Tuesday [28/9/22] Flashcards
what does TPMT stand for? [1]
Thiopurine methyltranferase
What is TPMT? [1]
An enzyme that in metabolises thiopurine drugs like 6-mercaptopurine/azithiopurine/6-thioguanine
How common is TPMT mutation? [1]
1 in 300
What can defects in TPMT lead to? [1]
Defects in the TPMT gene leads to decreased methylation and decreased inactivation of 6MP leading to enhanced bone marrow toxicity which may cause myelosuppression, anemia, bleeding tendency, leukopenia & infection
what type of drug is given for mild-to-moderate flare up of crohns? [1]
topical aminosalicylate alone or oral plus topical
What should be given to patients following severe relapse or over 2 exaerbations in the past year? [2]
oral azathioprine or oral mercaptopurine
Can you give MTX in UC? [1]
No, but you can crohns
Complication risk of a patient with UC [1]
colon ca
factors causing higher risk of cancer [4]
disease duration > 10 years
patients with pancolitis
onset before 15 years old
unremitting disease
poor compliance to treatment
S and S for IBD
In adults, it has a sensitivity of 93% and specificity of 96% for IBD. In children, the specificity falls to around 75%
What are some other causes of raised faecal calprotectin?
In addition to IBD, other causes of a raised faecal calprotectin include:
bowel malignancy
coeliac disease
infectious colitis
use of NSAIDs
What will the barium enema look like for a patient with crohn’s? [2]
loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’
Radiology sign for Crohn’s
Small bowel enema
high sensitivity and specificity for examination of the terminal ileum
strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae
Radiology sign for Crohn’s
Small bowel enema
high sensitivity and specificity for examination of the terminal ileum
strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae
What is a futuro splint? [1]
stabilises weak joints
Inflammation in CD [2]
No inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria
neutrophils migrate through the walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium
granulomas are infrequent
Inflammation in UX [4]
Inflammation in all layers from mucosa to serosa
increased goblet cells
granulomas
inducing remission CD [2]
GLucocorticoids first line
then 5)ASA
then azathiopurine/mercaptopurine
Surgery for CD [2]
The commonest disease pattern in Crohn’s is stricturing terminal ileal disease and this often culminates in an ileocaecal resection. Other procedures performed include segmental small bowel resections and stricturoplasty. Colonic involvement in patients with Crohn’s is not common and, where found, distribution is often segmental. However, despite this distribution segmental resections of the colon in patients with Crohn’s disease are generally not advocated because the recurrence rate in the remaining colon is extremely high, as a result, the standard options of colonic surgery in Crohn’s patients are generally; sub total colectomy, panproctocolectomy and staged sub total colectomy and proctectomy. Restorative procedures such as ileoanal pouch have no role in therapy.
Crohn’s disease is notorious for the developmental of intestinal fistulae; these may form between the rectum and skin (perianal) or the small bowel and skin. Fistulation between loops of bowel may also occur and result in bacterial overgrowth and malabsorption. Management of enterocutaneous fistulae involves controlling sepsis, optimising nutrition, imaging the disease and planning definitive surgical management.
Cx for CD
As well as the well-documented complications described above, patients are also at risk of:
small bowel cancer (standard incidence ratio = 40)
colorectal cancer (standard incidence ration = 2, i.e. less than the risk associated with ulcerative colitis)
osteoporosis
