142: IBD - Crohn's and Ulcerative Colitis

Question 1

abnormal immune response to gut flora (T2 cells and CD4).

Answer 1

Ulcerative Colitis

Question 2

uniform, diffuse inflammation of the mucosa

Answer 2

UC

Question 3

distorted crypts and loss of mucin production

Answer 3

UC

Question 4

bloody mucoid diarrhoea

Answer 4

UC

Question 5

UC affects which other parts of the body?

Answer 5

Liver: primary sclerosing cholangitis and cirrhosis
Joints: ankylosing spondylitis, arthritis, sacro-illitis
Eye: Uvitis and Episcleritis
Skin: Erythema nodosum, and pyoderma gangrenosum

Question 6

what is primary sclerosing cholangitis

Answer 6

inflammation of the bile ducts

Question 7

what is ankylosing spondylitis

Answer 7

inflammation of the spine

Question 8

NOD2 gene mutation

Answer 8

Crohn’s Disease

Question 9

Tissue damage following cell mediated immune response (granuloma - t1 cells surround macrophage)

Answer 9

CD

Question 10

pain, fever, diarrhoea, raised ESR and C-reactive protein, strictures causing obstruction,

Answer 10

CD

Question 11

Smoking and OCPill worsens

Answer 11

CD

Question 12

Smoking protects

Answer 12

UC

Question 13

skip lesions, fissures, fistula, cobble stoning

Answer 13

CD

Question 14

what is Meckel’s Diverticulum?

Answer 14

embryological remnant causing an out pouch of the distal ileum.

Question 15

what is Hirschsprung’s Disease?

Answer 15

ganglion cells migrate to the gut from the neural crest - i.e. lack of nerve bodies in the colon. collapsed rectum

Question 16

what is cystic fibrosis?

Answer 16

autosomal recessive disease = viscous secretions

Question 17

what is coeliac disease?

Answer 17

sensitivity to gluten, positive tissue transeglutaminase (TTG), villous atrophy, intra-epithelial lymphocytes.

Question 18

what is a volvulus?

Answer 18

twisting of sigmoid colon on its mesentery causing mass in the left iliac fossa, coffee bean sign.

Question 19

what is diverticulosis?

Answer 19

high luminal pressure leads to folds of mucosa pushed out through weaknesses in muscle.

Question 20

first line treatment for UC?

Answer 20

Aminosalicyltes e.g. Mesalazine

Question 21

name an aminosalicylate…

Answer 21

mesalazine

Question 22

aminosalicylate mechanism of action…

Answer 22

inhibits infllammatory mediators: prostaglindins, thromboxane, platlet activiating factor. scavenger of oxygen-radicals

Question 23

adverse effects of mesalazine.

Answer 23

diarrhoea, headache, nausea, rash. ( monitor renal function)

Question 24

what do mineralocorticoids do?

Answer 24

affect water and electrolyte balance

Question 25

what do glucocorticoids do?

Answer 25

affect proteins and carbohydrate metabolism, anti-inflammatory and immunosupressive activity

Question 26

what are NF-KB ad AP-1

Answer 26

Nuclear Factor Kappa light chain enhancer of activated B cells and Activator Protein 1 DNA transcription of cytokines

Question 27

what act on NF-KB and AP-1 ?

Answer 27

corticosteroids

Question 28

adverse effects of cortocosteroids?

Answer 28

buffalo hump, thinning of skin, thin arms with increased abdofat, osteoporosis, poor wound ehaling and easy bruising, moonfaced, cataracts.

Question 29

name some oral corticosteroids...

Answer 29

prednisolone, budesonide, beclometasone

Question 30

IV corticosteroid...

Answer 30

Hydrocortisone

Question 31

topical corticosteroid...

Answer 31

hydrocortisone and predisolone.

Question 32

what do thiopurines do?

Answer 32

Immunosuppressive drugs, deactivating key processes in T lymphocytes that lead to inflammation.

Question 33

name some thiopurines...

Answer 33

azathipprine, 6-mercaptopurine

Question 34

when do you use thiopurines?

Answer 34

severe or frequent relapses

Question 35

adverse effect of azathioprine...

Answer 35

bone marrow suppression, leukopenia and hepatotoxicity.

Question 36

What is ciclosporin?

Answer 36

immunosuppressant ( via T cells)

Question 37

what is methotrexate?

Answer 37

antifolate, antimetabolite. inhibit cytokine and eicosanoid ( prostaglandin, leukotrines, thromboxanes)) synthesis

Question 38

adverse effects of ciclosporin...

Answer 38

hypertension, renal impairments, increased seizure risk, gum hypertrophy.

Question 39

what is eicosanoid?

Answer 39

local hormones such as prostaglandin

Question 40

adverse effects of methotrexate...

Answer 40

Nausea, vomiting, diarrhoea. | hepatotoxicity

Question 41

what is infliximab?

Answer 41

anti TNF antibody.

Question 42

which tnf alpha inhibitor is used in crown's only?

Answer 42

adalimumab - subcut injection.

Question 43

first choice in Crohn's initially

Answer 43

corticosteroids - predisolone. | then move to azathioprine or monoclonal antibodies