Inflammatory Bowel Disease Flashcards by Sarah Anderson

What is the two aetiologies of IBD

Environmental triggers
(bacteria, diet, vaccinations, social, ethnicy)

and

Genetic susceptibility

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What is the two most common forms of Inflammatory bowel disease

Crohns disease

Ulcerative colitis

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What is the symptoms of Ulcerative colitis

Bloody diarrohea

abdominal pain

weight loss

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What is the signs of a severe attack of ulcer colitis

> 6 stools a day with blood

Fever

Tachycardia

Raised CRP

Anemia

Low Albumin

Leucocytosis

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What is the pathology of Ulcerative colitis

Continous inflammation starting from the rectum and only affecting the colon

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What is variable in Ulcerative colitis

Distribution and Severity

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What is the management of Ulcerative colitis

Surgical removal - colectomy

needs to be controlled within 7 days

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Why is Crohns disease called a patchy disease

Mouth to anus, called a patchy disease due to skipped lesions

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What is the complications of Crohns disease

Inflammation
Stricture
Fistula

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What does the clinical feature sypmtoms of crohns disease depend upon

the regions involved - therefore gives a wide variety of symptoms

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What is the symptoms of crowns disease

Diarrhoea 
abdominal pain 
Weight loss 
Malise 
Lethargy 
Anorexia 
Malabsorption: 
 Anemia 
 Vitamine deficiency

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What are the blood markers for Crohns disease

High ESR 
High platelet count 
High WBC 
Low Hb
Low Albumin

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What is investigated in stool samples for Crohns disease, why?

Calcoprotein,

Is a white cell protein found in the bowels, when bowels become inflammation there is an increase in cal protein in stool sample

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What differential diagnosis but be checked for crowns disease

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What are the other causes of Irritable bowel disorder

Lymphocytic colitis
Collagenous colitis
Microscopic colitis

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Where can extra manifestations occur in IBD

Eyes
Inflammation/conjunctivitis

Joint
inflammation/ arthritis

Renal calculi

Liver and Billary tree

Skin

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What are the manifestation of IBD that can be seen on the skin

Pyroderma gangrenosum

Erythema nosdum

Vasculitis

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What are the manifestations of IBD occurring in the liver and biliary tress

Fatty change

Pericholangitis

Sclerosing cholangitis

Gallstones

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What form of Irritable bowel disease manifest to renal calculi

Crohns disease

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What is the differential diagnosis of IBD

Chronic diarrhoea

malabsorption
malnutrition

Illeo-caecal TB

Different collitis:

infective
amoebic
ischaemic

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What is the long term complication of IBD

Colonic carcinoma

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What is the risk factors for colonic carcinoma

The extent of IBD

and the duration of IBD

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How is the potentially development of colonic cancer monitored

Surveillance colonoscopy - biopsy

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What is the problems of Surveillance colonoscopy

Cancers do not always arise from dysplastic mucosa

May be difficult to interpret

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What is the steps of medical management in IB

5-ASA or sulfasalazine Steroids: Predisolone /Budenoside Immunosuppressants Biologics Elemental feeding antibiotics Surgery

What are aminosalicylates (5ASA) drugs purpose

Reduces inflammation of the inning of the intestine

When are 5-ASA or sulfasalazine used in the treatment of IBD

1st line therapy used in the induction and maintenance of remission

How is 5ASA administrated

>3g per day tablet Rectal 5ASA

What is the purpose of rectal 5ASA

Treats distal and more extensive disease

What is the overall benefit of 5ASA as 1st line therapy

Greater and quicker clinical improvement Reduced number and severity of relapse Reduced colorectal cancer risk (>2g per day life long) Higher mucosal levels gives greater benefit

How is Predisolone administrated in IBD

Optimal dose 40mg per day with tapering reduction over a minimum of 4 weeks (longer to reach colon and control inflammation)

How does Budenoside steroid treatment compare to prednosiolone steroid treatment

Slightly less effective than Prednisolone but better side effect profile

What does Budenoside specifically treat

Illeal and ascending colon disease

What are examples of | immunosuppressants used in the treatment of IBD

``` Azathioprone Methotrexate Ciclosporin Mycocphenolate Tacrolimus ```

When is azathioprine (AZA/6MP) used in the treatment of IBD

Induction and maintenance of remission

What is the benefit of azathioprine

Is steroid sparing =lower the dose of steroids needed and thus spare some of the undesirable side effects of steroid therapy

What is the potential side effect of azathioprine

``` Leucopenia Hepatoxcity Pancreatits Possible long term lymphoma risk Intoleracne ```

What is essential when managing the side effect of azathioprine

Blood monitoring for the side effect of hepatoxicity - For 8 weeks - Then every 8 weeks - patients must see GP if throat sore/infection

What does methotextrate (MTX) specifically treat, and when is it administrated

Unlicensed use to treat Crohns disease Used in the Induction and maintenance of remission

What is methotextrate dependant upon

Steriods

When is the immunosuppressant ciclosporin used

Final option for treating refractory Ulcerative colitis Or used 3-6months as a bridge to azathioprine treatment

What are examples of the biologics used to treat IBD

(Anti TNF alpha antibodies) MONOCLONAL ANTIBODIES - Infliximab - Adulimunab BLOCKERS Alpha 4B7 integrin blockers -Vedolizumab IL12/IL23 Blockers - Ustekinumab

Define Biologic therapy

Treatment manufactured in living system | eg monolocalantibodies

How is biologics administrated

IV infusion - 8 weekly | Subcutaneous Injection - 2 weekly

What do biologics increase the risk of

Cancer

What is elemental feeding just as effective as

Steroid treatment

Who is elementary feeding more effective in and why?

Children as are more complaint to the treatment tastes disgusting so adults less complaint

What is the antibiotic used in IBD

Metronidazole

What does the antibiotic metronidazole treat specifically in IBD

Crohns peri-anal disease Small bowel bacterial growth

What are examples that show the failure of medical therapy in IBD treatment

Recurrent courses of steroids Relapse priori to shortly stopping therapy Failure to control symptoms Complications of steroids

What are some of the complications of steroids that indicate medial failure in the therapy of iBD

Diabetes severe Osteopororisis Psychosis

What are conditions that have a poor response to medical therapy for IBD

Fistulas Fibrotic strictures Peri-anal disease Severe fulminating disease (new disease)

What are the therapies used in the hospital to treat IBD

``` Steroids Anticoagulation rest surgery Cyclosporin - immunosuppressant Infliximab - monoclonal antibody ```

What therapies are used for out patients with IBD

5ASA Steroids Immunosuppression

When would emergency surgery rather than elective be performed on a patient with IBD

If they have had 5 day of medical treatment with still no improvement

What is the surgery option if a patent with severe colitis forms acutely ill

total colectomy Rectal preservation illeostomy

What are the two procedure for rectal preservation

Protectomy or Pouch procedure

Define proctectomy

Remove all part of the rectum

What happens in a pouch procedure

Small bowel is mobilised and lengthened | from Ileum to distal anal canal to construct pouch and stapled together creating a false rectum

Define an illeostomy

Ileum cut into and diverted to an artificial opening in the abdominal wall creating a stoma bag

What problems arising in the anus due to Crohns may need surgical intervention

Fissures abscesses Fistulas Skin tags

What is the surgical indication for crohns disease

Failure of medical management Relief of obstructive symptoms (small bowel) Management of fistulae Management of intra-abdominal abscess Management anal conditions Failure to thrive

Inflammatory Bowel Disease Flashcards

(62 cards)