Inflammatory Bowel Disease Flashcards by user delete

what are the 2 main inflammatory bowel disease?

Crohn’s Disease
Ulcerative Colitis
(they overlap- intermediate colitis)

How well did you know this?

Not at all

Perfectly

peri-anal disease is more suggestive of which inflammatory bowel disease?

Crohn’s

How well did you know this?

Not at all

Perfectly

rectal bleeding is more suggestive of which inflammatory bowel disease?

How well did you know this?

Not at all

Perfectly

within crohn’s and UC what are the main possible defects with T cells?

overactive effector T cells

2. absence of regulatory T cells

How well did you know this?

Not at all

Perfectly

which inflammatory bowel disease if smoking protective against?

smoking protects against UC but aggravates Crohn’s disease

How well did you know this?

Not at all

Perfectly

what are the 3 main disease extent patterns of UC?

proctitis
left0sided colitis
pancolitis

How well did you know this?

Not at all

Perfectly

what is the disease extent pattern of proctitis?

doesn’t go any more proximally than sigmoid colon

How well did you know this?

Not at all

Perfectly

what is the disease pattern of left sided colitis?

doesn’t go any more proximally than splenic flexure

How well did you know this?

Not at all

Perfectly

what is the disease pattern of pancolitis?

extends over entire colon

How well did you know this?

Not at all

Perfectly

how do you define severe ulcerative colitis?

>6 bloody stools in 1 day
\+ 1 more out of:
- fever (>37.8degrees)
-tachycardia (>90/min)
-anaemia (Hb below 10.5g/dl)
- elevated ESR (above 30mm/hr)

How well did you know this?

Not at all

Perfectly

when looking at a plain AXR of a patient with UC, where should the stool be absent?

in the areas of inflammed colon

How well did you know this?

Not at all

Perfectly

in UC, what happens to the crypts of lieberkahn?

crypt distortion and abscess

How well did you know this?

Not at all

Perfectly

both inflammatory bowel disease increase risk of colorectal cancer, but which inflammatory bowel disease increases risk the most?

How well did you know this?

Not at all

Perfectly

what are the extra-intestinal manifestations of UC within the mouth?

stomatitis

apthous ulcers

How well did you know this?

Not at all

Perfectly

what are the extra-intestinal manifestations of UC within the eyes?

episcleritis

uveitis

How well did you know this?

Not at all

Perfectly

what are the extra-intestinal manifestations of UC on the skin?

erythema nodosum
proderma gangrenosum
phlebitis

How well did you know this?

Not at all

Perfectly

what are the extra-intestinal manifestation of UC in the joints?

spondylitis
sacrolitis
peripheral arthritis

How well did you know this?

Not at all

Perfectly

what are the extra-intestinal manifestations of UC in the kidneys?

stones
hydronephrosis
fistulae
UTI

How well did you know this?

Not at all

Perfectly

what are the extra-intestinal manifestations of UC in the biliary tract?

gallstones

sclerosing cholangitis

How well did you know this?

Not at all

Perfectly

what are the extra-intestina lmanifestations of UC in the liver?

steatosis

How well did you know this?

Not at all

Perfectly

what is the main problem within primary sclerosing cholangitis

fibrotic strictures within the biliary tree

How well did you know this?

Not at all

Perfectly

what is the difference between crohn’s and UC in terms of the depth of wall they affect?

UC- mucosal inflammation

crohns- transmural inflammation

How well did you know this?

Not at all

Perfectly

why can crohns lead to perianal disease?

recurrent abscess formation can lead to fistula with persistent leakage as well as damages sphincters

How well did you know this?

Not at all

Perfectly

what will the symptoms of crohns be if the disease is within the small intestine?

peri-umbilical cramps
diarrhoea
weight loss

How well did you know this?

Not at all

Perfectly

what will the symptoms of crohns be if the disease is within the colon?

lower abdomen cramps bloody diarrhoea weight loss

what will the symptoms of crohns be if the disease is within the mouth?

painful ulcers swollen lips angular chelitis

what will the symptoms of crohns be if the disease is within the anus?

peri-anal pain | abscess

what is the difference between crohns and UC in terms of what happens to the wall? (macroscopically)

crohns- thickened wall with fat wrapping UC- thinned wall with loss of haustra

what complication can the thickened bowel wall with fat wrapping lead to?

stricture formation

within crohn's disease you get segmental areas of disease with intervening normal areas, what are these areas called?

skip lesions

what type of IBD are granulomas seen in biopsy?

crohns

what type of granulomas are seen in crohns?

non-caseating granulomas

what are the main complications of Crohns disease?

``` malabsorption fistula bowel obstruction perforation anal disease intractable disease malignancy amyloidosis ```

what is amylodisos?

accumulation of deposits of abnormally folded protein

what are the 5 main theories of environmental triggers for crohns disease?

``` smoking infectious agents NSAIDs vasulitis sterile environment theory ```

What are the main complications of UC?

``` blood loss electrolyte distrubances (esp hypokalaemia) extra-GI manifestations colorectal carcinoma toxic megacolon intractable disease ```

which inflammatory disease are fistulae common in?

crohn's

what lifestyle advice should you give to patients with Crohns disease?

stop smoking

what are the main drug therapy options for UC?

5ASA (amino salicylates) steroids immunosuppressants anti-TNF therapy

what are the main drug therapy options for crohns disease?

steroids immunosuppressants anti-TNF therapy

whare are the 2 main mechanisms of 5ASA action?

anti-inflammatory | reduces risk of colon cancer

what are the side efects of 5AsA?

diarrhoea | nephritis

what are the 2 ways of 5ASA administrations?

oral or topical

5ASA are prodrugs, how do they become activated?

pH dependent release

what are the ways of topical administration of 5ASA?

suppositories | enemas

which is a better mode of topical therapy- suppositories or enemas?

suppositories- better mucosal adherence

what are corticosteroids used for in IBD?

a short course over 6-8 weeks to induce remission

when a more potent suppression of inflammation is required what do you used?

UC- steroid sparing agents eg azathioprine | Crohns- maintenance therapy eg methotrexate

what is the onset of action of azathioprine like?

slow onset (16 weeks)

what should you avoid prescribing when a patient is on azathioprine?

allopurinol | used to treat gout or kidney stones

what are the 4 dangerous side effects of azathioprine?

pancreatitis leukopaenia hepatitis lymphoma/skin cancer

what are the 2 main anti-TNF therapies and how are the administered?

infliximab- IV | adalimumab- subcut injection

what do anti-TNF therapies promote?

promote apoptosis of activated T-lymphocytes

compare outcome of surgery for crohns to UC?

crohns- surgery isn't curative | UC- surgery is curative

what is the drug therapy pyramid for IBD?

1. smoking cessation 2. 5ASA (UC) 3. steroids 4. immunosuppresoin 5. anti-TNF

what is the onset of anti-TNF therapy like?

rapid onset

what is a fistula?

an abnormal communication between two epithelial surfaces

what are the 5 main indications for elective surgery in UC?

``` medicallly unresponsive disease intolerability dysplasi/malignancy growth retardation in children attempted resolution of extra-intestinal disease ```

what is the surgical options for UC?

elective proctocolectomy with either: - end ileostomy - pouch - ileorectal anastomosis

compare a colostomy and ileostomy in terms of what side of the abdomen they are on?

ileostomy- right | colostomy- left

compare a colostomy and ileostomy in terms of what comes out of them?

ileostomy- effluent | colostomy- stool

how many times do patients who get a prcotocolectomy with pouch have bowel movements?

average 6 bowel movements per day

what are the 6 main indications for surgery in crohns?

1. stenosis causing obstruction 2. enterocutaneeous fistula 3. intra-abdominal fistulas 4. abscesses 5. acute/chronic bleeding 6. free perforations

what can a gastrojejunostomy be used for?

duodenal or pyloric stenosis

what does a gastrojejunostomy allow?

allows food to bypass the stenosis (obstruction)

Inflammatory Bowel Disease Flashcards

(65 cards)