Flashcards in Inflammatory Bowel Disease Deck (89):
Abdominal pain and peri-anal disease?
Diarrhoea and bleeding?
What does NOD2/CARD15 (1BD-1) genes do?
Encodes a protein involved in bacterial recognition
In the innate immunity of the bowel, what do tight junction regulate?
In innate immunity, what protects the epithelial cell layer in the bowel?
In innate immunity of the bowel, what can be activated constitutively or in response to bacterial components?
Defensins (cationic anti-microbial peptides)
What gene contributes to normal mucosal defences in innate immunity of bowel?
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
What is a Th1 mediated disease?
What is a mixed Th1/Th2 mediated disease/NKTC?
What disease has reduced antimicrobial activity?
What disease is aggravated by smoking and what disease protects against it?
Crohns is aggravated
UC its protective in
Other than smoking, what is another environmental factor for IBD?
What age group is peak incidence for UC?
What area of the colon does UC affect?
Affects rectum extending proximally
What are increased bowel frequency, urgency, tenesmus, incontinence, night rising, lower abdominal pain and sometimes constipation all suggest?
What is classed as severe UC?
>6 bloody stools/24 hours + 1 or more of: fever, tachycardia, anaemia Hb30
What two blood test features are important in UC?
CRP and albumin
What three investigations can be used to help diagnose UC?
1. Plain AXR
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)
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?
Which condition affects the mucosal layer only?
What two histological features are found in UC?
Absence of goblet cells
Crypt distortion and abscess
What is a long term increased risk for UC patients?
What are two conditions found on skin in UC?
1. Pyoderma gangrenosum
2. Erythema nodosum
What are 3 joint conditions found with UC?
3. Peripheral arthritis
What two conditions of the biliary tract relate to UC?
Primary Slerosing cholangitis
What condition in the liver is related to UC?
What two conditions in the mouth relate to UC?
Name 1 eye condition found with UC?
What is the mean diagnosis age for Crohns?
Where can Crohns affect?
Any region of GI tract from mouth to anus
What are skip lesions and transmural inflammation found in?
Where is the most common area for Crohsn?
What type of disease is associated with Crohns?
What 4 features of peri-anal disease can Crohns cause?
1. Recurrent abscess formation
3. Fistula with persitent leakage
4. Damaged sphincter
What three symptoms of the mouth can appear with Crohns
1. Apthous ulcers
2. Swollen lips
3. Angular chielitis
Where can a mass commonly be felt in Crohns?
What 5 bloods are important to have with Crohns?
CRP, albumin, platelets, B12 (t.ileum), ferritin
What condition has cobblestoning and what has pseudopolyps?
Cobblestoning = crohns
Pseudopolyps = UC
What do barium follow-through, small bowel MRI and technetium-labelled white cell scan assess?
Transmural inflammation with non-caseating granulomas present?
How is Crohns diagnosed?
Colonoscopy and biopsy
What investigation for Crohnss shows cobblestoning and rose thorn ulcers?
What investigation do you not do in UC?
What has crypt absesses and continuous lesions>
What are the 4 therapy options for UC?
1. 5ASA mesalazine
4. Anti-TNF therapy
What are the three therapy options for Crohns?
What are two side effects of 5ASA mesalazine?
2. Idiosyncratic nephritis
What does mesalasine reduce the risk of?
What are three features of Oral 5-aminosalicylic acid (5ASA)?
2. pH dependent release
3. Delayed release
What are 2 features of topical 5ASA?
Name 4 5-ASA conjugates?
Name a pH release drug for UC and a delayed release drug for UC?
Asacol - pH
Pentasa - Delayed
Where does salazopyrin 5-ASA release into?
Where does balsalazide 5-ASA release into?
Where do asacol and salofalk 5-ASA release into?
Ileum and colon
Where does pentasa 5-ASA release into?
Duodenum, jejunum, ileum and colon
Name two corticosteroids used for UC?
Prednisolone and Budesonide
What do corticosteroids to in UC?
What are two side effects of corticosteroids?
Avascular necrosis and osteoporosis
What are three metabolic side effects of corticosteroids?
Weight gain, diabetes and hypertension
In UC what immunosuppression should be used?
In crohns what 3 immunosuppression drugs can be used for maintanence therapy?
What immunosuppression drug has a slow onset of action (16 weeks), TPMT activity which contributes to toxicity?
What drug should not be prescribed with azathioprine?
What are 4 side effects of azathioprine?
Small risk of lymphoma, skin cancer
What is tumour necrosis factor alpha?
Name two anti-TNF therapy agents?
1. Chimeric (infliximab: IV infusion)
2. Humanised (adalimumab:S/C injection)
What does anti-TNF therapy promote?
Apoptosis of activated T lymphocytes
In Crohns, what can repeated resection of the small intestine result in?
Short gut syndrome
Can surgery for UC be curative?
What are two otpions for UC therapy?
1. Permanent ileostomy
2. Restorative proctocoloectomy and pouch
What is an abnormal communication between two epithelial surfaces?
What are two planned emergency operations for UC and Crohns?
Subtotal colectomy for UC
Resection for Crohns
What are proctocolectomy with end ileostomy and proctocolectomy with ileorectal anastomosis elective operations on?
What is usually left, usually flush and stool?
What is usually right, usually spouted and usually effluent?
What assessment of severity is ESR, haemoglobin, bloody stools, temperature and heart rate from?
Truelove and Witt criteria
In a severe attack of IBD what is ESR?
What is Rigler's sign and what can it be found in?
Toxic megacolon and gas on outside of bowel wall
In Crohns what does stenosis causing obstruction, enterocutaneous fistulas, intra-abdominal fistulas, abscesses, bleeding and free perforation indicate the need for?
What investigations need to be done for diagnosing Crohns?
Endoscopy and mucosal biopsy
In Crohns pathology, what ileal and/or colonic chronic activate mucosal inflammation is present/
2. Crypt abscesses
What are 4 complications of Crohns disease?
2. Iatriogenic - short bowel syndrome
3. Hypoproteinaemia, vitamin deficiency, anaemia
4. Gall stones
What is acute fulminant colitis found in UC?
What is basal lymphoplasmacytic infiltrate with irregular shaped branching crypts found in?
What kind of exudate is found with severe ulceration in UC?