IBD - inflammatory bowel disease Flashcards Preview

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Flashcards in IBD - inflammatory bowel disease Deck (62):
1

IBD associated with sudden flare ups and remissions

Crohn's

2

IBD with skip lesions and anywhere from mouth to anus affected

Crohn's

3

IBD that is transmural

Crohn's

4

IBD that is associated with granulomas of macrophages and T cells and causes villi shortening

Crohn's

5

IBD associated with smoking

Crohn's

6

IBD prevented by smoking

UC

7

IBD more associated with blood and mucus in diarrhoea

UC

8

IBD with abdominal mass more common

Crohn's

9

IBD with a gradual onset of weeks of symptoms

UC

10

IBD that is continuous from rectum -> colon

UC

11

IBD associated with shortened and branched crypts with plasma cell infiltrates

UC

12

IBD that affects only mucosa and submucosa usually

UC

13

Extra-intestinal symptoms of IBD more common in _

UC

14

Extra-intestinal symptoms of IBD =

non-rheumatic arthritis
aphthous ulceration
pyoderma gangrenosum
uveitis/episcleritis
IDA

15

IBD with stronger genetic component

Crohn's

16

Obesity's effect on gut microbiome =

less diversity an increases proteobacteria

17

Bacteria ___ can infiltrate normally sterile mucus layer in IBD if there is ___ => extra ___

bound to IgA
inflam=> extra inflam

18

NOD2/CARD15(IBD-1) on chromosome ___ are mutated in 10-20% of ___
encodes protein involved in ____

16q12
Crohn's
bacterial recognition and presenting to T cells

19

UC is __ mediated with ___ and causes too few colonic bacteria to be present

Th1/2 with NKTC

20

Crohn's is __ mediated and so can't control ___

Th1
can't control bacterial numbers

21

Severity markers of UC (Truelove and Witt) =

more than 6 bloody stools in 24hrs and 1 or more of fever/ tachycardia/anaemia/increased ESR

22

which IBD:
on endoscopy is a clear transition zone
pseudopolyps

UC

23

Histology of UC =

enlarged and distorted crypts, abscence of goblet cells, abscesses that only affect mucosa

24

Cobblestonemucosa = which IBD

Crohn's

25

IBD associated with PSC =

UC

26

Peak incidence of UC is at ages

20-30yo

27

Commonest ages of Crohn's presenting =

90% present 10-40yo

28

Most commonly Crohn's affects the

RHS colon and distal ileum

29

Stenosis in Chron's may be __/__

fibrotic or inflammatory

30

knife-like fissures =

Crohn's

31

Histology of Crohn's -

thicker mucosa
knife like fissures
chronic active colits w non-casseating granuloma
increased inflam cells in lamina propria
crypt branching

32

Complications of Crohn's

greater omentum wraps around
strictures
gallstones
fistulas
perianal disease

33

Extra-intestinal symptoms/signs are rare in which IBD

Crohn's

34

Which IBD is more ac=ssociateed with colorectal cancer

UC

35

IBD that causes a thin wall

UC

36

Crohn's 3 steps of treatment

steroids>immunosuppression> anti-TNF therapy

37

UC 4 steps of treatment =

5-ASA>steroids>immunosuppression>anti-TNF therapy

38

___ is effective in UC but not in treating Crohn's

5-ASA

39

examples of 5-ASA drug names:
routes =

sulfasalazine, balsalazide, mezavant = prodrugs
asacol = pH release
pentasa = delayed release all PO
can get suppositories and enemas

40

Compare suppositories and enemas of 5-ASA for UC

suppository = morning, coats less than 20cm but better mucosal adherence
enema = night, reflex contraction aids proximal spread

41

for acute flare of UC give 5-ASA in ___ approach

top and tail
PO + enema/suppository

42

Steroids used in UC and Crohn's eg.s
used for flare ups so start ___ and ___ over 6-8wks
dont ____ as could get Addison's crisis

budesonide, prednisolone
high dose, taper down
DON'T stop immediately

43

Immunosuppression eg.s used in IBD
In Crohn's used as ___
In UC used as ___

azathioprine/mecaptopurine(6-MP), methotrexate
Crohn's = maintenance therapy
UC = steroid sparing agents

44

IS in IBD mechanism of action =

purine analogues and interfere with DNA synthesis

45

If hetero/homozygous for low ___ then giving mercaptopurine(6-MP) in IBD could be toxic as 6MP not converted to ___ which balances out toxic effects of 6-TGN which is formed by ___ breakdown of 6-MP

TPMT
6-MMP
HPRT

46

Don't prescribe ___ with IS for IBD because it inhibits xanthine oxidase which ___

allopurinol
breaks down 6-MP to 6-TU for clearance

47

IS for IBD has a slow/rapid onset so __

slow - 16wks
start when start steroids then when they end IS should take over

48

TNFα is a ____
functions =

pro-inflam cytokine
causes Th0 to differentiate
modulates MadCAM-1 on vessel walls which pull T cells to site of inflam

49

eg. of anti TNFs used in IBD
mechanism

IV infliximab
S/C adalimumab
block TNFα and increase apop of activated T cells

50

anti TNFs have a slow/rapid onset
give on day 0 then __ then __ then every ___ after that

rapid
wk 2
wk6
every 6-8wks to maintain

51

if give then can reactivate tb
must never have had tb to be put on them

anti-TNF therapy
for IBD/ rheumatoid arthritis

52

one side effect =may develop HACA

infliximab (antiTNF therapy)

53

biosimilars to infliximab that are cheaper =

inflectra and remsima

54

Which IBD:
If operate rarely see again
also doesn't cure ___ symptoms

UC
extra-intestinal

55

in toxic megacolon most likely part to perforate is __ because ___

caecum as it is most thin walled

56

2 methods of panproctocolectomy

with ileostomy
leave sphincter and make J/S pouch with at least 30cm of bowel

57

surgery for IBD is if -

no response to drugs, obstruction, abscess, fistulae = emergency
no response to drugs, dysplasia of mucosa = elective

58

If operate on this IBD is likely to come back within 10 yrs

Crohn's

59

Peri-anal fistulae are more common in which IBD

Crohn's

60

Surgery that can be done for strictures

stricturoplasty - cut longitudinally and stitch horizontally to widen = non-functioning any more

61

for terminal ileal disease in Crohn's the surgery done =

R hemicolectomy

62

Fistula are common in which ibd

Crohns