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IBD + IBS Flashcards

1
Q

What is the definition of Chron’s Disease?

A

Chronic inflammatory and ulcerative disease with skip lesions and transmural inflammation

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2
Q

What type of inflammatory inflitrate is found in CD?

A

Non-caseating granulomas

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3
Q

Where in the GI tract is CD most common? Can it occur anywhere in the GI tract?

A

Terminal ileum and colon

Can occur anywhere in GI tract

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4
Q

In what type of IBD would you find knife like fissures?

A

CD

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5
Q

Name two environmental triggers for CD

A

Smoking (big big one)

NSAIDS

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6
Q

What genetic factor is associated with CD?

A

NOD2

CARD15

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7
Q

Name 4 symptoms of CD

A
  • Anaemia (commonly Fe deficient)
  • Diarrhoea (rarely with blood and mucus)
  • Abdominal pain (visceral)
  • Weight loss and reduced growth in children (malabsoprion)
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8
Q

What investigations should be done for IBD?

A

Biopsy to stage disease
Colonscopy
Blood tests
Stool sample - faecal calprotectin

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9
Q

How can CD be managed through lifestyle?

A

Increase fruit and fibre

Smoking cessation

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10
Q

What drugs can be offered in CD?

A
  1. Steroids for managing flareups e.g. budesonide/prednisilone
  2. Immunosuppresnats - azathrioprine, methotrexate
  3. Anti-TNF - “-imab” - infliximab
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11
Q

When would surgery be offered in CD and is a patient likely to have many surgeries throughout their lifetime?

A 
Symptomatic after treatment
Peri-anal disease
Complications 
Carcinoma
Many surgeries
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12
Q

What type of IBD is more likely to present orally and give 3 examples of how it may present

A

CD

  • Swollen Lips
  • Linear ulceration
  • Cobble-stoning of mucosa
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13
Q

Name 5 complications of IBD (many more)

A
  • Peri-anal disease
  • Malnutrition
  • Fistulas
  • Obstruction
  • Perforation
  • Toxic megacolon
  • Sclerosing cholangitis (IMPORTANT)
  • Colorectal cancer
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14
Q

What kind of inflammatory response is in CD and UC?

A

Linked to T cells CD - TH1

UC - TH1 and TH2

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15
Q

Where does inflammation start in UC?

A

Rectum and works back - (never affects small bowel)

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16
Q

What criteria is used to measure the severity of UC? What are the criteria on this?

A 
Truelove and Witt
Bowel movements
<4 - mild
4-6 - moderate
6+ - severe
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17
Q

What is the main symptom of UC?

A

Diarrhoea with blood and mucus

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18
Q

What would be seen in examination of UC in a PR exam that would be different from CD?

A

Blood and mucus will very likely be present in UC

Blood is much rarely in CD

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19
Q

What is the method of drug management in UC?

A
  1. Mesalazine - 5-ASA (aminosalicyates) - remission

2. Steroids - prednisilone/Budesonide - flareups

20
Q

What is the name of the anti-TNF drug?

A

Infliximab

21
Q

What is the name for the removal of the colon?

22
Q

What type of IBD is cured through surgery?

23
Q

What kind of surgery would a patient with CD get?

A

Many surgeries dependant on location of disease e.g. hemi-colectomies

24
Q

What is the classical sign of mucosal inflammation/oedema on AXR?

A

Thumbprinting

25
What type of IBD is associated with toxic megacolon? What is toxic megacolon?
UC - presistent inflammation causes loss of muscle tone of the colon -> distension
26
What is one of the main indications for surgery in CD?
Fistula formation
27
What is the handy pneumonic to remember characteristics of UC and CD?
``` Crohns = NESTS N - no blood/mucus E - entire GI tract S - skip lesions T - transmural/ terminal ileum S - smoking increases (don't want the nest to catch fire) ``` UC = up close ``` U - use aminosalicylates P - primary sclerosing cholangitis (commonly tested) C - continuous inflam L - limited to colon and rectum O - only superfical mucosa S - smoking is protective E - excrete blood and mucus ```
28
What is IBS?
Functional bowel disorder in which abdo pain assoc. with defecation in ABSENCE OF STRUCTAL PATHOLOGY
29
Whats important for history of IBS?
SOCRATES Impact on daily activties Diet/exercise/mental well-being
30
Investigations for IBS?
Rule out IBD - negative faceal calprotectin Rule out coeliac - negative anti-TTG antibodies Regular - FBC, CRP, malabsorption
31
When can someone be diagonosed with IBS?
Doesn't have IBD (negative faceal calprotectin) and coeliac (negative anti-tTg antibodies) >6mnths of abdo pain w/ improvement on defecation Change in stool appearance/frequency
32
Bowel symptoms with other systemic conditions e.g. uveitis/ erythema nodosum - what should you think of?
IBD
33
Why do you test for B12 and ferritin in bloods?
Ferritin - iron levels Test for malabsorption
34
How would Crohns present endoscopically?
Cobble-stoning (lumps in lumen) and skip lesions
35
What is short gut syndrome?
If keep removing areas of bowel = malabsorption
36
How will UC appear on endoscopcy?
Red and inflamed Friable - easy to bleed (due to angiogenesis) Pseudo-polyps (buzzword)
37
Differnce in area of pain felt in UC and CD?
RIF - CD (most likely to be found in terminal ileum) LIF - UC (restricted to colon and rectum)
38
What clinical presentations are important to note in UC?
Finger clubbing Apthous ulcers Pallor
39
Surgery for UC?
Panproctocolectomy - removal of rectum and colon and anal canal = ileostomy OR Protcololectomy = removal of rectum and colon = formation of J-pouch (ileo-anal anastomosis) -> more bowel movements than before
40
A patient with Crohns comes in for a review and says she is still having trouble with her symptoms. She was put on steroids when she was first diagnosed 8 weeks ago. What would be the next line of treatment?
Immunosuppresants e.g. azathioprine, methotrexate
41
What test can be used on stool which is very accurate for IBD?
Faceal calprotectin - released by inflamed intestines
42
A patient with IBS would have what kind of bowel movements?
Change between diarrohea and constipation
43
Altered gut flora can be found in what disease?
IBD
44
Why does IBD occur?
An overactive immunological response to luminal antigens e.g. bacteria
45
What is the most common extra-intestinal disease in both UC and CD
Arthritis
46
What is the most important side effect of mesalazine?
agranulocytosis

GI (26 decks)

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