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GastroIntestinal (GI) > Crohn's disease > Flashcards

Flashcards in Crohn's disease Deck (31):
1

What are the two types of Inflammatory bowel diseases?

Crohn's disease
Ulcerative Collitis

2

What does Crohn's affect?

Any part of the GI tract

3

What type of inflammation is associated with crohn's?

Transmural Inflammation
Granulomatous Inflammation

The inflammation is deeper than Ulcerative colitis's inflammation

4

What effect does smoking have on crohn's disease?

Harmful

5

What is the cytokine profile in Crohn's disease?

Th1
IL23
Gamma IFN

6

What is the immunopathology of Crohn's disease?

Mediated by T Help 2 cells
CD 4+ T cells
Gamma Interferon
TNF alpha

7

What is the pathology of Crohn'sdisease?

Focal and discontinuous inflammation
Formation of eroding fissures
Granulomas
Paneth cell function problem - problem with the signalling between commensal bacteria and Endothelial cells.
Results in autophagy and ER stress

8

What are the symptoms of Crohn's disease?

Abdominal pain
Weight loss
Fever
Malaise

9

What is the genetic link of Crohn's?

NOD2
IFN mutation

10

What are complications of Crohn's disease?

Small bowel obstruction
Abscess formation

11

What is used to treat a mild flare up of Crohn's ?

Prednisolone

12

What is used to treat a severe flare up of Crohn's ?

Hydrocortisone - treats the rectal disease
Metronidazole - treats perianal disease
Infliximab - fistulising Crohn's
Adalimumab - fistulising Crohn's

13

What inflammatory cytokines are produced in Crohn's disease?

IL 1
IL6
TNF alpha

14

What can aggravates Crohn's?

Smoking - makes it a lot worse.

15

What effect does diet have on crown's?

No known the pathogenesis in Crohn's - though they diet can induce symptoms

16

What are the therapy options for Crohns?

Steroids
Immunosupresants
Anti-TNF therapy

17

How are steroids used for crohn's?

Used as a "bridge"
They are not that helpful

18

What immunosuppressive therapy is used in Crohn's?

azathioprine / mercaptopurine
methotrexate

19

If Azathioprine is prescribed what must be done?

Check white blood cell count

20

How is Azathioprine metabolised?

Meetbolised to 6 - MP

6- MP can be metabolised to 6-MMP by TPMT (which reduces omsk of the reactive constituents)

6- MP can also be metabolised to 6- TU by xanthine oxidase

6- MP can be metabolised by HPRT to 6-TGN (this is the active form)

21

What are the side effects of azathioprine?

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

22

What are the prescribing methods for azathioprine?

TPMT activity contributes to toxicity
Avoid co-prescription of allopurinol (XO inhibitor)
Regular blood monitoring required

23

What is TNF alpha?

Profinflammatory cytokine

24

What anti-tnf therapy can be used and what is its effect?

Infliximab (Once every 2 months)
Adaliumumab (Can be injected from home)
Inflectra
Remsima

Reduces inflammation

25

How do anti-TNF therapy work?

Promote apoptosis of activated T lymphocytes

8-12 weeks of remission
Reduces hospitalisation needed for surgery

26

What are the problems associated with anti-TNF alpha treatment?

Infusion reactions
Infectons
Cancer - lymphoma

27

What medical emergencies can occur in IBD?

Small bowel obstruction
Abscess
Fistulae

28

How is perianal abscess in crohn's disease treated?

Insertion of a Seton thread through the abscess

29

What is the therapy pyramid for Crohn's?

Smoking cessation
Steroids
Immunosuppression
Anti-TNF

30

What levels in the blood must be done to see if imunosupressive therapy is appropriate?

TPMT

31

What surgery is done for Corhn's?

Resection
Stricturolplasty
Fistulas
Anal disease