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Gastrointestinal > IBD > Flashcards

IBD Flashcards

1
Q

Features of Crohn’s?

A

Crows NESTS:
N - no blood or mucus (possible, less commong)
E - entire GI tract
S - skip lesions
T - transmural inflammation + terminal ileum most affected
S - smoking = risk factor

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2
Q

Features of UC?

A 
U-C-CLOSE UP
C - continuous inflammation
L - limited to colon + rectum
O - only superficial mucosa affected
S - smoking = protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis
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3
Q

What is IBD?

A

An umbrella term that refers to chronic, relapsing-remitting inflammation of the GI tract (Crohns entire, UC limited)

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4
Q

Presentation?

A
  • Diarrrhoea
  • Abdo pain
  • Passing blood/mucus
  • weight loss
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5
Q

Clinical features specific to Crohn’s

A

Aphthous ulcers
Clubbing
Possible RIF mass/tender
Perianal tags, fistula, abscess

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6
Q

2 dermatological features of Crohn’s and UC?

A

(1) Erythema nodosum (shins)

2) Pyoderma gangrenosum (well-defined ulcer, purple edge

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7
Q

Ocular manifestations of Crohns and UC?

A

(1) anterior uveitis (painful, red eye w/ blurred vision + photophobia)
(2) episcleritis (painful, red eye)

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8
Q

Are gallstones more common in Crohn’s or UC?

A

Crohns

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9
Q

Useful screening test?

A

Faecal calprotectin

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10
Q

Diagnostic test?

A

Endoscopy (OGD + colonoscopy) w/ biopsy

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11
Q

What is shown on biopsy if Crohns?

A

(1) Skip lesions (inflammation) / cobblestone mucosa (ulceration)
(2) Transmural inflammation (rose-thorn ulcer)
(3) Granuloma (non-caesating)

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12
Q

First line management to induce remission for Crohn’s?

A

Steroids = oral prednisolone OR IV hydrocortisone

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13
Q

If steroids don’t enter Crohn’s patient into remission, what else can be offered?

A

Immunosuppression:

  • Azathioprine (first)
  • Mercaptopurine
  • Methotrexate

Biologics (if dont respond):

  • Infliximab
  • Adalimumab
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14
Q

First line management to maintain remission for Crohns?

A

Either:

(1) Azathioprine
(2) Mercaptopurine

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15
Q

Alternatives for remission (Crohns)?

A

(1) Methotrexate
(2) Infliximab
(3) Adalimumab

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16
Q

When might you consider surgery for Crohn’s?

A

If only affecting terminal ileum (unlikely, non-curative)

17
Q

Management of peri-anal abscess?

A

(1) IV antibiotics (ceftriazone + metronidazole)

(2) Incision + drainage under anaesthesia

18
Q

Management of a high peri-anal fistula (trans-sphincteric)?

A

Drainage seton

19
Q

Management of a low peri-anal fistula (submucosal)?

A

Fistulotomy

20
Q

Symptoms suggestive of UC?

A

Diarrhoea containing blood/mucus
Tenesmus, urgency
Pain in LIF

21
Q

Bloods for Crohns and UC?

A

Routine + CRP:
FBC - anaemia, raised WCC
ESR/CRP - raised
LFTs - low albumin

22
Q

Biopsy result of UC?

A

(1) Loss of goblet cells,
(2) crypt abscess
(3) inflammatory cells (lymphocytes)

23
Q

First line management to induce remission for UC:

a) mild-moderate disease
b) severe disease

A

a) aminosalicylate (mesalazine) - offer topical then oral if no improvement after 4 weeks
b) IV hydrocortisone

24
Q

2nd line management to induce remission for UC:

a) mild-moderate disease
b) severe

A

a) add oral prednisolone

b) add IV cyclosporin (after 72hrs)

25
Q

Medications to maintain remission in UC?

A

(1) Aminosalicylate (mesalazine)
(2) azathioprine
(3) mercaptopurine

26
Q

Long-term complications of UC?

A

(1) colorectal cancer –> colonscopy surveillance
(2) PSC –> monitor LFTs yearly
(3) strictures + pseudopolyps

27
Q

Most common site affected by UC?

A

rectum

28
Q

Indications of severe UC (Truelove-Witt index)?

A
  • stools >6x day
  • tachycardiac HR>90
  • febrile T>37.5
  • anaemic Hb<105 w/ raised CRP >30
29
Q

If a patient comes in with an acute flare-up, what investigation might you perform?

A

Abdo X-Ray –> toxic megacolon (passmed)

30
Q

If mild-moderate UC flare, what would you give if UC extends past left-side colon?

A

Oral AND rectal mesalazine

31
Q

When would you give a UC patient oral azathioprine or mercaptopurine for maintenance?

A

If 2 or more exacerbations in the past year

32
Q

Appropriate management step of Crohn’s patient taking azathioprine presents with a sore throat? (OR for RA, recent chemotherapy, acute leukaemia)?

A

Urgent FBC - neutropenia?

Gastrointestinal (32 decks)

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