Gen Med - GI > IBS and IBD > Flashcards

IBS and IBD Flashcards

Crohn's, UC, IBS (78 cards)

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1
Q

What type of condition is Crohn’s disease, and what parts of the gastrointestinal tract can it affect?

A

A form of inflammatory bowel disease (IBD) that can affect any part of the GI tract from mouth to anus.

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2
Q

Which areas are most commonly affected in Crohn’s disease?

A

Terminal ileum and colon

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3
Q

At what age does Crohn’s disease typically present?

A

Late adolescence or early adulthood

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4
Q

What are some common non-specific symptoms of Crohn’s disease?

A

Weight loss and lethargy

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5
Q

What is the most prominent symptom of Crohn’s disease in adults?

A

Diarrhoea (which may be bloody in Crohn’s colitis)

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6
Q

What is the most prominent symptom of Crohn’s disease in children?

A

Abdominal pain

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7
Q

What is perianal disease in Crohn’s disease, and what are examples of its presentation?

A

involvement of the skin and tissues around the anus, e.g., skin tags or ulcers

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8
Q

In which patients are extra-intestinal features more common in Crohn’s disease?

A

In patients with colitis or perianal disease

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9
Q

Which blood marker correlates well with Crohn’s disease activity?

A

C-reactive protein (CRP)

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10
Q

Which stool marker is elevated in Crohn’s disease and indicates intestinal inflammation?

A

Faecal calprotectin

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11
Q

What type of blood disorder may be seen in Crohn’s disease due to chronic inflammation or malabsorption?

A

anaemia

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12
Q

Which vitamin deficiencies are common in Crohn’s disease due to malabsorption?

A

low vitamin B12 and low vitamin D

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13
Q

What is the gold standard investigation for diagnosing Crohn’s disease?

A

colonoscopy

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14
Q

What colonoscopic features are suggestive of Crohn’s disease?

A

Deep ulcers and skip lesions
‘cobble-stone’ appearance’

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15
Q

What histological features are characteristic of Crohn’s disease?

A
  • Inflammation affecting all layers from mucosa to serosa
  • goblet cells
  • granulomas.
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16
Q

What are typical small bowel enema findings in Crohn’s disease?

A
  • Strictures (“Kantor’s string sign”)
  • proximal bowel dilation
  • “rose thorn” ulcers
  • fistulae
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17
Q

What lifestyle modification is strongly recommended for all Crohn’s disease patients?

A

Stopping smoking (as it worsens Crohn’s).

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18
Q

What is the first-line pharmacological treatment to induce remission in Crohn’s disease?

A

Glucocorticoids (oral, topical, or intravenous)

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19
Q

Give 3 examples of glucocorticoids used to induce remission in Crohn’s disease

A

prednisolone
methyprednisolone
IV hydrocortisone

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20
Q

What non-pharmacological therapy can be used to induce remission, especially in children or when steroid side effects are a concern?

A

Enteral feeding (nutrition) with an elemental diet.

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21
Q

Which medication group are used off-license to induce remission in Crohn’s disease?

A

budesonide and 5-ASA drugs (e.g., mesalazine)

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22
Q

Which immunosuppressive agents can be used as add-on therapy to induce remission in Crohn’s disease?

A

Azathioprine
mercaptopurine
methotrexate
(none of the above should be used as monotherapy for inducing remission)

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23
Q

Which biologic agents are effective in refractory or fistulating Crohn’s disease?

A

Infliximab and adalimumab

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24
Q

What is the first-line drug treatment for maintaining remission in Crohn’s disease?

A

Azathioprine or mercaptopurine

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25
What should be assessed before offering azathioprine or mercaptopurine in the management of Crohn's disease?
Assess thiopurine methyltransferase (TPMT) activity
26
Which drug is second-line for maintaining remission in Crohn’s disease?
Methotrexate
27
What surgical procedures are used for stricturing terminal ileal Crohn’s disease?
Ileocaecal resection, segmental small bowel resections, and stricturoplasty.
28
What is the investigation of choice for suspected perianal fistula in Crohn’s disease?
MRI
29
How are symptomatic perianal fistulae managed in Crohn’s disease?
Oral metronidazole, anti-TNF agents (infliximab), and draining seton for complex fistulae
30
How is a perianal abscess managed in Crohn’s disease?
Incision and drainage with antibiotics; a draining seton may be placed if a tract is found
31
Give 3 complications of Crohn's disease
* small bowel cancer * colorectal cancer * osteoporosis
32
What is ulcerative colitis
a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract
33
How is the inflammation in ulcerative colitis distributed within the large bowel?
It is diffuse, continuous, and superficial, affecting only the intestinal mucosa
34
Which part of the bowel is usually always affected in ulcerative colitis?
The rectum
35
In ulcerative colitis, how far can inflammation extend from the rectum?
It may involve a variable length of the colon proximally
36
What is ulcerative proctitis, and which age group is it more common in?
Inflammation limited to the rectum without extension to the sigmoid colon; more common in adults
37
In ulcerative colitis, what is left-sided colitis?
Inflammation that does not extend proximally beyond the splenic flexure
38
In ulcerative colitis, what is extensive colitis, and which age group is it more common in?
Inflammation extending proximally beyond the splenic flexure, including pancolitis; more common in children
39
Give 2 factors that appear to be protective against developing ulcerative colitis?
* appendicectomy before adulthood * smoking
40
What are the two peak age ranges for the incidence of ulcerative colitis?
20-40 years and 55–65 years
41
How do symptoms typically develop in the initial presentation of ulcerative colitis?
They usually develop insidiously and occur intermittently.
42
What are the key gastrointestinal symptoms of ulcerative colitis?
* bloody diarrhoea * faecal urgency * tenesmus * abdominal pain, particularly in the left lower quadrant
43
What is the main investigation used to diagnose ulcerative colitis?
Colonoscopy with histology from multiple intestinal biopsies
44
In severe ulcerative colitis, which endoscopic test is preferred and why?
Flexible sigmoidoscopy, to reduce the risk of perforation
45
What are typical endoscopic findings in ulcerative colitis?
* Red, raw mucosa bleeding easily from the rectum proximally * no inflammation beyond submucosa (unless fulminant) * widespread ulceration with pseudopolyps.
46
What are key histological features of ulcerative colitis?
* Inflammatory cell infiltrate in lamina propria * crypt abscesses * depletion of goblet cells and mucin from gland epithelium
47
What barium enema changes are seen in ulcerative colitis?
* Loss of haustrations * superficial ulceration with pseudopolyps * in long-standing disease, a narrowed, shortened “drainpipe colon.”
48
What blood test abnormalities may be seen in ulcerative colitis?
* FBC - anaemia * raised CRP and ESR * electrolyte disturbances * TFTs may be done to exclude hyperthyroidism
49
What defines mild ulcerative colitis?
<4 stools/day, small amount of blood, no systemic upset.
50
What defines moderate ulcerative colitis?
4–6 stools/day, variable blood in stools, no systemic upset
51
What defines severe ulcerative colitis?
>6 bloody stools/day with systemic features (fever, tachycardia, anaemia, raised inflammatory markers).
52
What is first-line treatment to induce remission in mild distal UC (proctitis)?
Topical (suppository or enema) aminosalicylates (mesalazine/ sulfasalazine)
53
How is mild-to-moderate left-sided ulcerative colitis treated if topical aminosalicylates alone are insufficient?
Add high-dose oral aminosalicylate or combine oral aminosalicylate with topical corticosteroid; if still ineffective, use oral corticosteroids
54
How is extensive ulcerative colitis treated to induce remission?
High-dose oral aminosalicylate plus topical aminosalicylate; if no remission after 4 weeks, switch to oral aminosalicylate plus oral corticosteroid.
55
How is severe ulcerative colitis managed?
* should be treated in hospital * 1st line: IV corticosteroids (ciclosporin if steroid contraindicated) * if after 72 hours there has been no improvement, consider adding IV ciclosporin to IV corticosteroids or consider surgery
56
How is remission maintained after a mild-to-moderate flare of ulcerative colitis affecting the rectum or rectum plus sigmoid colon (proctitis and proctosigmoiditis)?
Topical (rectal) aminosalicylate +/- oral aminosalicylate daily or intermittent
57
How is remission maintained after a mild-to-moderate flare of left-sided or extensive ulcerative colitis?
Low maintenance dose of an oral aminosalicylate
58
How is remission maintained following a severe relapse or two or more exacerbations in the past year?
Oral azathioprine or oral mercaptopurine.
59
When is surgery considered for ulcerative colitis?
When the disease is unresponsive to optimal medical therapy or in the presence of serious complications, such as toxic megacolon or perforation
60
What is a complete panproctocolectomy in ulcerative colitis?
* Removal of the entire colon and rectum, resulting in a permanent ileostomy as no anastomosis is performed. * this removes the disease
61
What factors are often linked to triggering a flare of ulcerative colitis?
* Stress * medications - NSAIDs, antibiotics * cessation of smoking although most flares occur without an identifiable trigger.
62
Which extra-intestinal features are related to disease activity in both Crohn’s disease and ulcerative colitis?
* Pauciarticular arthritis - usually assymetric, acute and self-limiting * erythema nodosum (raised red nodules) * episcleritis * osteoporosis * aphthous mouth ulcers
63
Which extra-intestinal features are unrelated to disease activity in both Crohn’s disease and ulcerative colitis?
* Polyarticular, symmetric arthritis * uveitis * pyoderma gangrenosum * clubbing * primary sclerosing cholangitis.
64
Which extra-intestinal features are more common in Crohn’s disease?
Episcleritis
65
Which extra-intestinal features are more common in ulcerative colitis?
Uveitis and primary sclerosing cholangitis
66
How long must symptoms be present before considering a diagnosis of irritable bowel syndrome?
At least 6 months
67
What are the core symptoms required to consider a diagnosis of irritable bowel syndrome?
If any of the following have been present for at least 6m: Abdominal pain/ discomfort, or Bloating, or Change in bowel habit
68
Aside from the core symptoms, what additional features support a positive diagnosis of irritable bowel syndrome in primary care?
Abdominal pain relieved by defecation or associated with altered bowel frequency or stool form, plus 2 of: * altered stool passage (straining, urgency, incomplete evacuation) * abdo bloating, distension, tension or hardness * symptoms worse after eating * passage of mucus.
69
What extra-intestinal features are common in people with irritable bowel syndrome
* lethargy * nausea * back pain * headache * gynae/ bladder symptoms
70
What are the red flag features that should be checked when diagnosing irritable bowel syndrome?
* Rectal bleeding * unexplained weight loss * FHx of bowel or ovarian cancer * onset after age 60
71
What primary care investigations are suggested for irritable bowel syndrome?
* Full blood count * ESR/CRP * Coeliac disease screen (tissue transglutaminase antibodies) * Faecal calprotectin - exclude IBD (should all be normal in IBS)
72
Give 4 differentials of irritable bowel syndrome
* malignancy - colorectal cancer, ovarian cancer etc * hypothyroidism * IBD * Coeliac disease
73
What is first-line pharmacological treatment for IBS based on the predominant symptom?
* Pain, cramping, bloating: antispasmodics * Constipation: laxatives (avoid lactulose) * Diarrhoea: loperamide
74
Give 3 drugs that can be used to treat abdominal pain/ spasm in irritable bowel syndrome
Antispasmodics: * mebeverine hydrochloride * alverine citrate * peppermint oil
75
When can linaclotide be considered for IBS with constipation?
If constipation persists for ≥12 months despite optimal or maximum tolerated doses of laxatives from different classes
76
What is the second-line drug for IBS if an antispasmodic ineffective
low dose tricyclic antidepressant (amitriptyline 5-10mg, off-label indication)
77
What interventions may be considered for refractory IBS?
* consider alternative diagnosis * CBT * hypnotherapy * specialist referral
78
What general dietary advice is recommended for IBS?
* Regular meals; don’t skip meals * Adequate fluid intake * regular exercise (30 mins of moderate intensity activity at least 5 days/week * identify and reduce stress * Adjusting fibre intake according to symptoms (more fibre if predominantly constipated, less with diarrhoea/bloating) * Limit caffeine, alcohol and fatty foods * Low FODMAP diet, guided by a dietician
Gen Med - GI
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