Inflammatory Bowel Disease Flashcards Preview

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Flashcards in Inflammatory Bowel Disease Deck (43):
1

Inflammatory bowel disease mainly comprises of two idiopathic chronic inflammatory diseases - what are they?

Crohn's disease
Ulcerative colitis

2

Which 3 factors link together in the pathogenesis of IBD?

Genetic predisposition
Impaired mucosal immunity
Environmental triggers

3

There is a stronger genetic link in UC than Crohn's disease. True/False?

False
Stronger genetic link in Crohn's (36%) than UC (16%)

4

Which gene is susceptible to mutation which causes inflammatory bowel disease?

NOD2 (IBD-1) on chromosome 16
Encodes protein involved in bacterial recognition

5

Crohn's disease a TH1/TH2/TH1+TH2 mediated disease

TH1-mediated disease

6

UC is a TH1/TH2/TH1+TH2 mediated disease

(mixed) TH1 + TH2 -mediated disease

7

Smoking aggravates Crohn's disease + UC. True/False?

False
Aggravates Crohn's but no effect on/may even protect UC

8

Which age range is typical peak incidence of UC?

20-40s but variable

9

Where does the inflammation start in UC?

Rectum

10

Does UC produce skip lesions?

No
Continuous proximal inflammation from rectum to stop point

11

List typical symptoms of UC

Diarrhoea + bleeding
Increased bowel frequency
Urgency, tenesmus, incontinence
Night rising
Lower abdo pain (LIF)

12

Define severe UC

>6 bloody stools/day + 1 of:
Fever
Tachycardia
Anaemia
Elevated ESR

13

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

Thumbprinting

14

How does toxic megacolon arise?

Persistent inflammation causes loss of muscle tone of the colon, resulting in distention

15

What are some extra-intestinal manifestations of UC?

Primary sclerosing cholangitis
Apthous ulcers
Erythema nodosum
Uveitis

16

Which age range is typical for Crohn's disease?

Young children to 40 year olds

17

The inflammation in Crohn's and UC is transmural, i.e. it breaches the mucosa and goes beyond muscle layer. True/False?

False
Inflammation in Crohn's is transmural; inflammation in UC is confined to mucosa/submucosa

18

Does Crohn's disease produce skip lesions?

Yes
Can affect anywhere from mouth to anus

19

Can fistulas occur in Crohn's and UC?

Yes
Leads to abscess formations, especially peri-anally

20

Symptoms of Crohn's disease are dependent on where the disease occurs. List some common symptoms

Abdominal cramps
Diarrhoea
Weight loss
Painful ulcers
Abscesses

21

How common is granuloma in Crohn's disease?

50% of patients

22

Where does Crohn's disease most commonly occur?

Terminal ileum
Colon

23

Fissures are associated with which IBD - Crohn's or UC?

Crohn's disease
Deep, knife-like fissures

24

List some complications of Crohn's disease

Malabsorption
Short bowel syndrome
Vitamin deficiencies, anaemia
Fistulas

25

What are the 4 treatments available (excluding surgery) for UC and Crohn's disease, in order of step-up therapy?

5-ASA (mesalazine - UC ONLY)
Steroids
Immunosuppression
Anti-TNF drugs

26

How can mesalazine be administered?

Orally
Topically as a rectal suppository/enema

27

What is the main action of mesalazine?

Anti-inflammatory

28

Mesalazine can be given in an oral form that is "pH-dependent" - what does this mean?

Only activates at a certain pH; in this case, would only activate in the presence of the pH of the colon

29

What is the advantage of a mesalazine topical enema over a suppository?

Enema extends action to sigmoid colon

30

What is the advantage of a mesalazine topical suppository over an enema?

Suppository has better mucosal adherence

31

If mesalazine is ineffective/patient continues to experience symptoms, which class of drugs is prescribed? Give an example of the class of drug used

Steroids
Oral/topical prednisolone/budesonide

32

Steroids are given for a long course in IBD. True/False?

False

33

Is increasing or reducing dosage of steroids given for IBD?

Reducing dose
(start high and reduce over 6-8 weeks)

34

When a more potent suppression of inflammation than steroids is required, which class of drugs is prescribed? Give an example of this class of drug

Immunosuppression
Azathioprine, Methotrexate

35

Which class of drug is used after immunosuppression? Give an example of a drug of this class

Anti-TNF drugs
IV Infliximab

36

Anti-TNF has become the mainstay of treating Crohn's disease. When is it mainly used, according to NICE?

Long-term management
Refractory/fistulating disease
BUT NOT IN PRESENCE OF TB

37

What are "planned" surgical procedures for IBD in cases of emergency?

Subtotal colectomy (leave rectum) in UC
Resection in Crohn's disease

38

List elective surgery for Crohn's disease

Resection
Stricturoplasty
Fistula repair

39

List elective surgery for UC

Proctocolectomy with end ileostomy
Proctocolectomy with ileorectal anastomosis
Proctocolectomy with pouch

40

What is an ileostomy?

Small intestine is diverted to an opening in the abdomen and a bag is placed externally to collect waste products

41

What is a pouch? (AKA ileo-anal pouch; J/W/S pouch)

Loops of small intestine are folded and stapled on itself to create a reservoir, restoring normal function of the rectum

42

Surgery for UC is well tolerated. True/False?

True
Most live well with a stoma

43

Surgery for Crohn's is well tolerated. True/False?

False