Week 5 - Inflammation Pt 1 (all IBD screencasts)

Question 1

Aetiology

What are the two (chronic) GI inflammatory diseases?

Answer 1

Crohn’s Disease (CD)
Ulcerative Colitis (UC)

Question 2

Describe the differences between Crohns D and Ulcerative colitis

Answer 2

**1. Where it affects: **
CD - All parts of GI tract ( mouth to rectum)
UC- Only Colon and rectum

2. Inflammation sites:
CD - Inflammation extends through all 4 layers of the gut wall (Mucosa , submucosa , Muscularis externa & serosa)

UC- Inflammation extends as far as mucosa and submucosa

**3. Inflammation pattern: **

CD- Patchy distribution
UC- Diffuse in distribution

Question 3

Epidemiology

What ages is IBD prevelant in ?
How prevelant is IBD in the UK?

Answer 3

Peak incidence - 10-40yrs
1/250 ppl in UK

Question 4

Epidemiology

What is the prevelance of Crohn’s Disease and Ulcerative Colitis?

Answer 4

UC more common than CD

CD- ( typically at a younger age - slightly common F>M)

UC- ( Typically at an older age - slightly common M>F)

Question 5

Aetiology

What are the possible contributing factors to IBD onset?

Answer 5

** Environmental :**
- Diet
- smoking
- infection
- Drugs
** - Genetic **

Question 6

Aetiology

Describe how diet affects IBD onset?

Answer 6

• Typically a ‘western’ diet of high fat, milk and fibre content has been associated with exacerbating symptoms e.g gas
• particular foods may vary from person to person

Question 7

Describe how smoking (environmental factors) affects IBD onset?

Answer 7

• worsens prognosis of the disease
• increases relapse risk and surgery requirement
• **HOWEVER ** smoking may help prevent UC onset as the chemical including tobacco which can lower cytokine levels ( and therefore inflammation )

Question 8

Describe how Infection affects IBD onset?

Answer 8

– Exposure to Mycobacterium paratuberculosis can cause CD

– UC can occur after episode of infective diarrhoea,
* No definite association with a single infective agent*

– Association with measles & mumps infections

– Possibly immune system does not switch off after infection leading to autoimmunity

Question 9

Aetiology

Describe Enteric Microflora affects IBD onset?

Answer 9

– IBD patients - loss of immunological tolerance to intestinal microflora

– Can be manipulated by antibiotics, probiotics and prebiotics to balance favourably

Question 10

Describe Drugs affects IBD onset?

Answer 10

**NSAIDs can exacerbate IBD **
- Inhibit the synthesis of cytoprotective prostaglandins
– Antibiotics can change enteric microflora
* Precipitate a relapse
– Oral contraceptive pill
* Increase risk of developing CD
* Possibly caused by vascular changes
**– Isotretinoin **– for acne – possible risk factor`

Question 11

Aetiology

Describe how genetic factors can contribute to IBD onset

m

Answer 11

Genetic factors influence the risk of IBD by causing:
– Disruption of epithelial barrier integrity
genetics

– Deficiencies in innate pattern recognition receptors
– Problems with lymphocyte differentiation, especially CD

-Inappropriate response of the immune system in the mucosa of the
G.I tract to normal enteric flora

Question 12

Describe the pathophysiology of CD and what parts it affects

Answer 12

• Affects ileum and ascending (start) colon
• Discontinuous inflammation
• Deep ulcers
• Cobblestone appearance

Question 13

Describe the pathophysiology of UC

Answer 13

• Affects the the whole colon from the rectum
• bleeds easily

Question 14

What are the symptoms of CD

Answer 14

• abdominal pain
• anaemia
• abcesses
• fistula

Question 15

Name the distinguishing factors of CD ( exclusive to CD and not UC)

Answer 15

• Patchy inflammation
• cobblestone mucosa
• Transmural involvement
• not common in the rectum
• fistulas common

Question 16

What 4 complications come with IBD

Answer 16

Joints and bones - Osteopenia

Skin -

Begins to become tender hot red nodules
skin discolouration

Ocular - intense burning of blood vessels

Question 17

What tests can be done to diagnose CD?

Answer 17

Endoscopy