Inflammatory Bowel Disease Flashcards Preview

JL Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Flashcards in Inflammatory Bowel Disease Deck (89):
1

Abdominal pain and peri-anal disease?

Crohns

2

Diarrhoea and bleeding?

UC

3

What does NOD2/CARD15 (1BD-1) genes do?

Encodes a protein involved in bacterial recognition

4

In the innate immunity of the bowel, what do tight junction regulate?

Epithelial permeability

5

In innate immunity, what protects the epithelial cell layer in the bowel?

Hydrophobic mucus

6

In innate immunity of the bowel, what can be activated constitutively or in response to bacterial components?

Defensins (cationic anti-microbial peptides)

7

What gene contributes to normal mucosal defences in innate immunity of bowel?

NOD2

8

What two factors can lead to maladaptive responses of the adaptive immune system?

1. Overactive effector T cells = inflammation and disease
2. Absence of regulatory T cells = uncontrolled inflammation/aggressive disease

9

What is a Th1 mediated disease?

Crohns

10

What is a mixed Th1/Th2 mediated disease/NKTC?

UC

11

What disease has reduced antimicrobial activity?

Crohns

12

What disease is aggravated by smoking and what disease protects against it?

Crohns is aggravated
UC its protective in

13

Other than smoking, what is another environmental factor for IBD?

NSAIDs

14

What age group is peak incidence for UC?

20-30

15

What area of the colon does UC affect?

Affects rectum extending proximally

16

What are increased bowel frequency, urgency, tenesmus, incontinence, night rising, lower abdominal pain and sometimes constipation all suggest?

UC

17

What is classed as severe UC?

>6 bloody stools/24 hours + 1 or more of: fever, tachycardia, anaemia Hb30

18

What two blood test features are important in UC?

CRP and albumin

19

What three investigations can be used to help diagnose UC?

1. Plain AXR
2. Endoscopy
3. Histology

20

On a plain AXR, what three features suggest UC?

1. Absent stool distribution in inflamed colon
2. Mucosal oedema/thumb printing
3. Toxic megacolon (transverse>5.5cm and Caecum>9cm)

21

What can confluent inflammation extending proximally from anal margin to transition zone, loss of vessel pattern, granular mucosa and contact bleeding all be found on in UC?

Endoscopy

22

Which condition affects the mucosal layer only?

UC

23

What two histological features are found in UC?

Absence of goblet cells
Crypt distortion and abscess

24

What is a long term increased risk for UC patients?

Colorectal cancer

25

What are two conditions found on skin in UC?

1. Pyoderma gangrenosum
2. Erythema nodosum

26

What are 3 joint conditions found with UC?

1. Spondylitis
2. Sacroillitis
3. Peripheral arthritis

27

What two conditions of the biliary tract relate to UC?

Gall stones
Primary Slerosing cholangitis

28

What condition in the liver is related to UC?

Steatosis/cirrhosis

29

What two conditions in the mouth relate to UC?

Stomatitis
Apthous ulcers

30

Name 1 eye condition found with UC?

Uveitis

31

What is the mean diagnosis age for Crohns?

27

32

Where can Crohns affect?

Any region of GI tract from mouth to anus

33

What are skip lesions and transmural inflammation found in?

Crohns disease

34

Where is the most common area for Crohsn?

Terminal ileum

35

What type of disease is associated with Crohns?

Perianal

36

What 4 features of peri-anal disease can Crohns cause?

1. Recurrent abscess formation
2. Pain
3. Fistula with persitent leakage
4. Damaged sphincter

37

What three symptoms of the mouth can appear with Crohns

1. Apthous ulcers
2. Swollen lips
3. Angular chielitis

38

Where can a mass commonly be felt in Crohns?

LIF

39

What 5 bloods are important to have with Crohns?

CRP, albumin, platelets, B12 (t.ileum), ferritin

40

What condition has cobblestoning and what has pseudopolyps?

Cobblestoning = crohns
Pseudopolyps = UC

41

What do barium follow-through, small bowel MRI and technetium-labelled white cell scan assess?

Small bowel

42

Transmural inflammation with non-caseating granulomas present?

Crohns

43

How is Crohns diagnosed?

Colonoscopy and biopsy

44

What investigation for Crohnss shows cobblestoning and rose thorn ulcers?

Barium enema

45

What investigation do you not do in UC?

Barium enema

46

What has crypt absesses and continuous lesions>

uc

47

What are the 4 therapy options for UC?

1. 5ASA mesalazine
2. Steroids
3. Immunosuppressants
4. Anti-TNF therapy

48

What are the three therapy options for Crohns?

1. Steroids
2. Immunosuppressants
3. Anti-TNF

49

What are two side effects of 5ASA mesalazine?

1. Diarrhoea
2. Idiosyncratic nephritis

50

What does mesalasine reduce the risk of?

cOLON CANCER

51

What are three features of Oral 5-aminosalicylic acid (5ASA)?

1. Prodrugs
2. pH dependent release
3. Delayed release

52

What are 2 features of topical 5ASA?

1. Suppositories
2. Enemas

53

Name 4 5-ASA conjugates?

1. Sulphazalazine
2. Balsalazide
3. Mezavant
4. Mesalazine

54

Name a pH release drug for UC and a delayed release drug for UC?

Asacol - pH
Pentasa - Delayed

55

Where does salazopyrin 5-ASA release into?

Colon

56

Where does balsalazide 5-ASA release into?

Colon

57

Where do asacol and salofalk 5-ASA release into?

Ileum and colon

58

Where does pentasa 5-ASA release into?

Duodenum, jejunum, ileum and colon

59

Name two corticosteroids used for UC?

Prednisolone and Budesonide

60

What do corticosteroids to in UC?

Induce remission

61

What are two side effects of corticosteroids?

Avascular necrosis and osteoporosis

62

What are three metabolic side effects of corticosteroids?

Weight gain, diabetes and hypertension

63

In UC what immunosuppression should be used?

Steroid-sparing agents

64

In crohns what 3 immunosuppression drugs can be used for maintanence therapy?

1. Azathioprine
2. Mercaptopurine
3. Methotrexate

65

What immunosuppression drug has a slow onset of action (16 weeks), TPMT activity which contributes to toxicity?

Azathioprine

66

What drug should not be prescribed with azathioprine?

Allopurinol

67

What are 4 side effects of azathioprine?

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

68

What is tumour necrosis factor alpha?

Proinflammatory cytokines

69

Name two anti-TNF therapy agents?

1. Chimeric (infliximab: IV infusion)
2. Humanised (adalimumab:S/C injection)

70

What does anti-TNF therapy promote?

Apoptosis of activated T lymphocytes

71

In Crohns, what can repeated resection of the small intestine result in?

Short gut syndrome

72

Can surgery for UC be curative?

Yes

73

What are two otpions for UC therapy?

1. Permanent ileostomy
2. Restorative proctocoloectomy and pouch

74

What is an abnormal communication between two epithelial surfaces?

Fistula

75

What are two planned emergency operations for UC and Crohns?

Subtotal colectomy for UC
Resection for Crohns

76

What are proctocolectomy with end ileostomy and proctocolectomy with ileorectal anastomosis elective operations on?

UC

77

What is usually left, usually flush and stool?

Colostmy

78

What is usually right, usually spouted and usually effluent?

Ileostomy

79

What assessment of severity is ESR, haemoglobin, bloody stools, temperature and heart rate from?

Truelove and Witt criteria

80

In a severe attack of IBD what is ESR?

>30

81

What is Rigler's sign and what can it be found in?

Toxic megacolon and gas on outside of bowel wall

82

In Crohns what does stenosis causing obstruction, enterocutaneous fistulas, intra-abdominal fistulas, abscesses, bleeding and free perforation indicate the need for?

Surgery

83

What investigations need to be done for diagnosing Crohns?

Endoscopy and mucosal biopsy

84

In Crohns pathology, what ileal and/or colonic chronic activate mucosal inflammation is present/

1. Cryptitis
2. Crypt abscesses

85

What are 4 complications of Crohns disease?

1. Malabsorption
2. Iatriogenic - short bowel syndrome
3. Hypoproteinaemia, vitamin deficiency, anaemia
4. Gall stones

86

What is acute fulminant colitis found in UC?

Toxic megacolon

87

What is basal lymphoplasmacytic infiltrate with irregular shaped branching crypts found in?

UC

88

What kind of exudate is found with severe ulceration in UC?

Fibrinopurulent exudate

89

What condition are pseudopolyps seen in and the same condition does not have granulomas?

UC