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Flashcards in Inflammatory Bowel Disease Deck (63):
1

what are the two idiopathic chronic inflammatory diseases involved in IBD?

Ulcerative colitis
Crohn's disease

2

what do ulcerative colitis and Crohn's disease have in common?

epidemiology
clinical cases
therapeutic characteristics

3

How do ulcerative colitis and Crohn's disease differ?

clinical presentation
pathology

4

what are the 3 main factors involved in the pathogenesis of IBD?

Genetic predisposition
Mucosal Immune system
Environmental triggers

5

Is there a genetic link in IBD?

yes

6

which chromosome is thought to be involved in the genetic link in IBD?

Chromosome 16

7

In Crohn's disease what is the section in which a mutated form causes the disease?

NOD2

8

How does NOD2 cause Crohn's disease?

encodes for a protein involved in bacterial recognition

9

What is used in the treatment of peri-anal Crohn's disease?

antibiotics

10

In which type of Crohn's disease is antimicrobial activity highest?

Colonic Crohn's

11

what was does smoking effect IBD?

Aggravates Crohn's disease
Protects agains ulcerative colitis

12

What environmental factors can cause IBD?

smoking
NSAIDs use
Vasculitis
Infectious agents
Sterile environment therapy

13

what is pancolitis?

Ulcerative colitis which affects the whole colon

14

what is proctitis?

Ulcerative colitis which affects the anus and anal canal only

15

what are the symptoms of ulcerative colitis?

Diarrhoea and bleeding
Increased bowel habit
urgency
Tenesmus
Incontinence
Lower abdominal pain - LIF
Night rising

16

to determine sever UC 6 or more bloody stool need to be passed in 24 hours along with what else?

one or more of the following:
Fever
Tachycardia
Anaemia
Elevates ESR

17

what investigations would be used for ulcerative colitis?

Bloods - CRP and albumin
AXR
Endoscopy
Histology

18

what might an AXR show in ulcerative colitis?

no stool present in inflamed colon
Mucosal oedema - thumb printing
Toxic megacolon

19

what would be present at endoscopy in a patient with ulcerative colitis?

loss of vessel pattern
Granular mucosa
Contact bleeding

20

what differs in the histology of ulcerative colitis?

abscence of goblet cells
crypt distortion and abscess

21

which layer does ulcerative colitis effect in the colon?

mucosal layer

22

what determines the risk of cancer in ulcerative colitis?

Severity of inflammation
Duration of disease
Disease extent

23

what is Primary sclerosing cholangitis?

Chronic inflammatory disease of the biliary tree

24

How may primary sclerosing colangitis present?

mostly asymptomatic or presents as an itch and rigors

25

In which IBD does primary sclerosing colangitis present?

Ulcerative colitis

26

Which region of the GI tract does Crohn's affect?

Any

27

What are the common characteristics of Crohn's?

Skip lesions
Transmural inflammation

28

what is peri-anal disease?

Recurrent abscess formation which can then lead to fistula formation with a persistent leak - damaged sphincters

29

what are Crohn's symptoms when affecting the small intestine?

abdominal cramps
diarrhoea
weight loss

30

what are Crohn's symptoms when affecting the colon?

abdominal cramps
diarrhoea with blood loss
weight loss

31

what are the Crohn's symptoms when affecting the mouth?

Painful ulcers
Swollen lips
Angular chielitis - inflammation at the side of the mouth

32

what are the Crohn's symptoms when affecting the anus?

peri-anal pain
abscess

33

what are the investigations for Crohn's disease?

clinical examination
FBC
CRP, albumin, platelets

34

what might be found on examination of a patient with Crohn's disease?

evidence of weight loss
Right iliac fossa mass
Peri-anal signs

35

In which IBD are granulomas present?

Crohn's disease

36

How can the small bowel be assessed in Crohn's disease?

Barium follow through
Small bowel MRI
Technetium-labelled white cell scan

37

Define Crohn's disease

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

38

Where does Crohn's disease most commonly present?

Terminal ileum and colon

39

How does Crohn's disease generally present?

Abdominal pain
Small bowel obstruction
Diarrhoea
Bleeding PR
Anaemia
Weight loss

40

what is this patient most likely to have:

22years
Male
Abdominal pain
Bloody diarrhoea for 3/12
Tender abdomen

Crohn's disease

41

Is Crohn's does not respond to medical therapy what can this cause?

A bowel obstruction - leads to surgery

42

Is Crohn's disease patchy?

Yes - it is a segmented disease

43

Where does the inflammation occur in Crohn's?

Ileal and or colonic mucosa - includes cryptitis and crypt abscesses

44

what kind of inflammation occurs in Crohn's?

Transmural

45

How can the ulcers be described in Crohn's?

Deep knife-like fissuring

46

what are the complications of Crohn's disease?

Malabsorption
Fistula formation
Anal disease
Intractable disease
Bowel obstruction
perforation
Malignancy
Amylodiosis
Toxic megacolon

47

what does iretractable disease cause?

continous diarrhoea or pain

48

How does the immune system respond in Crohn's?

persistent activation of T-cells - don't switch off
excessive pro inflammatory cytokine production

49

what is ulcerative colitis?

Chronic inflammatory disorder confined to colon and rectum

50

which layers are inflamed in ulcerative colitis?

mucosal and submucosal

51

which part of the body does ulcerative colitis almost always involve?

Rectum

52

How can ulcerative colitis present clinically in terms of incidence?

Chronic course with exacerbation and remission
Continuous low grade activity
A single attack

53

what is this patient most likely suffering from:

32 years
Female
Bloody diarrhoea and mucus
Goes to toilet 25 times a day

Ulcerative colitis

54

what might need to be done if a patient doesn't respond to medical therapy?

subtotal colectomy

55

Are granulomas present in ulcerative colitis?

No

56

What are the complications of ulcerative colitis?

Intractable disease
Toxic megacolon
Colorectal carcinoma
Blood loss
Elecrolyte disturbance - hypokalaemia
Anal fissures
GI mannifestations

57

what is toxic megacolon?

When the colon swells up to a point where it will rupture unless removed

58

what GI manifestations may present in the eye?

Uveitis - eye redness

59

what GI manifestations may present in the liver?

Primary clerosing cholangitis

60

what GI manifestations may present in the joints?

Arthritis
Ank spondylitis (spinal arthritis)

61

what GI manifestations may be present on the skin?

Pyoderma gangrenosum, erythema nodusum

62

What genetic factor is ulcerative colitis associated with?

HLA-DR2

63

How is the immune system affected by ulcerative colitis?

Persistent activation of T-cells and macrophages - causes damage due to neutrophilic inflammation