inflammatory bowel disease Flashcards

(37 cards)

1
Q

what is inflammatory bowel disease?

A

chronic, relapsing, remitting inflammation of the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are examples of inflammatory bowel disease?

A

Crohn’s disease

ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what do Crohn’s disease and ulcerative colitis differ in?

A

location and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when does inflammatory bowel disease commonly present?

A

teens and twenties

mean age is 29.5 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what can IBD be due to?

A

genome

microbiome

environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

is IBD medelian inherited?

A

no, but has genetic susceptibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what kind of genetic variation makes people genetically susceptible to IBD?

A

SNPs (single nucleotide polymorphisms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what percentage of someones offspring who has IBD will also develop IBD?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do genes that cause inflammatory bowel disease regulate?

A
  • epithelial barrier
  • immune response
  • bacterial handling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the pathogenesis of IBD?

A

pathologic gut → altered microbiota

damaged epithelial barrier → increased bacterial adhesion and translocation

→ chronic inflammation occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the ratio of microbial cells in the gut lumen to eukaryotic cells in the human body?

A

10:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how many different species of bacteria are present in the gut?

A

at least 500 different species

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the metabolic activity of all gut bacteria equivalent to?

A

that of the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what part of the gut contains the most bacteria?

A

colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is different in the microbiota of people with IBD compared to those without?

A

in IBD there is dysbiosis in microbial communities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what kind of bacteria is massively more present in people with IBD than those who do not have it?

A

proteobacteria

17
Q

describe ulcerative colitis

A

continuous inflammation in colon (begins at rectum and works proximally)

male = female

symptoms: bloody diarrhoea, abdominal pain, weight loss, fatigue
features: no goblet cells, crypt absecces, mucosal inflamamtion

18
Q

describe proctitis

A

inflammation confined to rectum only

symptoms:

  • frequency, urgency, incontinence,
  • tenesmus, constipation (proximal faecal stasis), stool has small volume mucous and blood
    treatment: topical therapy
19
Q

what investigations are done for ulcerative colitis?

A

bloods: inflammatory markers

stool culture: rule out infection

faecal calprotectin: elevated (>200)

colonoscopy and colon mucosal biopsies

20
Q

what are examples of markers of inflammation checked for in ulcerative colitis?

A

normocytic/microcytic anaemia

increased CPR/WCC/platelets

decreased albumin

21
Q

what is faecal calprotectin?

A

protein biomarker released when there is inflammation in colon

22
Q

describe acute severe colitis

A

presentation: patients often appear well

>6 bloody stools/day &

fever/tachycardia/anaemia

23
Q

what must be done within the first 24 hours of a patient being admitted with acute severe colitis?

A
  • blood tests
  • stool chart
  • stool cultures: for c. difficile
  • avoid non-steroidal analgesics, opiates, anti-diarrhoels, anti-cholinergics
  • IV glucocorticosteroids
  • IV hydration
  • LMWH
  • Abdomen x-ray
24
Q

describe Crohn’s disease?

A

inflammation in the digestive tract

presentation: diarrhoea, abdominal pain, weight loss, malaise/lethargy, anorexia, malabsorption (anaemia, vitamins)
features: skip lesions, granulomas, transmural inflammation

25
what are the investigations for Crohn's disease?
bloods: inflammatory markers stool culture: rule out infection faecal calprotectin colonoscopy MRI small bowel study capsule endoscopy CT
26
what are possible complications of Crohn's disease?
* inflammation * stricture * fistula
27
what is perianal Crohn's disease?
inflammation at or near the anus symptoms: perianal pain, pus secretion, unable to sit down investigations: MRI pelvis, EUA treatment: surgery (drain abscess and place seton stitch), antibiotics, biologics (anti-TNF)
28
what are differential diagnoses of IBD
* other causes of chronic diarrhoea: malabsorption, IBS * ileocaecal TB * infective, amoebic and ischaemic colitis
29
what kind of approach does management of IBD use?
step up approach
30
what medication is given to treat Crohn's disease by reducing inflammation?
aminosalicylates (5-ASAs)
31
what are aminosalicylates?
these work by blocking prostaglandins and leukotrienes not effective in Crohn's disease
32
when are steroids used
to induce remission in both Crohn's and UC prednisolone budesonide
33
when are immunomodulators used
for maintenance in crohn's and UC azathioprine methotrexate (crohn's only)
34
what biologics are used
Anti-TNFa antibodies: infliximab, adalimumab A4b7 integrin blockers: vedolizumab
35
what surgery is used for acute severe colitis
subtotal colectomy rectal preservation ileostomy
36
what are extra-intestinal manifestations of IBD
* mouth ulcers * skin rashes/lesions * musculoskeletal * eyes * primary sclerosing cholangitis
37
describe pouch surgery
only for UC mobilise and lengthen small bowel → construct pouch