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GI > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is Crohns disease

A

Chronic inflammation and ulcerating condition of GI tract that can affect anywhere from mouth to anus

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2
Q

How does Crohns disease present

A

Abdominal pain, small bowel obstruction, diarrhoea, bleeding PR, anaemia, weight loss

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3
Q

Typical presentation of Crohns

A

21-year-old male patient, abdominal pain with bloody diarrhoea for 3/12 and a tender abdomen

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4
Q

Investigating Crohns

A

Endoscopy and mucosal biopsy

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5
Q

Endoscopic pattern of Crohns

A

Patchy, segmental disease with skip area (lesions) anywhere in GI tract

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6
Q

Histological appearance of Crohns

A

Increased chronic inflammatory cells in lamina propria and crypt branching with non-caeseating granulomas

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7
Q

TB vs Crohns histologically

A

TB has caeseating granulomas whereas Crohns are non-caeseating

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8
Q

Mucosa in Crohns can be described as

A

Cobblestone appearance due to deep fissures

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9
Q

Layers affected in Crohns

A

Transmural, effecting all the layers

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10
Q

What is ulcerative colitis (UC)

A

Chronic inflammatory disorder of rectum upto colon

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11
Q

What layers are affected in UC

A

Mucosa and submucosa

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12
Q

Who are more affected

A

30 year old male

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13
Q

Presentation of UC

A

Diarrhoea
Mucous
Bloody PR

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14
Q

Endoscopic pattern of UC

A

Diffuse continuous disease almost always involving the rectum

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15
Q

Histological findings of UC

A

Basal lymphoplasmacytic infiltrate with irregular shape branching crypts and acute cryptitis or crypt abscess

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16
Q

Does UC have granulomas

A

No

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17
Q

Complications of UC

A 
Toxic megacolon
Colorectal carcinoma
Anaemia due to blood loss
Electrolyte disturbance (hypokalaemia)
Anal fissures (not common)
Uveitis
Primary sclerosing cholangitis
Arthritis, ankylosing spondylitis
Pyoderma gangrenosum, Erythema nodosum
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18
Q

Complication of Crohns

A 
Malabsorption
Fistulas
Anal disease
Bowel obstruction
Perforation
Malignancy
Amyloidosis
Rarely toxic megacolon
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19
Q

Is smoking associated with UC

A

No. it is with Crohns

20
Q

Lifestyle advice for Crohns

A

Smoking aggravates Crohns

Diet not implicated in pathogenesis but can influence symptoms

21
Q

Therapy options for UC

A

5-ASA or Mesalazine
Steroids
Immunosuppresants
Anti-TNF therapy

22
Q

Therapy options of Crohns

A

Steroids
Immunosuppresants
Anti-TNF therapy

23
Q

Topical corticosteroids

A

Budesonide. Initial high dose and reduce over 6-8 weeks

24
Q

Azathioprine should not be prescribed with?

A

Allopurinol (XO inhibitor); decrease high blood uric acid levels

25
Q

What contributes to Azathioprine toxicity

A

TMNT - Thiopurine methyltransferase

26
Q

Anti-TNF therapy for IBD

A

IV infusion - Infliximab
S/C injection - Adalimumab
Reduces remission after single infusion. Duration of remission is 8-12 weeks after which re-treatment maintains remission.

27
Q

Side-effects of TNF-a therapy

A

Infections, cancer risk

28
Q

Surgery for Crohns

A

Minimise amount of bowel resected, not curative and might require repeat resections that can result in short gut syndrome

29
Q

What is proctolectomy

A

Surgical removal of rectum and part/all of the colon

30
Q

Surgery for UC

A

Generally curative by proctolectomy and pouch or permanent ileostomy.

31
Q

Most established risk factor for IBD

A

Genetics

32
Q

Inflammatory bowel disease and gut flora

A

Antibiotics are effective in treatment of peri-anal Crohns disease. Altered bacterial flora is seen in UC

33
Q

Disease susceptibility gene located on chromosome 16q12

A

NOD2/CARD15

Encodes a protein involved in bacterial recognition. Defect of this found in caucasian patients with Crohns disease

34
Q

Crohns vs UC in antimicrobial activity of gut

A

Reduces in Crohns, relatively unchanged in UC

35
Q

Extent of UC disease

A

Proctitis - Lining of rectum (36%)
Left-sided colitis - Till splenic flexure (27%)
Pancolitis - Entire colon (37%)

36
Q

Main symptoms of UC

A

Diarrhoea + Bleeding

37
Q

What constitutes severe UC

A 
> 6 bloody stools / 24 hours and one of the following -
Fever (>37.8)
Anaemia (Hb < 10.5g/dl)
Tachycardia (>90 beats/min)
Elevated ESR (>30 mm/Hr)
38
Q

What is ESR and what does it signify

A

ESR - Erythrocyte sedimentation rate. Elevated in inflammation but also in anaemia, infection, pregnancy and ageing.

39
Q

Mucosal oedema due to inflammation in IBS shows as what on AXR

A

Thumbprinting sign - Haustra become thickened at regular intervals appearing like thumbprints

40
Q

What can be found upon endoscopy

A

Used to define extent of inflammation
Loss of blood vessel pattern to a messy collection
Granular mucosa
Contact bleeding may be present

41
Q

Extra-intestinal manifestations of IBD

A

Skin - Erythema nodosum and pyoderma gangrenosum
Joints - Spondylitis, sacrolitis, arthritis
Eyes - Uveitis, episcleritis
Liver - LFT’s deranged, steatosis, sclerosing cholangitis

42
Q

What is primary sclerosing cholangitis

A

Chronic inflammation of biliary tree

43
Q

Symptoms of primary sclerosing cholangitis

A

Mainly asymptomatic, may have itch and rigors

May develop into cholangiocarcinoma

44
Q

How can Crohns affect the anus

A

Development of peri-anal disease which includes recurrent abscess formation, pain, fistula with persistent leakage and damaged sphincters

45
Q

Endoscopy findings on Crohns vs UC

A

Crohns has cobblestone appearance whereas UC has pseudopolyps

46
Q

How can small bowel be assessed for Corhns

A

Barium follow through
Small bowel MRI
Technetium-labelled white cell scan; white cells are labelled which allows the operator to see inflamed part

GI (32 decks)

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