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07. Year 2: Alimentary System > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is inflammatory bowel disease?

A

Chronic, relapsing, remitting inflammation of the GI tract

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2
Q

What are examples of inflammatory bowel disease?

A

Crohn’s disease

Ulcerative colitis

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3
Q

What do Crohn’s disease and ulcerative colitis differ in?

A

Location and inflammation

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4
Q

When does inflammatory bowel disease commonly present?

A

In the teens and twenties

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5
Q

What can IBD be due to?

A

Genome

Microbiome

Environment

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6
Q

Is IBD medelian inherited?

A

No, but has genetic susceptibility

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7
Q

What kind of genetic variation makes people genetically susceptible to IBD?

A

SNPs (single nucleotide polymorphisms)

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8
Q

What percentage of someones offspring who has IBD will also develop IBD?

A

10%

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9
Q

What do genes that cause inflammatory bowel disease regulate?

A

Epithelial barrier

Immune response

Bacterial handling

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10
Q

What is the pathogenesis of IBD?

A

Pathogenic gut causes altered microbiota

Damaged epithelial barrier increases bacterial adhesion and translocation

Chronic inflammation occurs

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11
Q

What is the ratio of microbial cells in the gut lumen to eukaryotic cells in the human body?

A

10:1

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12
Q

How many different species of bacteria are present in the gut?

A

At least 500 different species

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13
Q

What is the metabolic activity of all gut bacteria equivalent to?

A

That of the liver

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14
Q

What part of the gut contains the most bacteria?

A

Colon

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15
Q

What is different in the microbiota of people with IBD compared to those without?

A

In IBD there is a dysbosia in microbial communities

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16
Q

What kind of bacteria is massively more present in people with IBD than those who do not have it?

A

Proteobacteria

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17
Q

What is ulcerative colitis?

A

Chronic condition where the colon and rectum become inflammed

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18
Q

How does ulcerative colitis affect males compared to females?

A

Both affected the same

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19
Q

What are symptoms of ulcerative colitis?

A

Blood diarrhoea

Abdominal pain

Weight loss

Fatigue

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20
Q

What investigations are done for ulcerative colitis?

A

Bloods for markers of inflammation

Stool culture to rule out infection

Faecal calprotectin

Colonoscopy and colon mucosal biopsies

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21
Q

What are examples of markers of inflammation checked for in ulcerative colitis?

A

Normocytic anaemia

Increased CPR/platelets

Low albumin

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22
Q

What is considered normal faecal calprotectin?

A

<50ug/g of stool

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23
Q

What is considered elevated faecal calprotectin?

A

>200ug/g of stool

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24
Q

What is faecal calprotectin?

A

Substance that is released into the intestines when inflammation is present

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25
Q

Where in the GI tract is inflammation due to ulcerative colitis present?

A

Only in the colon, starting at the rectum and working proximally

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26
Q

What percentage of people with ulcerative colitis require a colectomy within 10 years of diagnosis?

A

20-30%

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27
Q

What are the different levels of severity of ulcerative colities?

A

Mild

Moderate

Severe

Fulminant

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28
Q

What are characteristics of mild ulcerative colitis?

A

<4 stools/day

With or without blood

Normal ESR

No signs of toxicity

29
Q

What are characteristics of moderate ulcerative colitis?

A

4-6 stools/day

Occasional blood

Minimal signs of toxicity

CRP less than or equal to 30mg/L

30
Q

What are characteristics of severe ulcerative colitis?

A

More than or equal to 6 blood stools/day

AND any of:

temperature > 37.8

tachycardia > 90bpm

anaemia (Hb < 105g/L)

ESR > 30mm/h, CRP > 30mg/L

31
Q

What are characteristics of fulminant colitis?

A

10 stools/day

Continuous bleeding

Toxicity

Abdominal tenderness or distention

Transfusion requirement

Colonic dilation on x-ray

32
Q

What is proctitis?

A

Condition where lining of tissue in inner rectum becomes inflammed

33
Q

What is stool like with proctitis?

A

Frequency, urgency, incontinence

Small volume mucus, blood

Constipation

34
Q

What does proctitis respond to?

A

Topical therapy

35
Q

What percentage of mortality does acute severe colitis have?

A

2%, very serious condition

36
Q

What percentage of people with acute severe colitis get an emergency colectomy at admission?

A

20-30%

37
Q

What do patients with acute severe colitis often look like?

A

Well

Self-caring

Mobilising around ward

Often young with physiogical reserve

38
Q

What is the main differential of acute severe colitis?

A

Infection

39
Q

What must be done within the first 24 hours of a patient being admitted with acute severe colitis?

A

IV glucocorticosteroids

LMWH

Abdomen x-ray

IV hydration

Stop non-steroidal analgesics, opiates, anti-diarrhoels, anti-cholinergics

Stool chart

Stool culture for C. Difficile

40
Q

Why are patients with acute severe colitis given LMWH?

A

They are at 3x increased risk of thromboembolism

41
Q

What is Crohn’s disease?

A

Inflammatory bowel disease that causes inflammation in the digestive tract

42
Q

Where can Crohn’s disease occur?

A

Anywhere in the GI tract from mouth to anus

Patchy disease (skip lesions)

Clinical features depend on regions involved

43
Q

What are possible complications of Crohn’s disease?

A

Inflammation

Stricture

Fistula

44
Q

What are clinical features of Crohn’s disease?

A

Diarrhoea

Abdominal pain

Weight loss

Malaise, lethargy, anorexa, nausea and vomiting, low grade fever

Malabsorption (anaemia, vitamin deficiency)

45
Q

What investigations are done for Crohn’s disease?

A

Blood for markers of inflammation

Stool culture to rule out infection if dirrhoea

Faecal calprotectin

Colonoscopy with terminal ileum intubation and colon mucosal biopsies

MRI small bowel study

Capsule endoscopy

Occasionally CT if acutely unwell and want to rule out complications such as abscess

46
Q

What are differences in the histology of Crohn’s disease and ulcerative colitis?

A

Granulomas in CD

Transmural inflammation in CD

Mucosal in UC

Goblet cells depleted in UC

Crypt abscesses more likely in UC than CD

47
Q

What does PCD stand for?

A

Perianal Crohn’s disease

48
Q

What is perianal Crohn’s disease?

A

Inflammation at or near the anus

49
Q

What are symptoms of perianal Crohn’s disease?

A

Perianal pain

Pus secretion

Unable to sit down

50
Q

What investigations are done for perianal Crohn’s disease?

A

MRI pelvis

Examination under anaesthetic

51
Q

What is the treatment for perianal Crohn’s disease?

A

Surgery to drain abscess

Antibiotics and biological therapy (anti-TNF)

52
Q

What must be considered by IBD differential diagnosis?

A

Chronic diarrhoea

Ileocaecal TB

Colitis must also be distinguished from infective and amoebic and ischaemic colitis

53
Q

What does chronic diarrhoea cause?

A

Malabsorption

Malnutrition

54
Q

What is a possible long term complication of colitis?

A

Colonic carcinoma

55
Q

How do different kinds of colitis change the risk of colonic carcinoma?

A

Pancolitis 26x normal

Left colitis 6x normal

Proctitis minimal

56
Q

What is done for IBD management?

A

Colorectal surgeon with IBD specialist interest

Weekly IBD MDT

Dedicated colonoscopy lists for surveillance

Direct communication between GP and consultant

IBD specialist nurse telephone hotline

Nurse led infusion clinic every 3 weeks

IBD pharmacist

57
Q

What kind of approach does management of IBD use?

A

Step up approach

58
Q

What medication is given to treat Crohn’s disease by reducing inflammation?

A

Aminosalicylates

59
Q

What are aminosalicylates?

A

Family of medications with various formulations that deliver active ingredient, mesalamine, to target sites

60
Q

What is the abbreviation for aminosalicylates?

A

5-ASA

61
Q

How do amionsalicylates work?

A

Blocking prostaglandins and leukotrienes

62
Q

Is 5ASA effective with both ulcerative colities and Crohn’s disease?

A

No, only with ulcerative colitis

63
Q

When is rectal 5-ASA given?

A

For distal and left sided Crohn’s disease

64
Q

What do steroids induce in Crohn’s disease and ulcerative colitis?

A

Remission

65
Q

What are examples of steroids used to IBD?

A

Prednisolone

Budenoside

66
Q

What is an example of an immunomodulation therapy for IBD?

A

Azathioprine

67
Q

What are side effects of azithioprine?

A

Leucopenia

Hepatotoxicity

Pancreatitis

68
Q

What biological agents are used for IBD?

A

Anti-ANFa antibodies

A4b7 integrin blockers

69
Q

Explain each of the steps up in management of IBD?

A

1) 5-ASA
2) Steroids (prednisone or budesonide)
3) Immunomodulators
4) Biologic agents
5) Surgery

07. Year 2: Alimentary System (41 decks)

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