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1st year GI > IBD > Flashcards

IBD Flashcards

1
Q

what are the 2 idiopathic chronic inflammatory diseases that make up IBD

A
  • Crohns disease’s

- ulcerative colitis

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2
Q

what is crohns disease

A

lifelong condition where parts of the digestive tract become inflamed

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3
Q

what is ulcerative colitis

A

inflammation of the lower end of the digestive system, including large bowel and rectum

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4
Q

what is the aetiology of crohns disease

A
  • immune system
  • heredity (NOD2 and CARD15 -encodes a protein involved in bacterial recognition )
  • the environment - smoking aggregates crohns but protects against UC, NSAIDS
  • intestinal microbiota - enhanced level of antimicrobial activity
  • host immune response
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5
Q

what is the distribution like in crohns disease

A
  • can affect any region of GI tract from mouth to anus
  • skip lesions
  • transmural inflammation
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6
Q

what are symptoms of crohns disease in the small intestine

A
  • abdominal cramps (periumbilical)
  • diarrhoea
  • weight loss
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7
Q

what are symptoms of crohns disease in the colon

A
  • abdominal cramps ( lower abdomen )
  • diarrhoea with blood
  • weight loss
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8
Q

what are symptoms of Crohns disease in the mouth

A
  • painful ulcers
  • swollen lips
  • angular chielitis
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9
Q

what are symptoms of Crohns disease in the anus

A
  • peri-anal apin

- abscess

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10
Q

what further assessments of Crohns should be done

A
  • examination : evidence of weight loss, Right iliac fossa, peri-anal signs
  • bloods : CRP, albumin, platelets, B12, ferritin (Deficient in iron), FBC
  • stage the disease extent
  • stool test including a c.difficile toxin assay
  • colonoscopy if colonic involvement suspected
  • upper GI endoscopy to exclude oesophageal and gasproduodenal disease
  • small bowel imaging
  • ultrasound scanning
  • perianal MRI
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11
Q

what are the therapeutic strategies to managing Crohns

A
  • lifestyle advice
  • smoking aggregates Crohns
  • drugs
  • all therapies have an anti inflammatory effect
  • surgery
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12
Q

what is the aims of management of Crohns

A

to induce and then maintain clinical remission and to achieve mucosal healing in order to prevent disease progression and complications

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13
Q

how is remission introduced for Crohns

A

Glucacoisteroids

  • used in moderate and severe attacks of Crohns
  • mild to moderate ileoceacal disease should be treated with controlled release of corticosteroid (Budesonide)

Aminosalicylates

Antibiotics
- used for treating secondary complications of CD

Exclusive enteral nutrition
- traditional treatment for moderate to severe attacks of CD in paediatric practice

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14
Q

how is remission maintained for Crohns

A

Conventional maintenance therapies

  • Azathioprine, Mercaptopurine and Methotrexate
  • the long term treatment with these drugs is needed as the rate of relapse on discontinuation is high

Anti-TNF agents

  • Infliximab, Adalimumab
  • reduces inflammation
  • used with patients who have a poor prognosis
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15
Q

what is the surgical management for Crohns

A
  • minimise amount of bowel respected
  • not curative
  • repeated resection of small intestine can lead to ‘short gut’ and requirement of lifelong total parenteral nutrition
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16
Q

what does UC disease effect

A
  • only ever effects the large bowel and always starts at the rectum
17
Q

what areas can UC effect

A
  • only rectum = proctitis
  • rectum, up the splenic lecture and descending colon = left sided colitis
  • whole colon and rectum = pancolitis
18
Q

what are symptoms of UC

A
  • diarrhoea and bleeding
  • increased bowel frequency
  • urgency
  • tenesmus (cramping rectal pain)
  • incontinence
  • night rising
  • lower abdominal pain
  • toxic megacolon
19
Q

what is classified as severe UC

A

> 6 bloody stools in 24 hours and 1 or more of

  • fever
  • tachycardia
  • anaemia
  • elevated ESR
20
Q

what further assessment is done for UC

A

Bloods

  • c reactive protein
  • albumin
  • platelets

Plain AXR
Endoscopy
Histology

21
Q

what is seen in an endoscopy of UC

A
  • confluent inflammation extending proximally from anal margin to a ‘transition’ zone
  • loss of vessel pattern
  • granular mucosa
  • contact bleeding
22
Q

what is primary sclerosis cholangitis

A

is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder.

23
Q

what is medical management for UC

A
  • Aminosalicylates, also known as 5-ASAs, are medicines that help to reduce inflammation
  • Corticosteroids, such as prednisolone, are a more powerful type of medicine used to reduce inflammation.
    They can be used with or instead of 5-ASAs to treat a flare-up if 5-ASAs alone are not effective.

-Immunosuppressants, such as tacrolimus and azathioprine, are medicines that reduce the activity of the immune system.

They’re usually given as tablets to treat mild or moderate flare-ups, or maintain remission if your symptoms have not responded to other medicines.

1st year GI (16 decks)

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