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Inflammatory Bowel Disease Flashcards

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1
Q

What is the general definition of IBD?

A

Dysregulation of the immune response to foreign proteins and host bacteria is the cause

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2
Q

Which type of IBD has been shown to have a stronger genetic input?

A

Crohn’s

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3
Q

What is a common gene affected in IBD and what is this involved in?

A

NOD2- encodes a protein involved in bacterial recognition

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4
Q

What are 5 common presenting complaints of IBD?

A

Change in bowel habit, PR bleeding, weight loss, anaemia, abdominal pain

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5
Q

What is most likely to be the diagnosis in a child < 12 with IBD symptoms?

A

Crohn’s

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6
Q

Symptoms of bloody diarrhoea, pain in the left lower quadrant and tenesmus are more likely to be what?

A

UC

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7
Q

Symptoms of non-bloody diarrhoea, upper GI symptoms, pain or mass in the right lower quadrant are more likely to be?

A

CD

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8
Q

Per-anal disease is more commonly associated with?

A

CD

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9
Q

Weight loss is more common in?

A

CD

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10
Q

What co-morbidities are more common in UC?

A

Primary sclerosing cholangitis and uveitis

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11
Q

What co-morbidity is more common in CD?

A

Gallstones

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12
Q

Which IBD has a higher risk of colorectal cancer?

A

UC

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13
Q

What are complications of CD?

A

Colorectal cancer, obstruction and fistula

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14
Q

Where in the GI tract does UC affect?

A

From rectum anywhere up to ileocaecal valve- continuously

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15
Q

Where in the GI tract does Crohn’s affect?

A

Anywhere from mouth to anus- usually patchy

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16
Q

Where does inflammation invade in UC?

A

Never beyond the submucosa

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17
Q

Where does inflammation invade in CD?

A

All layers from mucosa to serosa

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18
Q

Which IBD are pseudopolyps associated with?

A

UC

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19
Q

Which IBD is cobble-stoning of mucosa associated with?

A

CD

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20
Q

Which IBD does smoking protect against and which does it affect?

A

Protects- UC

Aggravate- CD

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21
Q

What age range is the peak incidence of UC?

A

20-30

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22
Q

What mediates UC?

A

Th1 and Th2

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23
Q

In UC, there is persistent activation of what?

A

T cells and macrophages

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24
Q

Natural killer cells in UC are mediated by what?

A

IL5 and IL13

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25
Can there ever be a single attack of UC?
Yes, but rarely
26
Where does UC tend to attack first?
The rectum, then works proximally
27
What does proctitis mean?
UC affecting only the rectum
28
What is left-sided colitis?
UC affecting rectum and sigmoid/descending colon
29
What is UC affecting the whole colon known as?
Pancolitis
30
What are 5 common symptoms of UC?
Bloody diarrhoea, urgency and tenesmus, increased bowel frequency, incontinence and night rising and lower abdominal pain
31
What are 5 extra-intestinal manifestations of UC?
Skin rashes, joint pain, eye problems, deranged LFTs, renal stones
32
What are the criteria involved in Truelove and Witt for UC?
Number of bowel movements, bloody stool, temp > 37.8, HR > 90bpm, anaemia
33
A temp > 37.8, HR > 90bpm and anaemia suggests what type of UC?
Severe
34
What distinguishes between mild and moderate UC?
Mild: < 4 bowel movements, spots of blood Moderate: 4-6 bowel movements, mild-severe blood
35
What tests would be done to assess UC?
Bloods, AXR, endoscopy or sigmoidoscopy, biopsy, histology
36
What would you test blood for in UC?
CRP and albumin
37
What should you look for on an AXR of UC?
Bowel dilatation, absent stool distribution, mucosal oedema (thumbprint), toxic megacolon
38
What is Wriggler's sign?
Can see the outside of the bowel wall- suggests perforation
39
What would you look for on histology of UC?
Absence of goblet cells and crypt distortion
40
Will there be granulomas on UC histology?
No
41
When should UC be monitored for colorectal cancer?
Every 10 years if patients have extensive colitis (beyond splenic flexure)
42
What is an electrolyte complication of UC?
Hypokalaemia
43
What parts of the GI tract tend to be involved in Crohn's in older and younger patients?
Younger- upper GI | Older- lower GI
44
What is the mediator of CD?
Th1
45
CD is driven by the production of what?
Interleukins, TNF alpha by dendritic cells and macrophages
46
What are symptoms of Crohn's in the mouth?
Painful ulcers, cobble-stoning of buccal mucosa, angular stomatitis, swollen lips
47
What are symptoms of Crohn's in the SI?
Abdominal cramps, diarrhoea, weight loss
48
What are symptoms of Crohn's in the LI?
Abdominal cramps, bloody diarrhoea, weight loss
49
What are symptoms of Crohn's in the anus?
Peri-anal pain, abscesses
50
What tests are used to assess CD?
Bloods, colonoscopy, endoscopy, mucosal biopsy, histology
51
What is looked for in blood tests of CD?
CRP, albumin, platelets, vitamin B12, ferritin
52
What will be seen on histology of CD?
Large, non-caseating granulomas
53
What can peri-anal disease lead to?
Fistula formation
54
What is used to treat peri-anal colitis?
Metronidazole
55
What type of effect do all IBD drugs have?
Anti-inflammatory
56
What are the drugs used for UC?
5ASA, steroids, immunosuppression, anti TNF
57
What are the drugs used for CD?
Steroids, immunosuppression, anti TNF
58
What is important to remember about the order of usage of IBD drugs?
Often start with strongest first to reduce symptoms and then decrease
59
As well as being an anti-inflammatory, what is another important effect of mesalazine?
Decreases risk of colorectal cancer
60
What are side effects of 5ASA?
Diarrhoea and nephritis
61
What is a suppository?
Solid dose in rectum
62
What is and enema?
Fluid dose in rectum
63
How can mesalazine be given?
Orally, suppository, enema
64
When should enemas and suppositories be used?
Enema- night | Suppository- morning
65
What are the first and second line corticosteroids used?
1- prednisolone | 2- budesonide (not systemic)
66
What drugs should be co-administered with corticosteroids?
Omeprazole
67
Because of unwanted steroid dependence, what drugs are used long term instead?
Immunosuppressants
68
What should you avoid co-prescribing with immunosuppressants?
Allopurinol
69
What are side effects of immunosuppressants?
Pancreatitis, leukopenia, hepatitis, small risk of skin cancer
70
Biological agents work by blocking what?
TNF alpha secreted by dendritic cells and macrophages
71
What are side effects of biological agents?
Cancers, reactivation of TB, irreversible MS
72
What are some emergency operations for IBD?
Subtotal colectomy for UC, resection of Crohn's
73
What are some elective operations for UC?
Proctocolectomy with end ileostomy, ileorectal anastomoses
74
What are some elective operations for CD?
Resection, stricturoplasty, fistula surgery, surgery for anal disease
75
Removal of the terminal ileum in Crohn's is common. This leads to a deficiency of what?
Vitamin B12
76
What are some indications for elective surgery of IBD?
Medically unresponsive disease, intolerable, dysplasia or malignancy, growth retardation in children
77
What is a proctocolectomy?
Removal of some or all of the colon without the rectum
78
What is a panproctocolectomy?
Removal of some or all of the colon with the rectum
79
What side is an ileostomy usually on?
Right
80
What are the two types of ileostomy and which is preferred?
End or loop- loop is preferred
81
Why is it important that ileostomies are spouted?
What comes out is toxic and can cause skin reactions
82
Where usually is the spout from a colostomy?
Left
83
Who are pouches following a proctocolectomy more common in and what do they create?
Younger people- create a reservoir
84
What shapes can pouches be?
W, S, J
85
What are the functional outcomes of a pouch?
Bad- usually around 6 bowel movements in 24 hours
86
Who are pouches not given to?
Crohn's patients (in UK) and young females without a family
87
What is pouchitis?
A common complication of pouch procedures which results in patients being at the toiler around 20-30 times a day with mucus and pain
88
How do you treat pouchitis?
Antibiotics and probiotics
89
Surgery for UC is usually what?
Curative
90
When is surgery for CD done?
Only when necessary- usually they will have it again after 10 years
91
What is a seton?
Technique used for fistulas

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