inflammatory bowel disease Flashcards
(67 cards)
1
Q
age group for uc or cd
A
any
2
Q
gender divide uc and cd
A
m=f for uc
f>m for cd
3
Q
genetic factors for uc and what defect assoc. too
A
HLA-DR103
Colonic epithelial barrier function
4
Q
genetic factors for CD and what defect assoc. too
A
HLA locus NOD2 ATG16L1 IRGM genetic defect in innate immunity and autophagy
5
Q
ethnic group ibd
A
ashkenazi jew
6
Q
risk factors/ protective for UC
A
more common in non or ex smokers
-appendiectomy also proective
7
Q
risk factors for cd
A
smokers
fhx
8
Q
presentation of uc
A
bloody diarrhoea tenesmus abdominal cramps anorexia malaise weight loss
9
Q
presentation of cd
A
variable pain, diarrhoea and weight loss
often watery diarrhoea and then lethargy mouth ulcers peri-anal abscess perianal skin tags fistulae
10
Q
management of uc
A
5ASA Steroids azathioprine/mercaptopurine biologicals colectomy
11
Q
management cd
A
steroids azathioprine methotrexate mercaptopurine budesonide (ileocaecal) biological nutritional smoke cessation
12
Q
site of uc
A
rectum +- along colon
13
Q
site of cd
A
anywhere from mouth to anus
perianal and skin
14
Q
distribution / image of uc
A
diffuse
continuous
confined to mucosa
(only calcaneal patch ie appendix can be skipped)
15
Q
distribution/ image of cd
A
patchy
transmural
16
Q
features of uc
A
cryptitis crypt abscess goblet cell distribution crypt architecture distorotion crypt loss
17
Q
features of cd
A
patchy
lymphoid aggregates
granulomas
crypt stuff preserved
18
Q
uc ulceration
A
broad based, shallow may undermine mucosa
19
Q
cd ulceration
A
apthaous ulcers
deep fissuring ulcers
20
Q
granulomas uc
A
uncommon
assoc. to ruptured ulcers
21
Q
gramulomas cd
A
common may be transumural and involve lymph nodes
22
Q
which uc or cd has fistulae and strictures
A
cd
23
Q
which cd or uc more likely to have inflammatory polyps
A
uc get pseudopolyps
may be larger in cd tho
24
Q
other features of uc
A
paneth cell metaplasia
pseudopolyps
25
other features of cd
pyloric metaplasia in si
| cobblestone mucosa from ulcers
26
what is pouchitits
after a proctocolectomy which removes the colon and rectum
the ileal is joined to anus = ileal pouch anal anasatomosis
this pouch can get inflamed as stores faeces
27
cd risk of fhx with sibling twin and parent
sibling=25-35
twin=45
parent=12-16
28
what is dysbiosis
altering of commensal gut microbiota
29
what is proctitis
inflammation of the rectum
30
what is pancolitis
inflammation of the whole colon
31
complication of UC and presentation
toxic megacolon
fever tachycardia
peritoneal inflammation
-distended colon so bacterial toxins pass across diseased mucosa into portal->systemic system
32
factors promoting relapse
```
emotional stress
intercurrent infection
gastroenteritis
antibiotics
nsaid therapy
```
33
dx of a acute severe colitis in UC
```
-diarrhoea >6 with blood
then plus 1 systemic feature
-haemoglobin <105 or
esr >30
-temperature >37.8
-pulse rate >90bpm or
crp>30
```
34
extra-intestinal features of IBD (more CD)
```
A- apthous ulcers
P-pyoderma gangrenosum
I-iritis
E-erythema nodosum
S-sclerosing cholangitis
A-arthritis
C-clubbing
```
hepatobiliary
- psc
- gallstone
- fatty liver
- autoimmune hepatitis
arthritis
-sacroiliitis
-ank spond (HLA)
DVT risk increased
35
investigations ibd
- crp and esr
- low haem and anaemia
- low albumin
- stool microscopy and culture negative
- clostridium difficile negative
- faecal calprotectin
- mrcp of biliary tree if lfts abnormal maybe
36
what test needs to be done before starting azathioprine
TMPT enzyme test
| - enzyme needed to break down aza toxins
37
cd histology appearance
```
oedematous
thickened wall
deep ulcers
fisturing ulcers
fistulae and strictures
cobblestone
perforation
lymph node
thickened mesentry
patchy distribution
lymphoid aggregates
granlomatous
```
38
most common site of getting CD
1. ileocecum- terminl ileum
2. small bowel
3. colon
39
what is the window of opportunity for cd
ie the window in which anti-inflammatory can be given to prevent strictures
as don't have anti-fibrosis
40
treatment severe attack of UC
1. methylprednisolone IV 60mg or hydrocortisone
2. heparin thrombophylaxis
3. iv fluids resuscitate
4. invetigations
5. sigmoidoscopy
41
indication for surgery of UC
1.severe attacks failing to respond to treatment
2.toxic megacolon
3.perforation
4.chronic cont disease
dysplasia/malignancy
42
adverse reaction of 5ASA
headache
nausea
diarrhoea
blood dyscrasias
43
how do thiopurines work
immunomodulation by inducing T cell apoptosis
| eg azathioprine and mercaptopurine
44
ciclosporin work by
inhibiting t cell activation
45
anti-diarrhoeal drugs for ibd
loperamide
| co-phenoxylate
46
adverse of budesonide
dependency
tolerance
failure
toxicity
47
what treatment is usually good for CD in children
polymeric diet
48
when should metronidazole also be given
for perianal disease
49
indication for cd surgery
```
sepsis-fistulae, abscess and perforation
obstruction
haemorrhage
growth retardation
colitis fulminans
cancer
```
50
azathioprine adverse
```
minor toxicity (nausea, fever, rash and malaise)
pancreatitis
bone marrow depression
allergy
hepatitis
```
51
methotrexate adverse
```
leukopenia
nausea
malaise
fatigue
stomatitis
nephrotoxcitiy
oligospermia
methotrexate pneumonia
```
52
infliximab safety issues
check for tb
malignancy
lupus
immunosuppression
53
where does CD most commonly affect
terminal ileum
54
3 main causes of acute severe colitis
1. ibd
2. infection- gastroenteritis
3. ischaemic
55
initial medical management for acute severe colitis
- fluids
- steroids
- electrolytes
- dvt prophylaxis
- dietician
- consider blood transfusion if Hb <80
- daily bloods
56
what is tenesmus
feeling like need to empty bowels even though colon empty
57
definition of toxic megacolon
diameter of >6cm of the transverse or right colon with loss of haustrations in patients with severe UC
58
which has the higher risk of malignancy uc or cd
UC
59
indiction for emergency surgery versus elective
emergency
- acute toxic dilation no response 48 hrs
- perforation
- severe bleeding
- failure to respond to med therapy
elective
- failure to respond to med therapy
- malignant transformation
60
definition of if medical management of UC is not working
```
day 3
-stools 3-8
-crp>45
day7
->3 bloody diarrhoea
need to change management
```
61
surgical managementof UC
```
-total colectomy with ileostomy and closure of rectal stump/ rectosigmoid mucus fistula
then
-stoma and rectum excision
or
-ileal pouch so rectum and ileum joined
but cant control stools
```
62
difference between a ileostomy and colostomy
ileostomy=rif and spouted and more liquid
| colostomy=lif and flatter more solid for segmental resection
63
what is a proctolectomy
removal of both colon and rectum for UC
64
what must patients be counselled for an ileal pouch procedure
- loose bowels
- fluid
- incontinence
- risk sexual dysfunction and risk infertility if nerve damaged
- pouchitis
65
surgical options for CD
- abscess drainage
- resection
- strictureplasty
- bypass duodenal disease
66
severe UC attack definition
```
>6 blood stools plus 1 feature of systemic toxicity
- hr>90
hb <105
esr >30
crp >30
temp >37.8
```
67
toxic megacolon definition
diameter of >6cm of transverse or right colon with loss of haustrations in severe UC
