Inflammatory Bowel Disease

Question 1

Inflammatory Bowel Diseases Outline

Answer 1

Group of conditions in which intestines become inflammed. 2 diseases: Crohn’s and Ulcerative Colitis

Question 2

Crohn’s Disease Outline

Answer 2

Causes are unclear but involve genetic, environmental and immunological factors. Severe inflammation throughout GIT (mouth to anus). No cure (symptoms can only be treated)

Question 3

Chron’s Disease Identifying Factors

Answer 3

Deep ulceration, mucosa fissuring and granulomas (white blood cell build up) with skip lesions (unaffected areas between affected). Effects transmucosally.

Question 4

Chron’s Disease Signs and Symptoms of active disease

Answer 4

Diahorrea, fever, fatigue, abdominal pain and cramps, blood in stool, mouth sores, reduced appetite, weight loss and pain/drainage around anus. Different areas have specific regions

Question 5

Ulcerative Colitis Outline

Answer 5

Causes unclear: genetic, environmental and immunological factors. Chronic diffuse mucosal inflammation of colon and proximal tissues. Relapsing-remitting pattern (life long condition)

Question 6

Ulcerative Colitis Signs and Symptoms

Answer 6

Diahorrea (containing blood and pus), rectal bleeding (small amountof blood in stool), rectal pain, inability to defecate despite urgent feelings, weight loss, fatigue and fever

Question 7

4 types of Ulcerative Colitis

Answer 7

proctosigmoiditis (rectum and sigmoid colon), ulcerative proctitis (rectum only), pancolitis (entire colon) and left sided colitis (rectum, sigmoid colon and descending colon)

Question 8

IBD Mechanisms

Answer 8

due to genetic susceptibility/diet/stress epithelial cells release an excess of cytoines, these cytokines stimulate immune cells which release their own proinflammatory cytokines

Question 9

IBD Pathogenesis Study

Answer 9

Genetic susceptibility, environmental factors, dysbiosis, epithelial transport dysfunction and chronic mucosal immune activation

Question 10

Common extra-epithelial symptoms of IBDs

Answer 10

Conjunctivitis, axial arthritis, altered pancreatic function, peripheral arthritis and thromboembolism

Question 11

IBD Intestinal Complications

Answer 11

Hemorrhage, strictures, colon perforation, anal fistulas, pelvic abscesses, toxic megacolon and cholangiocarcinoma

Question 12

IBD extraintestinal complications

Answer 12

osteoporosis, deep vein thrombosis, anemia, gall stones and arthritis

Question 13

Fistula Def

Answer 13

A connection between 2 parts of the body that doesn’t exist in the average healthy person

Question 14

Enterocutaneous Fistula

Answer 14

Connection between the intestines and the skin. Through connections contents of intestines can leak through skin

Question 15

Enetroentric Fistula Outline

Answer 15

Connection between intestines and kidney

Question 16

Strictures Def

Answer 16

Narrowing of the large intestine and colon. Limits amount of bolus that can pass

Question 17

Symptoms that indicate an increase in severity

Answer 17

Blood in feces, abdominal pain, nausea, diahorrea (>2 weeks), unexplained weight loss and fever

Question 18

Stepwise IBD Treatment

Answer 18

Mild -> severe. Aminosalicylates, corticosteroids, immunomodulators and biologics (to surgery). Used to induce remission IBDs are never fully cured

Question 19

Aminosalicylates Outline

Answer 19

Mild to moderate IBDs. More effective in ulcerative colitis. Acts locally on colonic epithelium, multiple anti-inflammatory effects

Question 20

Aminosalicylates Anti-inflammatory effects

Answer 20

Reduce leukotrine + prostaglandin production, inhibits TNF production (via PPR gamma activation) and antioxidant activity

Question 21

Amino salicylates side effects

Answer 21

Headache, nausea, abdominal pain, dyspepsia, fatigue and rash

Question 22

Osalazine Outline

Answer 22

Amino salicylate. Prodrug cleaved by enzymes in the colon. Increases net luminal secretion and increases rate of GI meal transit

Question 23

Corticosteroids Outline

Answer 23

Moderate IBDs. Higher % sucess in ulcerative colitis the Chronn’s disease. Used to induce remission has anti-inflammatory properties. Admin route (oral and IV (severe)). Used with aminosalicylates if monotherapy is inadequate

Question 24

Corticosteroids Mechanism of Action

Answer 24

Binds glucocorticoid receptor, inhibits protein transcription/synthesis and down tegulation of proinflammatory cytokines Eg IL1, IL6 and TNF

Question 25

Corticosteroids Side Effects

Answer 25

Treatment can only be used for short time. May develop a dendency (~ Cushing's Syndrome)

Question 26

Immunomodulators Def

Answer 26

Used to maintain remission or treat severe IBDs. Slow onset (can't treat flares). Anti-inflammatory and cytotoxic effects

Question 27

Azathioprine Outline

Answer 27

Immunomodulator. Produces metabolites that damage RNA/DNA in epithelial and immune cells. Side effects: bone marrow immunosupression and opportunistic infections. Red flags: rash, unexplained bruising/bleeding and infections

Question 28

Methotrexate Outline

Answer 28

Inhibits dihydrofolate reductase, inhibiting DNA synthesis. Inhibits AICAR enzyme resulting in supression of inflammatory response. Daily oral/IV admin. Red flags: sore throat and fever

Question 29

Biologics Def

Answer 29

Medicines that are grown and purified from large-scale cell cultures of bacteria/yeast/plant/animal cells. Proteins are purified from biological systems/lood

Question 30

3 examples of aminosalicytes

Answer 30

Sulfasalazine, olsalazine and mesalazine

Question 31

Corticosteroid examples

Answer 31

Hydrocortisone (oral/IV), prednisolone (oral), buedesone (oral) and methylprednisone (IV)

Question 32

Examples of anti-TNF-alpha biologics

Answer 32

Infliximab, adalimuamb and golimuamb

Question 33

anti-TNF-alpha Biologics Mechanism of action

Answer 33

Apoptosis (infliximab and adalimuamb) of cells producing TNF-alpha (imunosupression). Need to screen for latent diseases eg TB beore administrating

Question 34

Vendolizumab Mode of Action

Answer 34

Monoclonal antibody. Binds to alpha4-beta7 intigrin on white blood cells in gut. Reducing inflammation specifically in gut

Question 35

Ustekunimab Mode of Action

Answer 35

Monoclonal antibody. Targets IL-12 and IL-23, reducing T cell stimulation, reducing inflammation from T cell cytokines

Question 36

Mild ulcerative Colitis

Answer 36

<4 bowel movements daily, small amount blood in stool, no pyrexia, pulse <90 bpm, no anaemia, erythrocyte sedimentation < 30 mm/hr

Question 37

Severe Ulcerative Colitis

Answer 37

6+, some indication of systemic problems, visible blood in stool, >37.8 degrees C, pulse > 90 bpm, anemia, erythrocyte sedimentation > 30 mm/hr

Question 38

Mild to Moderate UC treatment

Answer 38

topical amino salicylates (4 weeks), add systemic amino salicylates if not in remission after 4 weeks. If required add course of topical/oral steroid

Question 39

Crohn's Treatment 1st line

Answer 39

Corticosteroid,/Budesenoid (if steroids aren't tolerated, less effective)/aminosalicylate therapy (steroids not tolerated or contradicted)

Question 40

Crohn's Treatment Add Ons

Answer 40

Immunosuppressant drug

Question 41

Non-pharmacological Treatments

Answer 41

Avoid smoking, balanced + low fat diet, avoid regylar NSAIDs, target average BMI, regular physical activity and mental health care

Question 42

Emergency Surgery Reasoning

Answer 42

Bowel perforation, rectal hemorrhage or toxic megacolon

Question 43

Proctocolometry Outline

Answer 43

Removal of large intestine and (colon and rectum). Results in stoma

Question 44

Colostomy Def

Answer 44

Surgery where opening is made in colon and skin to form stoma

Question 45

Ileostomy Def

Answer 45

Surgery where opening is made in small intestine and skin to form stoma

Question 46

Urostomy Def

Answer 46

Surgery where opening is made in bladder and skin to form stoma

Question 47

Stoma Def

Answer 47

Temporary/permanent surgical opening allow waste excretion from colon to bag