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Flashcards in Crohns and UC Deck (42)
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1
Q

Give five types of inflammatory bowel disease

A

• Ulcerative colitis • Crohn’s disease • Diversion colitis • Diverticular colitisRadiation, drugs, infectious diseases, ischaemic colitis

2
Q

What is ulcerative colitis?

A

• An inflammatory disorder that affects the rectum and extends proximally, in continuity (no breaks in inflammation!)

3
Q

Where is the incidence of ulcerative colitis the highest?

A

• US, UK and northen Europe • Presents in young adults, more commonly young women

4
Q

What inflammatory cells are found in the mucosa of patients with ulcerative colitis?

A

• T helper cells, which produce transforming growth factor (TGF and IL-5)

5
Q

What are the three main symptoms of ulcerative colitis?

A

• Rectal bleeding • Diarrhoea • Abdominal pain

6
Q

What is Chrohn’s disease?

A

• A condition of chronic inflammation involving any location of the GI tract from mouth to anus

7
Q

When are the two peaks of incidence of Chron’s disease?

A

• 1st at 15-30 • 2nd at 60 years

8
Q

What inflammatory cells are found in the mucosa of Chron’s disease patients?

A

• Th1 helper cells, which produce interferon gamma and IL-2

9
Q

What does the presentation of Chrohn’s disease depend on?

A

Diseases location

10
Q

What is the presentation of Chron’s disease in someone with upper GI tract involvement?

A

• Nausea and vomiting • Dyspepsia • Small bowel obstruction • Anorexia, weight loss • Loose stools

11
Q

What is the presentation of chron’s disease in someone with colonic diseasE?

A

• Diarrhoea • Passage of blood

12
Q

What happens if terminal ileum is involved in Chron’s disease?

A

• May be pernicous anaemia due to poor absorption of B12

13
Q

What is hypothesised to cause IBD (of which Chrohn’s and UC are two types)

A

• Genetic presdispostion • Environmental factors

14
Q

What genetic factors cause IBD?

A

• IBD1 • NOD2/CARD15 • Having one copy of a risk allele confers 2-4 fold risk for Crohn’s • Two couples of risk allele confers 20-40 fold risk for Crohn’s

15
Q

What environmental factors cause IBD?

A

• NSAIDs ○ Altered intestinal barrier due to decreased mucous production • Early Appendectomy ○ Increased UC incidence • Smoking ○ Protects against UC ○ Increases risk of CD

16
Q

Give 6 triggers of IBD

A

• Antibiotics ○ Gets rid of normal flora • Diet • Acute infections • NSAIDs • Smoking ○ Increase’s risk of Crohn’s • Stress

17
Q

Give six methods of investigating inflmamtory bowel disease

A

• Colonoscopy ○ Biopsies of involved mucosa ○ Ulceration • Stool analysis ○ Parasites ○ Clostridium difficile toxin ○ Culture • Barium radiographs • CT scan • Capsule endoscopyPlain X-Ray if bowel obstruction or perforation suspected

18
Q

Outline the macroscopic changes found in Chrohn’s

A

• Involved bowel is usually thickened and is often narrowed • Deep ulcers and fissures in the mucosa may produce a cobblestone appearanceFistulae and abcesses may be seen

19
Q

Outline the macroscopic changes found in Ulcerative Colitis

A

• Mucosa looks reddened, inflamed and bleeds easily • In severe disease there is extensive ulceration with the adjacent mucosa appearing as inflammatory polyps

20
Q

Outline the microscopic changes found in chrohn’s

A

• Inflammation through all layers of the bowel (Transmural) • Increase in chronic inflammatory cells • Lymphoid hyperplasia • Granulomas (TH1 Response)

21
Q

Outline the microscopic changes found in Ulcerative Colitis

A

• Superficial inflammation • Chronic inflammatory cell infiltrate in the lamina propria • Crypt abscesses • Goblet cell depletion

22
Q

Outline three ways in which CD and UC can be separated

A

• Clinical • Radiological data • Histological differences seen in rectal mucosa

23
Q

When is it difficult to tell difference between CD and UC?

A

Acute phase, tissues look very much the same

24
Q

What is CD/UC in acute phase called when it is difficult to tell the difference?

A

• Colitis of undetermined type and aEitologyCUTE

25
Q

What serological tests can be used to distinguish UC from CD?

A

• Anti-neutrophil cytoplasmic antibodies in UC • Anti saccaromyces cervisiae antibodies in CD

26
Q

Give 5 ways in which abnormalities can be seen in Chrohn’s disease

A

• Colonoscopy • Upper GI endoscopy • Small bowel imaging • Perianal MRI or endoanal Ultrasound • Capsule endocscopy

27
Q

What can a colonoscopy be used to see in Chrohn’s disease?

A

• Performed if colonic involvement is suspected • Mild, patchy surface ulceration à Cobblestoning

28
Q

How does Upper GI Endoscopy do in a Chrohn’s diagnosis?

A

• Required to exclude oesophageal and gastroduodenal disease in patients with relevant symptoms

29
Q

Outline the process of small bowel imaging in Crohn’s

A

• Barium follow through • CT scan with oral contrast • Small bowel ultrasound • MRI • Asymmetrical alteration in the mucosal pattern with deep ulceration, and areas of narrowing or structuringr • String sign of Kantor

30
Q

What does perianal MRI or endoanal ultrasound do?

A

• Used to evaluate perianal disease

31
Q

What is capsule endoscopy used for in Chrohn’s?

A

• Used in Chrohn’s disease patients who have a normal radiological examination

32
Q

Give two tests used to define Ulcerative Colitis?

A

• Colonoscopy • Imaging

33
Q

What does colonoscopy do in UC?

A

• Allows biopsy, which is gold standard for UC diagnosis • Allows us to assess disease activity and extent

34
Q

What does imaging allow to see in UC?

A

• Plain Abdominal X-Ray to exclude colonic dilation • Other imaging techniques rarely used as endoscopy is preferred • Collar Button Ulcers ○ Ulcer through the bowel mucosa to the muscle, then up and down in a ‘T’ shape

35
Q

Give three overarching aims of Chrohn’s disease treatment?

A

• Induction of remission • Maintenance of remission • Perianal disease

36
Q

How is induction of remission initiated in Chrohn’s?

A

• Oral or IV Glucocorticosteroids • Enteral Nutrition • Anti-TNF antibodies (Infliximab)

37
Q

How is maintenance of remission achieved in Crohn’s disease?

A

• Methotrexate, Azathioprine • Anti-TNF antibodies (Infliximab)

38
Q

How is perianal disease treated in Crohn’s?

A

• Ciprofloxacin and Metrronidazole • Azathioprine • Anti-TNF antibodies (Infliximab)

39
Q

What do anti-TNF antibodies do?

A

• Bind to membrane bown TNF-a and induce immune cell apoptosis

40
Q

Outline the surgical management of crohn’s

A

• Failure of therapy with acute or chronic symptoms • Complications, e.g. dilation, obstruction, perforation, abscesses • Failure to grow in children despite treatment • Colectomy and ileorectal anastomosis may be performed.

41
Q

Give three types of UC and their treatment

A

• Distal Disease (Proctitis) ○ Topical or suppository corticosteroids • Left Sided Colitis ○ Topical corticosteroid enema • Extensive Colitis ○ Oral corticosteroids ○ Infliximab

42
Q

Outline the surgical management of UC

A

• Patients with complications / Corticosteroids dependence • In acute disease, subtotal colectomy with end ileostomy and preservation of the rectum is the operation of choice.