inflammatory bowel disease

Question 1

what is inflammatory bowel disease?

Answer 1

chronic, relapsing, remitting inflammation of the GI tract

Question 2

what are examples of inflammatory bowel disease?

Answer 2

Crohn’s disease

ulcerative colitis

Question 3

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

Answer 3

location and inflammation

Question 4

when does inflammatory bowel disease commonly present?

Answer 4

teens and twenties

mean age is 29.5 yrs

Question 5

what can IBD be due to?

Answer 5

genome

microbiome

environment

Question 6

is IBD medelian inherited?

Answer 6

no, but has genetic susceptibility

Question 7

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

Answer 7

SNPs (single nucleotide polymorphisms)

Question 8

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

Answer 8

10%

Question 9

What do genes that cause inflammatory bowel disease regulate?

Answer 9

• epithelial barrier
• immune response
• bacterial handling

Question 10

what is the pathogenesis of IBD?

Answer 10

pathologic gut → altered microbiota

damaged epithelial barrier → increased bacterial adhesion and translocation

→ chronic inflammation occurs

Question 11

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

Answer 11

10:1

Question 12

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

Answer 12

at least 500 different species

Question 13

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

Answer 13

that of the liver

Question 14

what part of the gut contains the most bacteria?

Answer 14

colon

Question 15

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

Answer 15

in IBD there is dysbiosis in microbial communities

Question 16

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

Answer 16

proteobacteria

Question 17

describe ulcerative colitis

Answer 17

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

Question 18

describe proctitis

Answer 18

inflammation confined to rectum only

symptoms:

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

Question 19

what investigations are done for ulcerative colitis?

Answer 19

bloods: inflammatory markers

stool culture: rule out infection

faecal calprotectin: elevated (>200)

colonoscopy and colon mucosal biopsies

Question 20

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

Answer 20

normocytic/microcytic anaemia

increased CPR/WCC/platelets

decreased albumin

Question 21

what is faecal calprotectin?

Answer 21

protein biomarker released when there is inflammation in colon

Question 22

describe acute severe colitis

Answer 22

presentation: patients often appear well

>6 bloody stools/day &

fever/tachycardia/anaemia

Question 23

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

Answer 23

• 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

Question 24

describe Crohn’s disease?

Answer 24

inflammation in the digestive tract

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

Question 25

what are the investigations for Crohn's disease?

Answer 25

bloods: inflammatory markers stool culture: rule out infection faecal calprotectin colonoscopy MRI small bowel study capsule endoscopy CT

Question 26

what are possible complications of Crohn's disease?

Answer 26

* inflammation * stricture * fistula

Question 27

what is perianal Crohn's disease?

Answer 27

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)

Question 28

what are differential diagnoses of IBD

Answer 28

* other causes of chronic diarrhoea: malabsorption, IBS * ileocaecal TB * infective, amoebic and ischaemic colitis

Question 29

what kind of approach does management of IBD use?

Answer 29

step up approach

Question 30

what medication is given to treat Crohn's disease by reducing inflammation?

Answer 30

aminosalicylates (5-ASAs)

Question 31

what are aminosalicylates?

Answer 31

these work by blocking prostaglandins and leukotrienes not effective in Crohn's disease

Question 32

when are steroids used

Answer 32

to induce remission in both Crohn's and UC prednisolone budesonide

Question 33

when are immunomodulators used

Answer 33

for maintenance in crohn's and UC azathioprine methotrexate (crohn's only)

Question 34

what biologics are used

Answer 34

Anti-TNFa antibodies: infliximab, adalimumab A4b7 integrin blockers: vedolizumab

Question 35

what surgery is used for acute severe colitis

Answer 35

subtotal colectomy rectal preservation ileostomy

Question 36

what are extra-intestinal manifestations of IBD

Answer 36

* mouth ulcers * skin rashes/lesions * musculoskeletal * eyes * primary sclerosing cholangitis

Question 37

describe pouch surgery

Answer 37

only for UC mobilise and lengthen small bowel → construct pouch