Flashcards in Inflammatory Bowel Disease Deck (43)
Inflammatory bowel disease mainly comprises of two idiopathic chronic inflammatory diseases - what are they?
Which 3 factors link together in the pathogenesis of IBD?
Impaired mucosal immunity
There is a stronger genetic link in UC than Crohn's disease. True/False?
Stronger genetic link in Crohn's (36%) than UC (16%)
Which gene is susceptible to mutation which causes inflammatory bowel disease?
NOD2 (IBD-1) on chromosome 16
Encodes protein involved in bacterial recognition
Crohn's disease a TH1/TH2/TH1+TH2 mediated disease
UC is a TH1/TH2/TH1+TH2 mediated disease
(mixed) TH1 + TH2 -mediated disease
Smoking aggravates Crohn's disease + UC. True/False?
Aggravates Crohn's but no effect on/may even protect UC
Which age range is typical peak incidence of UC?
20-40s but variable
Where does the inflammation start in UC?
Does UC produce skip lesions?
Continuous proximal inflammation from rectum to stop point
List typical symptoms of UC
Diarrhoea + bleeding
Increased bowel frequency
Urgency, tenesmus, incontinence
Lower abdo pain (LIF)
Define severe UC
>6 bloody stools/day + 1 of:
What is the classic sign of mucosal inflammation/oedema on an AXR?
How does toxic megacolon arise?
Persistent inflammation causes loss of muscle tone of the colon, resulting in distention
What are some extra-intestinal manifestations of UC?
Primary sclerosing cholangitis
Which age range is typical for Crohn's disease?
Young children to 40 year olds
The inflammation in Crohn's and UC is transmural, i.e. it breaches the mucosa and goes beyond muscle layer. True/False?
Inflammation in Crohn's is transmural; inflammation in UC is confined to mucosa/submucosa
Does Crohn's disease produce skip lesions?
Can affect anywhere from mouth to anus
Can fistulas occur in Crohn's and UC?
Leads to abscess formations, especially peri-anally
Symptoms of Crohn's disease are dependent on where the disease occurs. List some common symptoms
How common is granuloma in Crohn's disease?
50% of patients
Where does Crohn's disease most commonly occur?
Fissures are associated with which IBD - Crohn's or UC?
Deep, knife-like fissures
List some complications of Crohn's disease
Short bowel syndrome
Vitamin deficiencies, anaemia
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)
How can mesalazine be administered?
Topically as a rectal suppository/enema
What is the main action of mesalazine?
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
What is the advantage of a mesalazine topical enema over a suppository?
Enema extends action to sigmoid colon
What is the advantage of a mesalazine topical suppository over an enema?
Suppository has better mucosal adherence
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 are given for a long course in IBD. True/False?
Is increasing or reducing dosage of steroids given for IBD?
(start high and reduce over 6-8 weeks)
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
Which class of drug is used after immunosuppression? Give an example of a drug of this class
Anti-TNF has become the mainstay of treating Crohn's disease. When is it mainly used, according to NICE?
BUT NOT IN PRESENCE OF TB
What are "planned" surgical procedures for IBD in cases of emergency?
Subtotal colectomy (leave rectum) in UC
Resection in Crohn's disease
List elective surgery for Crohn's disease
List elective surgery for UC
Proctocolectomy with end ileostomy
Proctocolectomy with ileorectal anastomosis
Proctocolectomy with pouch
What is an ileostomy?
Small intestine is diverted to an opening in the abdomen and a bag is placed externally to collect waste products
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
Surgery for UC is well tolerated. True/False?
Most live well with a stoma