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GI (Semester 4) > 7.2 Inflammatory bowel disease > Flashcards

7.2 Inflammatory bowel disease Flashcards

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1
Q

What defines IBD

A

A group of related conditions characterized by idiopathic inflammation of GIT

Conditions that cause macroscopic inflammation.

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2
Q

What are the 2 main non-specific IBDs?

What part of the GIT do they normally affect?

A

1) Ulcerative Colitis: only large bowel

2) Crohns Disease: small and or large bowel

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3
Q

Give 4 other causes of Colitis

A
  • Drugs esp NSAIDs
  • Ischaemic colitis
  • Radiation colitis
  • Diverticular colitis
  • Microscopic colitis
  • Collagenous colitis
  • Infectious colitis
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4
Q

What are the 3 mains causes of IBD

A

1) Genetic susceptibility
2) Immune dysregulation
3) Environmental trigger

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5
Q

Give 4 triggers of IBD

A 
Antibiotics
Diet
Acute Infections
NSAIDs
Smoking 
Stress
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6
Q

What is Crohn’s disease?

A

Chronic relapsing and remitting inflammatory disease of the digestive tract

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7
Q

What are the characteristics of Crohn’s disease

A
  • Asymmetric
  • Transmural involvement of the bowel wall
  • Chronic Inflammatory process with non-caseating granulomas
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8
Q

Where are granulomatous infections seen in Crohn’s most commonly located

A

Frequently affects terminal ileum (but can affect any part of the GI tract)

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9
Q

What are the 2 main histological features of Crohn’s

A

1) Large epitheloid granulomas

2) Multinucleated giant cells

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10
Q

Compare the association with autoimmune disease in Crohn’s vs UC

A

UC: strong association with autoimmune disease eg hashimoto’s thyroiditis, SLE

Crohns: weak association with autoimmune disease

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11
Q

Compare the association with autoantibody production in Crohn’s vs UC

(Humoral component)

A

UC: common associated with autoantibody production eg anticolon antibody, perinuclear antineutrophil cytoplasmic antibody (pANCA)

Crohn’s: rare association with autoantibody production

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12
Q

Compare the Mucosal infiltration in Crohn’s vs UC

cell-mediated component

A

UC: Non granulomatous and neutrophil prominent

Crohn’s: Granulomatous and T cells prominent

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13
Q

Compare the T-cell reactivity in Crohn’s vs UC

cell-mediated component

A

UC: Normal or decreased

Crohn’s: Increased

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14
Q

List the clinical features of Crohn’s

A
  • Diarrohea (chronic or nocturnal)
  • Abdominal pain
  • Weight loss
  • Fatigue
  • Anorexia or fever
  • Abdominal mass or tenderness
  • Intestinal obstruction
  • May present with acute onset abdominal pain
  • May mimic appendicitis
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15
Q

What is Ulcerative colitis

A

Chronic inflammation of part or the whole of the mucosa of the large bowel, diffusely inflamed and may ulcerate

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16
Q

What are the characteristics of UC

A
  • only effects the colon (usually starts in rectum and extends proximally)
  • continuous inflammation– no skip lesions (symmetrical)
  • Circumferential
  • Uninterrupted pattern
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17
Q

What parts of the GI tract does UC affect

A

The colon, Inflammation effects only the mucosa and submucosa

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18
Q

What are the 3 types of pattern of distributions seen in UC

A

1) Proctitis (rectum)
2) Left sided colitis (extends from the rectum up the colon and stops at the splenic flexure)
3) Pancolitis (entire large intestine)

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19
Q

What is the aetiology is UC/ what is a potential theory?

A

aetiology is unclear

theory: autoimmune disease caused by an inflammatory response to normal colonic microflora

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20
Q

What are the 3 main histological features of UC

Study These Flashcards
A

1) Intense inflammatory cell infiltrate of the lamina propria
2) Goblet cell depletion
3) Crypt abcesses

21
Q

List 4 other types Inflammatory Bowel diseases?

Study These Flashcards
A

1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis

22
Q

what is the link between non-smokers and UC?

What is another thing that reduces risk of UC?

Study These Flashcards
A

x3 more common in NON smokers

Appendecctomy before age 20

23
Q

List 4 clinical features of UC?

Study These Flashcards
A
  • Bloody diarrohea
  • Urgency
  • Tensemus
  • Nocturnal defecation
  • Crampy abdominal pain or ache in left iliac fossa
  • Pre-defactation pain relieved by passing stools
24
Q

Tensemus is a clinical feature of UC, what does this mean?

Study These Flashcards
A

a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness

25
List 4 UC clinical SIGNS?
* Pallor * Dehydration * Mouth ulcers * Abdominal tenderness
26
List 4 conditions associated with UC?
* Erythema Nodosum * Pyoderma gangrenosum * Uveitis * Arthritis
27
In brief sentences how would you compare Crohn's vs UC
Crohns Disease (CD) is a condition of chronic inflammation potentially involving any location of the GIT from mouth to anus in a discontinuous manner. Ulcerative Colitis (UC) is an inflammatory disorder that affects the rectum (in 90% pts) & extends proximally in continuity to affect a variable extent of the colon.
28
What are the 2 main early findings of Crohn's disease
1) Aphthous ulcer | 2) The presence of granulomas
29
What are 4 main late findings of Crohn's disease
1) Linear ulcers 2) The classic cobble stoned appearance may arise 3) Transmural inflammation 4) Sinus tracts, and strictures 5) Fibrosis.
30
UC can be classified as specific and non-specific, what do these mean?
Non-specific -> seen with any acute inflammation | Specific -> suggest chronicity
31
Describe 3 things that would be seen in non-specific UC
1) The lamina propria becomes oedematous. 2) Inflammatory infiltrate of neutrophils 3) Neutrophils invade crypts, causing cryptitis & ultimately crypt abscesses.
32
Describe 3 things that would be seen in specific UC
1) Distorted crypt architecture 2) crypt atrophy 3) a chronic inflammatory infiltrate
33
What is Toxic megacolon? | List a complication of Toxic Megacolon and its prognosis?
TM is a serious side effect of IBD: transverse colon becomes extremely dilated (above 6cm) resulting in ineffective function and serious infection. Complication: perforation and rupture which can lead to peritonitis (in the presence of steroids physical signs may be absent) Prognosis: four to five percent mortality without perforation and about 20% with perforation
34
List in order the treatment plan for IBD patients
1) 5-ASAs eg. Mesalazine 2) Steroids (short term) and Azathioprine (long term) 3) Clylosporine/ Infliximab 4) Surgery (then Probiotics, alternative therapies, antibiotics)
35
What is thumb printing and what does it indicate?
Radiological sign: thickening at regular intervals throughout lumen which appear like thumb prints TMC Indicative of Crohn's
36
What is the Fat Halo sign and what does it indicate?
CT scan: infiltration of the mucosal layer of the fat causing a halo around it Indicative of Crohn's
37
What is Mesalazine (also known as mesalamine) and what is its mode of action
- also known as 5-aminosalicylic acid (5-ASA) it is a derivative of salicylic acid - more effective in UC than Crohns - used for IBD maintenance Mode of Action: mesalazine is thought to be an antioxidant that traps free radicals
38
List 4 side effects of Mesalazine
- renal impairment - diarrhoea - allergy - hepatitis - myopericarditis
39
What is the mode of action of steroids in use of IBD treatment? What is its route of administration?
- Potent anti inflammatory actions via multiple inflammatory pathways - used to obtain control in active disease (more effective than 5 ASA) Route of administration: Oral / Topical / IV
40
List 4 side effects of Thiopurines
- Allergic ( fever, arthralgia, rash) - Hepatoxic, - Bone marrow toxicity - long term .... malignancy Need regular monitoring of bloods FBC / LFT
41
List 4 side effects of Thiopurines
- Allergy - Hepatoxic - Bone marrow toxicity - long term .... malignancy Need regular monitoring of bloods FBC / LFT
42
What is the mode of action of Methotrexate in use of IBD treatment? When would you use it and at what dose?
Mode of action: inhibits dihydrofolate reductase hence cytotoxic BUT its anti inflammatory action is by inhibiting cytokine and eicosanoid synthesis. Use: second line drug of azothioprine failes or is not tolerated. Dose: Once weekly with folic acid
43
List 4 side effects of Methotrexate
Short term: nausea, diarrhoea Long term : hepatoxicity, pneumonitis Note: Very Teratogenic
44
What is the Mode of action of calcineurin inhibitors? Give an example of one How is it administered?
eg. Ciclosporin and Tacrolimus Mode of action : inhibition of calcineurin which inhibits clonal expansion of T cell subsets Administration : IV or oral Only beneficial As a rescue therapy in severe UC (no effect in Crohn's)
45
Give 4 side effects of calcineurin inhibitors
``` minor tremor paraesthesia hirutism major seizures if low cholesterol or magnesium renal ```
46
List 2 Biological Therapies that can be used in treatment of IBDs
1) Infliximab and Adalimumab | 2) Etanercept
47
What is TNF-α
TNF-α is a chemical messenger (cytokine) and a key player in the inflammatory process involved in IBD.
48
What is the mode of action of Infliximab and Adalimumab?
Infliximab and Adalimumab are monoclonal antibodys targeting tumour necrosis factor α (TNF-α). Infliximab works by binding to TNF-α and preventing it from binding to receptors involved in the inflammatory process
49
What is the mode of action Etanercept?
Etanercept is a recombinant human TNF receptor fusion protein It inhibits the binding of TNF to its cell surface receptor

GI (Semester 4) (19 decks)

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