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Medicine Gastrointestinal > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

(49 cards)

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1
Q

Which conditions fall under inflammatory bowel disease?

A

Ulcerative colitis, Crohn’s

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2
Q

Crohn’s disease

A

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

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3
Q

Where is Crohn’s disease most common?

A

Terminal ileum and colon

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4
Q

Which gender is more susceptible to Crohn’s disease?

A

Males

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5
Q

Presentation of Crohn’s disease

A

Abdominal pain, small bowel obstruction, diarrhoea, bleeding PR, anaemia, weight loss, ulcers, swollen lips, angular cheilitis

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6
Q

Investigations for Crohn’s disease

A

Endoscopy and mucosal biopsy

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7
Q

Endoscopy findings in Crohn’s disease

A

Patchy segmental disease with skip lesions

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8
Q

Histological stains for Crohn’s disease

A

Large non-caseating Granuloma formation, increased chronic inflammatory cells in the lamina propria and crypt branching with granulomas

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9
Q

Complications of Crohn’s disease

A

Malabsorption, fistulas, anal disease, intractable disease, bowel obstruction, perforation, malignancy, amyloidosis

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10
Q

Environmental triggers of Crohn’s disease

A

Smoking, infectious agents, vasculitis

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11
Q

Immune response in Crohn’s disease

A

Persistent activation of T-cells and macrophages and excess proinflammatory cytokine production. TH1 mediated

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12
Q

Ulcerative colitis

A

Chronic inflammatory disorder confined to the colon and rectum and nearly always involves the rectum

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13
Q

Clinical presentation of ulcerative colitis

A

Diarrhoea, mucus and blood PR, increased bowel frequency, urgency, tenesmus, incontinence, night rising, lower abdomen, pain

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14
Q

Histological stains in ulcerative colitis

A
  • Massive influx of inflammatory cells
  • Basal lymphoplasmacytic infiltrate with irregular shaped branching crypts
  • Crypt abscesses
  • Severe ulceration with fibrinopurulent exudate
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15
Q

Complications of ulcerative colitis

A

Intractable disease, toxic megacolon, colorectal carcinoma, blood loss, electrolyte disturbance, anal fissures, extra GI manifestations

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16
Q

Toxic megacolon

A

When the colon swells up to a massive size which can rupture if it isn’t removed

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17
Q

Extra GI manifestations of ulcerative colitis

A

Uveitis, primary sclerosing cholangitis, arthritis, ankylosing spondylitis, pyoderma gangrenosum

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18
Q

Immune response in ulcerative colitis

A
  • Persistent activation of T-cells and macrophages
  • Autoantibodies
  • Excess proinflammatory cytokine production and bystander damage due to neutrophilic inflammation
  • Mixed Th1/Th2 mediated disease
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19
Q

Which chromosome is the disease susceptibility gene for IBD?

A

16q12

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20
Q

Which score is used to assess severity of ulcerative colitis

Study These Flashcards
A

Truelove and Witt criteria

21
Q

Severe ulcerative colitis determination

Study These Flashcards
A

> 6 bloody stools in 24 hours and one or more of:

  • Fever
  • Tachycardia
  • Anaemia
  • Elevated ESR
22
Q

Further assessments for ulcerative colitis

Study These Flashcards
A

Bloods - CRP, albumin
AXR - toxic megacolon
Endoscopy
Histology

23
Q

Extra-intestinal manifestations of UC:

  • Skin
  • Joints
  • Eyes
  • Mouth
Study These Flashcards
A

Skin - erythema nodosum, pyoderma gangrenosum
Joints - spondylitis, sacroiliitis, peripheral arthritis
Eyes - epsiscleritis, uveitis
Mouth - stomatitis, aphthous ulcers

24
Q

Primary sclerosing cholangitis

Study These Flashcards
A

Chronic inflammatory disease of the biliary tree

25
Clinical exam in assessment of Crohn's disease
Evidence of weight loss, RIF mass, peri-anal signs
26
Which blood tests do you want in assessment of Crohn's disease?
CRP, albumin, platelets, ferritin, B12
27
Colonoscopy findings in Crohn's disease and ulcerative colitis
Crohn's disease - cobblestoning | Ulcerative Colitis - psuedopolyps
28
Drug therapy in ulcerative colitis
5ASA (mesalazine), steroids, immunosuppressants, anti-TNF therapy
29
Drug therapy in Crohn's disease
Steroids, immunosuppressants, anti-TNF therapy
30
5-aminosalicylic acid side effects
Diarrhoea, idiosyncratic nephritis
31
Examples of 5-aminosalicylic acid
Sulphasalazine, Balsalazide, Mezavant, Mesalazine
32
Side effects of corticosteroids
Avascular necrosis, osteoporosis, acne, thinning of skin, weight gain, diabetes, hypertension, cataracts, growth failure
33
Side effects of azothioprine
Pancreatitis, leucopenia, hepatitis
34
Side effects of anti-TNF therapy
Infusion reactions, infection, cancer
35
Surgery options for Crohn's disease
Resection, stricuroplasty, fistulas, anal disease
36
Surgery options for ulcerative colitis
Proctocolectomy with end ileostomy, proctocolectomy with ileorectal anastomosis
37
Indications for elective surgery in ulcerative colitis
Medically unresponsive disease, Intolerability, Dysplasia/malignancy, Growth retardation in children, Attempted resolution of extra-intestinal disease
38
End ileostomy with pouch - how many bowel movements do patients with these have in 24 hours
6 on average
39
Complications of end ileostomy with pouch: - Immediate - Early - Late
Immediate - local – haemorrhage, enterotomy, systemic – anaphylaxis Early - local – urinary dysfunction, wound infection, pelvic abscess, anastomotic leak, systemic – atelectasis, ileus, portal vein thrombosis Late - infertility, pouchitis, systemic – DVT/PE, small bowel obstruction
40
Surgery as an option for ulcerative colitis
Patient is 'cured'
41
Indications for surgery in Crohn's disease
- Stenosis causing obstruction - Enterocutaneous fistulas - Intra-abdominal fistulas - Abscesses - Bleeding - Free perforation
42
Colonic surgery for Crohn's
- Emergency colectomy - Segmental colectomy - Total colectomy - Panproctocolectromy
43
Causes of malnutrition in inflammatory bowel disease
Inadequate dietary intake, alterations in energy requirements, malabsorption, side effects of medications
44
Things that can cause inadequate dietary intake in patients with inflammatory bowel disease
Reduced appetite secondary to symptoms, taste changes as a result of vitamin and mineral deficiencies and drug interactions, self-restriction of diet to avoid symptoms
45
Factors leading to increased risk of osteoporosis in inflammatory bowel disease
Systemic inflammation, age, corticosteroid use, inadequate vitamin D and calcium status
46
Recommended calcium intake for patients with IBD
1000mg/day with most coming from diet
47
What is exclusive enteral nutrition?
Withdrawal of all food and drink, except water, and replacement with enteral nutrition formula
48
When is exclusive enteral nutrition a primary treatment option in IBD?
In children and adolescents
49
How can adherence to enteral nutrition be improved?
Prescriptible flavours and ensuring it is cold and taken with a straw from a beaker

Medicine Gastrointestinal (24 decks)

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