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Revision Cards > Week 142 - Inflammatory Bowel Disease > Flashcards

Week 142 - Inflammatory Bowel Disease Flashcards

1
Q

What is Crohn’s Disease and what is it characterised by?

A
  • Inflammatory disease affecting the whole thickness of the bowel wall across the whole GIT.
  • Characterised by :
  • Skip lesions
  • Granulomatous nature
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2
Q

What are the risk factors associated with Crohn’s disease?

A
  • Genetic
  • Diet
  • Smoking
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3
Q

What is the pathophysiology of Crohn’s disease?

A
  • Abnormal response to normal gut flora.
  • Immune response mediated by Th1 cells and macrophages leading to-
  • Inflammation (Infiltration of neutrophils and macrophages)
  • Tissue damage and fibrosis.
  • May lead to metaplasia.
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4
Q

What are the macroscopic features of Crohn’s disease?

A

Skip lesions with the development of ulceration.

Fistulaes, fissures and strictures.

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5
Q

What part of the bowel is most commonly affected by Crohn’s disease?

A
  • Ileum and Colon (50%)
  • Small bowel only (30%)
  • Colon only (20%)
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6
Q

What are the GI presenting symptoms of Crohn’s Disease?

A
  • Diarrhoea +/- blood
  • Abdo pain
  • Bloating / Flatulence
  • Bowel obstuction
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7
Q

What are the associated symptoms of Crohn’s Disease?

A

Anorexia

Fever

Weight loss

Dietary deficiency syndromes

Erythema Nodosum and Pyoderma Gangrenosum

Arthralgia

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8
Q

What investigations should be performed for suspected Crohn’s disease?

A
  • FBC (Expect Anaemia and B12 deficiency), Inflammatory Markers, Antibody serology.
  • X-ray, Barium follow-through, CT, MRI
  • Coloscopy +/- biopsy
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9
Q

What is the medical treatment for Crohn’s disease?

A
  • Glucocorticoids
  • 5-ASA drugs
  • Infliximab
  • Methotrexate
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10
Q

What is ulcerative colitis and what is it characterised by?

A

Inflammatory disease affecting the mucosal layer of the rectum +/- colon only.

• Characterised by:

  • Continual distribution, always starting from rectum.
  • Non-granulomatous nature.
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11
Q

What are the risk factors for ulcerative colitis?

A
  • Genetic factors
  • Family history
  • Autoimmune disease
  • Diet
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12
Q

What is the pathophysiology of Ulcerative colitis?

A
  • Abnormal response to normal gut flora.
  • Immune response mediated by Th2 cells and B-cells, produce auto-antibodies.
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13
Q

What is the presentation of GI symptoms in Ulcerative Colitis?

A
  • Diarrhoea with mixed in blood and mucus
  • Abdominal cramping
  • Pain
  • Tenesmus
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14
Q

What are the associated symptoms of Ulcerative Colitis?

A
  • Fever
  • Weight loss -less than in Crohn’s
  • Erythema Nodulosum and Pyoderma Gangrenosum
  • Arthralgia
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15
Q

What investigations should be performed for ulcerative colitis?

A
  • Stool sample
  • Bloods - FBC, inflammatory markers, U&Es, LFT.
  • Abdo X-ray
  • Colonoscopy and biopsy
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16
Q

What is the medical treatment for ulcerative colitis?

A
  • Glucocorticoids
  • 5-ASAs
  • Infliximab
  • Ciclosporin
17
Q

What complications can occur due to Ulcerative Colitis?

A
  • Primary Sclerosing Cholangitis
  • Bowel CA
  • Toxic Megacolon
18
Q

Which three drugs (or drug categories) are used to induce remission in IBD patients?

A
  • 5-ASAs
  • Glucocorticoids
  • Infliximab
19
Q

What are 5-ASAs and what is their role in treating IBD?

A
  • Aim to induce remission.
  • Slow to work (6-8) weeks.
  • Side-effects: Diarrhoea, abdo pain, N & V.
  • What are the two forms?
  • Sulfasalazine
  • Mesalazine
20
Q

What are the two forms of 5-ASAs used in the treatment of IBD and what is the difference?

A
  • Sulfasalazine and Mesalazine
  • Mesalazine is coated so does not get absorbed as high and reduces side-effects.
  • Side effects of Sulfasalazine include headache, decreased sperm and leukopenia.
21
Q

What is the role of glucocorticoids in the treatment of IBD?

A
  • Induces remision.
  • E.g. Prednisolone, Budesonide
  • Quick acting but should only be used for short periods.
  • Reduces arachidonic acid which reduces cytokines and therefore reduces inflammatory response.
22
Q

What is infliximab? What is it’s role in the treatment of IBD?

A
  • Induces and maintains remission, given as an infusion.
  • It binds and neutralises to TNF-alpha.
  • Side-effects: Immunosupression, increased risk of cardiac failure. Contra-indicated in sepsis, TB, Ca.
23
Q

What is methotrexate? What is its role in treating IBD?

A

Used for Crohn’s disease.

An immunosupressant that reduces IL-1 and causes T-cell apoptosis.

24
Q

What is ciclosporin? What is it’s role in treating IBD?

A

Used in severe ulcerative colitis.

• Immunosupressant, inhibits the action of T-cells.

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