon and toxic megacolon?

A
  • Megacolon: diameter>5.5cm or caecum >9cm

* Toxic megacolon: megacolon and signs of systemic toxicity

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14
Q

What causes a megacolon in ulcerative colitis?

A

Inflammation in the colon causes gas to get trapped resulting in the colon becoming enlarged and swollen

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15
Q

What investigations should be carried out in someone with suspected ulcerative colitis?

A
  • Abdominal X ray
  • Flexible sigmoidoscopy or colonoscopy
  • Potentially a CT scan
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16
Q

What are the layers of the normal bowel wall starting at the luminal surface?

A
  • Mucosa
  • Sub mucosa
  • Muscularis
  • Sub-serosa
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17
Q

What are the two components of the muscularis in the bowel wall?

A
  • Inner circular

* Outer longitudinal

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18
Q

Describe the lamina propria

A
  • Supporting scaffold of connective tissue
  • contains a few inflammatory cells
  • Fibroblasts, blood vessels, lymphocytes, plasma cells, a few eosinophils
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19
Q

What are the acute pathological changes in inflammatory bowel disease?

A
  • Acute inflammation
  • Ulceration
  • Loss of goblet cells
  • Crypt abscess formation - collection of neutrophils
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20
Q

What are the chronic pathological changes in IBD?

A
  • Architectural changes
  • Paneth cell metaplasia (in more distal bowel)
  • Chronic inflammatory infiltrates in the lamina propria (more plasma cells)
  • Neuronal hyperplasia
  • Fibrosis
21
Q

In ulcerative colitis, where is the inflammation confined to?

A

The mucosa

22
Q

In regards to the histopathology, what is lost in inflammatory bowel disease which is not lost in infective colitis?

A

The plasma cell gradient - normally there are more plasma cells on the luminal side of the bowel wall whereas in IBD there are increased plasma cells throughout the whole of the bowel wall

23
Q

What are the macroscopic features of ulcerative colitis?

A
  • Diffuse involvement of the lower GIT

* The terminal ileum can be involved but generally only if severe

24
Q

What are the microscopic features of ulcerative colitis?

A
  • Crypt architectural changes are generally very marked
  • Little to no fibrosis
  • No granulomas
25
Q

What drugs can be prescribed for chronic ulcerative colitis

A
  • 5-ASA/mesalazine both orally and topically (foam enema or suppository)
  • Azathioprine/6MP (severe relapses/frequently relapsing)
26
Q

What is the treatment of an acute severe ulcerative colitis?

A
  • IV steroids e.g. methylprednisolone

* Low molecular weight heparin

27
Q

What can predict the need for a colectomy in those with an acute severe ulcerative colitis?

A

Either of the following on day 3 of treatment:
•Stool frequency >8 a day
•Stool frequency >3 and CRP > 45

28
Q

What are the rescue medical therapy for those with ulcerative colitis

A

Infliximab or ciclosporin

29
Q

What is infliximab?

A

•Monoclonal antibody to TNF-alpha

30
Q

What are the local complications of ulcerative colitis?

A
  • Haemorrhage

* Toxic dilation (aka toxic megacolon)

31
Q

What are the systemic complications of ulcerative colitis?

A
  • Skin: erythema nodosum( red bumps and patches), pyoderma gangrenosum (painful ulcers)
  • Liver: sclerosing cholangitis, cholangiocarcinoma
  • Eyes: iritis, uveitis, episcleritis
  • Ankylosing spondylitis
  • malignancy
32
Q

What surveillance should be done in those with ulcerative colitis?

A

Screening colonoscopies:
•If no active inflammation: once every 5 years
•If mild active inflammation: once every 3 years
•If moderate/severe inflammation; once a year

33
Q

Which of the IBDs is more likely to cause a high MCV?

A

Chron’s - due to the effect on the absorption of B12

34
Q

What is Chron’s disease?

A

Ac chronic inflammatory condition affecting anywhere from the mouth to the anus

35
Q

Where are the most common sites of Chrons?

A

The terminal ileum and caecum

36
Q

What is the peak incidence of Chron’s disease?

A

15-25 years

37
Q

What lifestyle change can someone with Crohn’s do to reduce the risk of relapse?

A

Stop smoking

38
Q

What are the features of Crohn’s disease?

A
  • Abdominal pain
  • Diarrhoea
  • Weight loss
  • Fistulae, abscesses, oropharyngeal, gastroduodenal
  • Extra-intestinal symptoms
39
Q

What are the extra-intestinal symptoms of crohn’s disease?

A
  • Eyes: uveitis and episcelritis
  • Joints: sacroilitis, inflammatory arthropathy
  • Skin: erythema nodosum
40
Q

What investigations should be carried out in suspected Crohn’s disease?

A
  • Abdominal Xray
  • Ileocolonoscopy
  • Faecal calprotectin
  • Stool cultures
  • MR/CT enterography
41
Q

What is faecal calprotectin?

A

Calcium binding protein, predominantly derived from neutrophils

42
Q

What is faecal calprotectin useful for?

A

Differentiating between IBD and IBS

43
Q

What can be seen on histology of the bowel which would confirm Crohn’s?

A

Granulomas

44
Q

How can a pathologist tell the difference between ulcerative colitis and Crohn’s?

A
  • Distribution of the inflammation
  • Type of inflammation
  • Clinical context/scope findings
45
Q

What are the differences between Crohn’s and ulcerative colitis?

A
  • Crohn’s = small and large bowel inflammation, UC= large bowel only
  • Crohn’s tends to involve the proximal large bowel, UC tends to extend from the rectum to involve left side of bowel
  • Crohn’s= patchy inflammation with skip lesions , transmural deeply ulcerating, UC= confluent, diffuse inflammation centred on mucosa
46
Q

What is the classification system of crohn’s?

A

The Montreal category

47
Q

What are the medications for Crohn’s?

A 
•Azathioprine and 6-mercaptopurine 
•Methotrexate 
•Biologics:
 - TNF alpha antagonists 
 - Anti-integrins 
 - Anti-interleukin
48
Q

What are the risk factors for needing surgery in Crohn’s disease?

A
  • Young onset
  • smoking
  • Perianal disease
  • Stricturing SB disease

Week 10 -GI (8 decks)

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