2: Inflammatory Bowel Disease Flashcards
(99 cards)
1
Q
What are the two types of inflammatory bowel disease
A
Ulcerative Colitis
Crohn’s disease
2
Q
Where does UC affect
A
Large colon
3
Q
Where does Crohn’s disease affect
A
Entire GI tract - especially the terminal ileum
4
Q
Where does crohn’s disease most commonly affect
A
Terminal ileum
5
Q
Where is inflammation in UC
A
Confined to mucosa
6
Q
Where is inflammation in Crohn’s disease
A
Transmural
7
Q
What are two microscopic changes associated with UC
A
- Crypt abscesses
- Decrease goblet cells
8
Q
What are two macroscopic changes associated with UC
A
- Continuous inflammation
- Pseudopolyps
9
Q
What is a microscopic sign of crohn’s disease
A
- Non-cesating granuloma
10
Q
What are two macroscopic signs associated with crohn’s disease
A
- Discontinuous inflammation = cobblestonong
- Fistula
11
Q
What age does Crohn’s disease present
A
Bimodal:
- 13-30
- 60-80
12
Q
Which ethnicity is Crohn’s disease more common in
A
Ashkenazi Jews
13
Q
What are 3 RF for Crohn’s disease
A
- Smoking
- FH
- Appendectomy - increases risk post-op crohn’s
14
Q
What are 5 symptoms of crohns disease
A
- Colicky abdominal pain
- Diarrhoea - may contain blood or mucus
- Low-grade fever
- Anorexia
- Malaise
- Peri-anal disease
- Oral aphthous ulcers
- In late stages can present as malnourishment and failure to thrive
15
Q
What are 4 presentations of perianal disease associated with crohn’s
A
- Skin tags
- Skin fistulas
- Perianal abscess
- Bowel stenosis
16
Q
What are extra-intestinal manifestations of Crohn’s disease that affect the following
a. Joints
b. Skin
c. Eye
A
a. enteropathic arthritis (SI Joints)
b.
erythema nodosum
pyoderma gangrenosum
c.
Anterior Uveitis
Episcleritis
Iritis
17
Q
What is erythema nodosum
A
Inflammation subcutaneous fat - presents as tender erythematous nodules over the shins
18
Q
What is pyoderma gangrenosum
A
Usually on the lower limbs. Starts as a red papule then develops to have a necrotic base with vialaceous borders
19
Q
What investigations are ordered for all patients with Crohn’s disease
A
- Faecal calprotectin
- FBC
- CRP
- U+E
- Colonoscopy w/biopsy
20
Q
What does faecal calprotectin shown in Crohn’s disease
A
Raised
21
Q
How will FBC present in crohn’s disease
A
Microcytic anaemia
22
Q
How will U+Es present in Crohn’s disease
A
Low albumin
23
Q
How will CRP present in Crohn’s disease
A
Raised
24
Q
What is gold-standard investigation of Crohn’s disease
A
Colonoscopy and biopsy
25
What will colonoscopy with biopsy shown
- Cobblestonong (Skip Lesions)
| - Histologically: non-cesating granuloma
26
When is CT used and what does it show
Used in severe Crohn's disease to look for fistulas
27
When will examination under anaesthesia and protosigmoidoscopy be useful
If peri-anal disease is present
28
What is important for acute-flares of Crohn's disease and why
IV Fluids
Nutrition
LMWH - as crohn's puts individuals in a pro-thrombotic state
29
What is first-line medication to induce remission in Crohn's disease
Glucocorticoids
30
What glucocorticoids are used
Methylprednisolone
Prednisolone
Hydrocortisone
31
What is second-line to induce remission in Crohn's disease
5-ASA drugs, such as mesalazine
32
What is third-line to induce remission in Crohn's disease
Azathioprine or Metcartopurine
33
What needs to be assessed before giving aziothioprine
Thioprine methyl transferase levels (TPMT)
34
If individuals have low TPMT levels what can be given
Methotrexate
35
What is used as fourth-line for inducing remission in Crohn's disease
Infilximab
36
What are two indications for use of infliximab
Refractory crohn's
| Fistulas
37
What may be used to manage isolated peri-anal disease
Metronidazole
38
What is first-line to maintain remission in Crohn's disease
Azathioprine and Mercatopurine
39
If low TPMT activity, what may be an alternative to azathioprine to maintain remission
Methotrexate
40
What % of crohn's patients will have surgery
70-80
41
What are three indications for surgery in Crohn's disease
1. Refractory to medical therapy
2. Child with FTT
3. Complication
42
What is a common procedure offered to crohn's patients
Ileocaecal resection
43
What is used to manage peri-anal abscesses
Abscess drainage
44
What is stricutoplasty
Removal strictures in crohn's
45
Why are fistulas more common in crohn's
trans-mural inflammation - means more likely to be a fistula between adjacent structures
46
What fistulas can form in Crohn's disease
- Perianal (54%)
- Enteroenteric (24%)
- Enterovaginal (9%)
47
What is a stricture and the problem with it
Inflammation heals by fibrosis which can occlude the lumen resulting in obstruction.
48
What does Crohn's disease increase the risk of
Small bowel cancer
49
What can Crohn's disease in children cause
Failure to thrive
50
What is a long-term complication of steroid-use in crohn's disease
Osteoporosis
51
Why are gall stones more common in crohns disease
Crohn's disease reduces absorption of bile salts in the terminal ileum. Therefore disrupting concentration of bile leading to increased risk of gall stones.
52
Why are renal stones more common in Crohn's disease
Calcium - leads to malabsorption of fat in small bowel causing calcium to retain in lumen.
53
What is the most common form of IBD
Ulcerative colitis
54
What ethnicity is IBD more common
Caucascian
55
What age-group is IBD more common
15-25
| 55-65
56
What are the symptoms of ulcerative colitis
Left-quadrant abdo pain
Tenesmus
Blood diarrhoea
Urgency
57
How can attacks of ulcerative colitis be graded
Mild
Moderate
Severe
58
What are the following in mild UC
a. bowel movements
b. blood in stool
c. pyrexia
d. pulse >90
e. anaemia
f. ESR
a. <4
b. Minimal
c. No
d. No
e. No
f. <30
59
How many bowel movements define mild UC
< 4
60
What are the following in moderate UC
a. bowel movements
b. blood in stool
c. pyrexia
d. pulse >90
e. anaemia
f. ESR
a. 4-6
b. Mild
c. No
d. No
e. No
f. 30
61
What are the following in severe UC
a. bowel movements
b. blood in stool
c. pyrexia
d. pulse >90
e. anaemia
f. ESR
a. >6
b. Yes
c. Yes
d. Yes
e. Yes
f. >30
62
How many bowel movements define mild UC
<4
63
How many bowel movements define moderate UC
4-6
64
How many bowel movements define severe UC
>6
65
What are two biliary conditions associated with UC
- Primary sclerosing cholangitis
| - Cholangiocarcinoma
66
What is a joint condition associated with UC
- Enteropathic arthritis
67
What nail sign is associated with UC
Nail pitting
68
What eye signs are associated with UC
- Anterior Uveitis
- Episcleritis
- Iritis
69
Explain inflammation in UC
Inflammation starts at the rectum and works proximally in the large colon but does not pass the ileocaecal valve
70
What may repeat inflammation in UC lead to
Pseudopolyps
71
What investigations are ordered for UC
```
Faecal calprotectin
FBC
CRP/ESR
U+Es
Flexible sigmoidoscopy and biopsy
AXR
```
72
What will faecal calprotectin show
Raised
73
Why is stool MC+S still ordered in UC
To exclude infection
74
How will FBC present in UC
Anaemia
| Raised wCC
75
How will albumin present in UC
Low
76
How will CRP present in UC
Raised
77
What will flexible sigmoidoscopy and biopsy show
- Continuous inflammation
- Pseudopolyps
Biopsy:
- Crypt abscesses
- Mucosal inflammation
- Decrease goblet cells
78
Why is an AXR or CT ordered
Investigate for toxic megacolon in acute-exacerbation
79
How will UC present initially on AXR
Thumb-printing sign - due to oedema of mucosal wall
80
How will chronic UC present on AXR
Led-pipe colon
81
Why is a flexibly sigmoidoscopy ordered for UC, but colonoscopy ordered for crohn's
UC = confined to large-intestine.
Crohn's = entire GI tract.
82
What is proctitis
Inflammation of the rectum
83
What is first-line to manage proctitis in UC
Topical aminosalicyates (mesalazine)
84
What is second-line to manage proctitis in UC
Oral prednisolone + tacrolismus
85
What is tacrolismus
Calcineurin inhibitor
86
What is first-line to manage mild-moderate UC in GI tract
Oral aminosalicyates (mesalazine)
87
What is second-line to manage mild-moderate UC in GI tract
Oral prednisolone and tacrolismus
88
What is used to manage severe UC
IV glucocorticoids
89
If individual with severe UC does not respond to IV corticosteroids, what is the next step
Infliximab
90
What is given to maintain remission in UC as first line
Aminosalicylates - mesalazine
91
What is given to maintain remission in Crohn's first line
Azathiprone, Metcartopurine
92
What is second-line medication to maintain remission in UC
Infliximab
93
What does UC increase risk of
Colorectal cancer
94
Which individuals with UC should have colonoscopy surveillance
Disease >10years
| >1 segment bowel affected
95
What are 4 complications of UC
- Pouchitis
- Colorectal cancer
- Toxic megacolon
- Osteoporosis due to steroids
96
How will toxic megacolon present
Acute abdominal pain
Acute distention
Pyrexia
Absolute constipation
97
What sign are strictures in Crohn's disease called
Kantor string sign
98
What ulcers may be seen in crohn's disease
Rosethorn ulcers
99
What surgery is often offered to patients with Crohn's disease
Total protocolectomy with ileostomy
