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GASTROENTEROLOGY SCE > IBD > Flashcards

Flashcards in IBD Deck (81):
1

Histology in CD

Goal
Transmural
Asymmetrical
Granulomatous

2

1. How many UC Pt flare each yr
2. How many patients with pancolitis eventually have a colectomy?
3. What is the CRC incidence at 20yrs in UC?
4. What is the colorectal cancer incidence at 40years
5. What is the relative risk reduction for CRC with 5ASA?

1. 50%
2.25%
3. 8%
4. 16%
5. 50%

3

When is a 5 year screening colonoscopy required for UC screening?

Extensive colitis with no macro/microscopic activity
Left sided colitis
Crowns colitis affecting <50% colon
Pouch surveillance post-colectomy

4

When is a 3 year screening colonoscopy required for UC screening?

Extensive colitis with mild micro and macroscopic activity
Pseudo-polyp
Post inflammatory polyp
CRC in 1st degrees relative >50yrs

5

When is annual screening colonoscopy required for UC screening?

Extensive colitis and severe micro/macroscopic changes
Hx stricture/dysplasia declining surgery in last 5yrs
CRC in relative <50yrs
PSC
Pouch with dysplasia
Severely inflamed pouch

6

Describe diversion colitis
What Rx is given
What is the definitive Rx

Deficiency of short chain fatty acids
Unabsorbed carbs enter colon are metabolised by bacteria to SCFA to provide nutrition for colonic mucosa
Rx - SCFA enema, steroid enema, mesalazine
Surgery to restore faecal flow

7

Describe type 1 peripheral arthropathy

Affects <5 joints, acute, self-limiting
Occurs alongside intestinal inflammation

8

Describe type 2 peripheral arthropathy

>5 joints
Prolonged course, independent of gut inflammation
Associated with uveitis only

9

Classically what is the B12 and folate in SBBO

B12 low
Folate HIGH

10

What is the criteria for a severe attack based on True Love and Witt criteria

Tachycardia >90
Temperature >37.8
Hb <10.5
ESR>30

11

In what situations can't you give ciclosporin

Uncontrolled HTN
Renal impairment
My <0.5
Cholesterol <3

12

What can we use VSL#3 for?

Proctitis

13

What is the General role of CT colonoscopy

Tumour or polyp detection

14

Describe the histology in UC

Severe crypt architecture distortion
Reduced crypt density
Collins surface appearance
Severe mucin depletion
Diffuse, transmural lamina propria cell increase

15

Describe histology in Crohn's

Epithelial granuloma
Discontinuous inflammation
Crypt distortion
Focal cryptitis

16

Which medication used to treat UC reduces sperm count and motility?

Sulfasalazine
Reversible infertility

17

IBD and pregnancy:
1. do you continue maintenance medications?
2. Are congenital defects reported in infliximab?
3. Infliximab is found in breast milk? Y/N
4. 1st line management of N+V in pregnancy
5. Which antibiotic used in CD should be avoided in pregnancy
6. 1st line constipation treatment

1. Yes
2. No
3. No
4. Ginger and P6 acupuncture
5. Metronidazole
6. Fibre supplements

18

Which medications are safe in pregnancy and IBD

Sulfasalazine
Mesalazine
Azathiprine
Infliximab (undetectable)

19

Which antibiotics are not safe in pregnancy and IBD?

Metronidazole
Cilrofloxacin

20

After prednisolone hoe long should you delay breastfeeding for

4 hours

21

What strongly predicts the presence of a peri-anal abscess?

Peri-anal pain

22

Treating fistulating disease

Map fistula - MRI
Assess current disease activity
EUA is gold standard - can then give therapeutic treatment if required
(Equivalent is ano-rectal USS

23

Describe the different types of simple fistulas

Superficial perianal
Inter-sphincteric perianal or duo-vaginal

24

Describe the types of complex fistula

Trans-sphincteric = enterocutaneous
Supra-sphincteric = enters-enteric
Extra-sphincteric = entero-enteric, enterovesical, rectovaginal

25

What is the benefit of colonic release budesonide

As effective as prednisolone in mild-moderate left sided disease (UC).

But high first pass metabolism and fewer side effects

26

What to tell pt when counselling for thiopurines

Slow onset
Avoid sun
Risk of cancer (<1% at 10 yrs)
Avoid allopurinol
Rise in MCV
Monitor bloods 2-4/52 for 2/22 then every 3months

27

Treatment of complex fistula

Drain abscess and seton suture
ABX and thiopurine first line
Anti-TNF 2nd line

Emerging therapy - topical IFX, stem cells, fistula plug, hyperbaric O2

28

There is evidence for VSL#3 in pouchitis, what main bacteria does it contain?

Strep. Thermophilus
Bifidobscterium species
Lactobacillus

29

Which genes show the greatest association with CD

NDD2
CARD15

30

What is the chance of offspring developing IBD if both parents have IBD

30%

If only one parent = 9% CD and 6% UC

31

Which cytokines does Th1 produce?

IL1 and IL6 and TNG

32

Th17 produces...

IL-17 and IL22
They are proinflammatory cytokines

33

What increases risk of immunogenicity in IFX

Mono therapy
Episodic IFX therapy

34

Describe IFX and antibody production and how we manage this

Low IFX and positive antibody = switch drug (92% clinical response)

Low IFX and negative antibody = increase drug dose

35

What is considered gold standard for diagnosing small bowel IBD

Capsule endoscopy

36

Describe the Vienna classification

Age - A1<40, A2>40
Location - L1 TI, L2 colonic, L3 ileocolonic, L4 upper GI tract
Behaviour - B1 non-structuring, non-penetrating, B2 structuring, B3 penetrating, intra-abdominal or peri-anal fistula/ulcer

37

Management of peristomal pyoderma gangrenosa

Topical corticosteroids

Pustules and rapidly ulcerates
Serpinginous painful, bluish ulcer

38

Describe sweets syndrome

Acute onset febrile illness
Pathergy at immunisation site
Skin Bx shows diffuse polynuclear neutrophilic infiltration in upper dermis

Treat with topical/oral steroids

39

Is episcleritis painful

NO it is painless

40

What proportion of patients have a significantly low TPMT level

0.3% (1 in 300).
This increases the risk of leucopenia - can consider dose reduction

41

MOA of sulfasalazine

Depends on cleavage of 5ASA dinners by colonic bacteria.

It is linked to 5ASA by an AZO bond. This bond is split by colonic bacteria to release 5ASA

42

What is FCP

Protein complex of s100 family
Present in neutrophils and macrophages
Biomarker of inflammation
Correlates well with mucosal inflammation

43

HBI - what score indicates remission and severe flare

<5 remission
>5 is a relapse
>16 = severe disease

44

What test should be performed in asymptomatic iron deficiency in patients with quiescent UC

Possibly colon cancer
Do colonoscopy

45

What is the prevalence of colon cancer in patients with a positive FOB test

8%

46

Antigen exposure leads to activation of CD4 cells which produce TH1 and TH2 cells.

Which cytokines are produced by TH1 cells

IL1, IL2, IL6, IL12, IFN, TNF-alpha

47

Antigen exposure leads to activation of CD4 cells which produce TH1 and TH2 cells and TH17

Which cytokines are produced by TH2 cells

IL4, IL5, IL13

48

Antigen exposure leads to activation of CD4 cells which produce TH1 and TH2 cells and TH17

Which cytokines are produced by TH17

IL17, IL6, IL22

49

Which cytokines are anti-inflammatory

TGF

IL4

IL10 - levels found to be low in IBD

50

Which EIM of IBD run a course alongside IBD flare

EN
Episcleritis (painless)
Type 1 peripheral arthritis
Oral ulcers

51

Which EIM is associated with type 2 arthritis

Uveitis

52

What proportion of IBD patients are under hospital follow up

30%

53

What proportion of patients with IBD have UC

66%

54

What is the lifetime risk of surgery in:

1. Crohn's
2. UC

1. 70%

2. 30%

55

What congenital defects are associated with infliximab

VACTERL

56

In pregnancy, increasing daily recommended dose of folic acid is required when taking which IBD medication

Sulfasalazine

Increase by further 2mg

57

There is evidence for what treatment in pouchitis

VSL3

58

Which EIM of IBD has RCT evidence for infliximab use

Pyoderma gangrenosum

59

1st line treatment for perianal fistula

ABX

Azathioprine

Then consider anti-TNF if above doesn't work

60

In a patient with mild-moderate colonic disease, what treatment can be offered

Increase 5ASA

Addition of enemas

Prednisolone

BUDESONIDE MR - as effective as prednisolone with less side effects and high first pass metabolism

61

What bacteria are present in VSL3

Strep thermophilus
Bifidobacterium species
Lactobacillus

62

If both parents have IBD what is the chance of offspring developing disease

30% by age 30years

63

If one parent has IBD what is the chance of developing the disease

9% CD

6% UC

64

IBD is more common in black people compared to white? T or F

false

65

What is the incidence of CD in UK population

5-10/100,000

66

What is the incidence of UC in the U.K population

10-20/100,000

67

Th17 produces which pro-inflammatory cytokines

IL17
IL22

68

Th1 cells produce which pro-inflammatory cytokines

IL1, IL-2, IL-6, TNF-alpha

69

Th2 cells produce which proinflammatory cytokines

IL4, IL10, TGF

70

What percentage of patients with toxic colon perforate?

35%

71

Treatment of peristomal pyoderma gangrenosum

Topical steroids

Po steroids

Painful serpinginous ulcer, bluish

72

Treatment of erythema nodosum

Treat flare of underlying IBD - PO steroids

Can also give PO K-iodine, NDAIDS

73

What proportion of those who are homozygous (wild type) for TPMT have high/normal levels

90%

74

Those who are heterozygous for TPMT have ............. levels of TPMT

LOW

10%

75

What does the mechanism of sulphasalazine depend on...

Cleavage of 5-ASA diners by colonic bacteria

5ASA bound by an AZO bond. This bond is split by colonic bacteria to release 5ASA

76

HBI score that defines remission

<5

77

HBI score that defines severe disease

>16

78

What percentage of those with positive FOB test are then identified to have CRC on investigation

8%

79

What is the most useful test for assessing/monitoring toxicity with azathioprine use

FBC - WBCs

80

Excess of what metabolite can cause toxicity in azathioprine use

6-TGN

6-thioguanine nucleotide

81

1st line treatment of aphthous ulcers

Topical steroid (hydrocortisone lozenges)

But ensure there is no need to treat IBD flare e.g. With PO steroids