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Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

what are the 2 main inflammatory bowel disease?

A

Crohn’s Disease
Ulcerative Colitis
(they overlap- intermediate colitis)

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2
Q

peri-anal disease is more suggestive of which inflammatory bowel disease?

A

Crohn’s

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3
Q

rectal bleeding is more suggestive of which inflammatory bowel disease?

A

UC

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4
Q

within crohn’s and UC what are the main possible defects with T cells?

A
  1. overactive effector T cells

2. absence of regulatory T cells

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5
Q

which inflammatory bowel disease if smoking protective against?

A

smoking protects against UC but aggravates Crohn’s disease

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6
Q

what are the 3 main disease extent patterns of UC?

A

proctitis
left0sided colitis
pancolitis

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7
Q

what is the disease extent pattern of proctitis?

A

doesn’t go any more proximally than sigmoid colon

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8
Q

what is the disease pattern of left sided colitis?

A

doesn’t go any more proximally than splenic flexure

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9
Q

what is the disease pattern of pancolitis?

A

extends over entire colon

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10
Q

how do you define severe ulcerative colitis?

A 
>6 bloody stools in 1 day
\+ 1 more out of:
- fever (>37.8degrees)
-tachycardia (>90/min)
-anaemia (Hb below 10.5g/dl)
- elevated ESR (above 30mm/hr)
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11
Q

when looking at a plain AXR of a patient with UC, where should the stool be absent?

A

in the areas of inflammed colon

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12
Q

in UC, what happens to the crypts of lieberkahn?

A

crypt distortion and abscess

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13
Q

both inflammatory bowel disease increase risk of colorectal cancer, but which inflammatory bowel disease increases risk the most?

A

UC

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14
Q

what are the extra-intestinal manifestations of UC within the mouth?

A

stomatitis

apthous ulcers

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15
Q

what are the extra-intestinal manifestations of UC within the eyes?

A

episcleritis

uveitis

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16
Q

what are the extra-intestinal manifestations of UC on the skin?

A

erythema nodosum
proderma gangrenosum
phlebitis

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17
Q

what are the extra-intestinal manifestation of UC in the joints?

A

spondylitis
sacrolitis
peripheral arthritis

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18
Q

what are the extra-intestinal manifestations of UC in the kidneys?

A

stones
hydronephrosis
fistulae
UTI

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19
Q

what are the extra-intestinal manifestations of UC in the biliary tract?

A

gallstones

sclerosing cholangitis

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20
Q

what are the extra-intestina lmanifestations of UC in the liver?

A

steatosis

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21
Q

what is the main problem within primary sclerosing cholangitis

A

fibrotic strictures within the biliary tree

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22
Q

what is the difference between crohn’s and UC in terms of the depth of wall they affect?

A

UC- mucosal inflammation

crohns- transmural inflammation

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23
Q

why can crohns lead to perianal disease?

A

recurrent abscess formation can lead to fistula with persistent leakage as well as damages sphincters

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24
Q

what will the symptoms of crohns be if the disease is within the small intestine?

A

peri-umbilical cramps
diarrhoea
weight loss

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25
Q

what will the symptoms of crohns be if the disease is within the colon?

A

lower abdomen cramps
bloody diarrhoea
weight loss

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26
Q

what will the symptoms of crohns be if the disease is within the mouth?

A

painful ulcers
swollen lips
angular chelitis

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27
Q

what will the symptoms of crohns be if the disease is within the anus?

A

peri-anal pain

abscess

28
Q

what is the difference between crohns and UC in terms of what happens to the wall? (macroscopically)

A

crohns- thickened wall with fat wrapping

UC- thinned wall with loss of haustra

29
Q

what complication can the thickened bowel wall with fat wrapping lead to?

A

stricture formation

30
Q

within crohn’s disease you get segmental areas of disease with intervening normal areas, what are these areas called?

A

skip lesions

31
Q

what type of IBD are granulomas seen in biopsy?

A

crohns

32
Q

what type of granulomas are seen in crohns?

A

non-caseating granulomas

33
Q

what are the main complications of Crohns disease?

A 
malabsorption
fistula
bowel obstruction
perforation
anal disease
intractable disease
malignancy
amyloidosis
34
Q

what is amylodisos?

A

accumulation of deposits of abnormally folded protein

35
Q

what are the 5 main theories of environmental triggers for crohns disease?

A 
smoking
infectious agents
NSAIDs
vasulitis
sterile environment theory
36
Q

What are the main complications of UC?

A 
blood loss
electrolyte distrubances (esp hypokalaemia)
extra-GI manifestations
colorectal carcinoma
toxic megacolon
intractable disease
37
Q

which inflammatory disease are fistulae common in?

A

crohn’s

38
Q

what lifestyle advice should you give to patients with Crohns disease?

A

stop smoking

39
Q

what are the main drug therapy options for UC?

A

5ASA (amino salicylates)
steroids
immunosuppressants
anti-TNF therapy

40
Q

what are the main drug therapy options for crohns disease?

A

steroids
immunosuppressants
anti-TNF therapy

41
Q

whare are the 2 main mechanisms of 5ASA action?

A

anti-inflammatory

reduces risk of colon cancer

42
Q

what are the side efects of 5AsA?

A

diarrhoea

nephritis

43
Q

what are the 2 ways of 5ASA administrations?

A

oral or topical

44
Q

5ASA are prodrugs, how do they become activated?

A

pH dependent release

45
Q

what are the ways of topical administration of 5ASA?

A

suppositories

enemas

46
Q

which is a better mode of topical therapy- suppositories or enemas?

A

suppositories- better mucosal adherence

47
Q

what are corticosteroids used for in IBD?

A

a short course over 6-8 weeks to induce remission

48
Q

when a more potent suppression of inflammation is required what do you used?

A

UC- steroid sparing agents eg azathioprine

Crohns- maintenance therapy eg methotrexate

49
Q

what is the onset of action of azathioprine like?

A

slow onset (16 weeks)

50
Q

what should you avoid prescribing when a patient is on azathioprine?

A

allopurinol

used to treat gout or kidney stones

51
Q

what are the 4 dangerous side effects of azathioprine?

A

pancreatitis
leukopaenia
hepatitis
lymphoma/skin cancer

52
Q

what are the 2 main anti-TNF therapies and how are the administered?

A

infliximab- IV

adalimumab- subcut injection

53
Q

what do anti-TNF therapies promote?

A

promote apoptosis of activated T-lymphocytes

54
Q

compare outcome of surgery for crohns to UC?

A

crohns- surgery isn’t curative

UC- surgery is curative

55
Q

what is the drug therapy pyramid for IBD?

A
  1. smoking cessation
  2. 5ASA (UC)
  3. steroids
  4. immunosuppresoin
  5. anti-TNF
56
Q

what is the onset of anti-TNF therapy like?

A

rapid onset

57
Q

what is a fistula?

A

an abnormal communication between two epithelial surfaces

58
Q

what are the 5 main indications for elective surgery in UC?

A 
medicallly unresponsive disease
intolerability
dysplasi/malignancy
growth retardation in children
attempted resolution of extra-intestinal disease
59
Q

what is the surgical options for UC?

A

elective proctocolectomy with either:

  • end ileostomy
  • pouch
  • ileorectal anastomosis
60
Q

compare a colostomy and ileostomy in terms of what side of the abdomen they are on?

A

ileostomy- right

colostomy- left

61
Q

compare a colostomy and ileostomy in terms of what comes out of them?

A

ileostomy- effluent

colostomy- stool

62
Q

how many times do patients who get a prcotocolectomy with pouch have bowel movements?

A

average 6 bowel movements per day

63
Q

what are the 6 main indications for surgery in crohns?

A
  1. stenosis causing obstruction
  2. enterocutaneeous fistula
  3. intra-abdominal fistulas
  4. abscesses
  5. acute/chronic bleeding
  6. free perforations
64
Q

what can a gastrojejunostomy be used for?

A

duodenal or pyloric stenosis

65
Q

what does a gastrojejunostomy allow?

A

allows food to bypass the stenosis (obstruction)

Gastrointestinal (15 decks)

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