Inflammatory bowel disease- clinical Flashcards Preview

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Flashcards in Inflammatory bowel disease- clinical Deck (17):
1

What do UC and Crohn's differ in?

Pathology
Clinical presentation:
Crohn's: abdominal pain and peri-anal disease
UC: diarrhoea and bleeding

2

What three factors contribute to the pathogenesis of IBD?

Genetic predisposition
Mucosal immune system
Environmental triggers

3

Which gene has been recognised has a IBD susceptibility gene?
Where is it found?
What does this gene encode?

NOD2/CARD15 (IBD-1)
It is found on chromosome 16q12
It encodes a protein involved in bacterial recognition

4

a) Which immune cell mediates Crohn's disease?
b) Which immune cells mediate UC?

a) Th1
b) Mixed Th1/Th2 and NKTC

5

Is there reduced or increased antimicrobial activity compared to normal in a) Crohn's and b) UC?

a) Reduced
b) Increased- body produces its own "antibiotics" in the cells lining the intestine

6

How does smoking affect a) Crohn's disease and b) UC?

a) Aggravates
b) Protects against

7

What is the effect of NSAIDs on IBD?

They can aggravate it as they break down the mucous lining

8

How is severe ulcerative colitis identified?

If there are at least 6 bloody stools per day as well as one or more of:
Fever (>37.8)
Tachycardia (>90)
Anaemia (Hb < 10.6 g/ld)
Elevated ESR (> 30mm/hr)

9

How wide is a toxic colon in a) the transverse colon and b) the caecum?

a) >5.5 cm
b) >9cm

10

What is a longterm complication of ulcerative colitis?
What is this determined by?

Increased risk of colorectal cancer.
Risk determined by:
Severity of inflammation
Duration of disease
Disease Extent

11

What is primary sclerosing cholangitis (in IBD)?

The pipes which drain bile out of the liver are inflamed in tandem with the gut. Causes cirrhosis of the liver very rapidly and people require a liver transplant.

12

What perianal disease can be present in Crohn's disease?

Recurrent abscess formation
Pain
Can lead to fistula formation with persistent leakage
Damaged sphincters

13

What percentage of Crohn's patients require surgery in 8-10 years?

75%
50% of these patients require a second operation

14

What are the symptoms of UC?

Diarrhoea + bleeding
Increased bowel frequency (HOW OFTEN?)
Urgency
Tenesmus
Incontinence
Night rising
Lower abdo pain (esp. LIF)
(proctitis can cause constipation)

15

What determines the symptoms in Crohn's?

The site of the disease

16

What are symptoms of Crohn's disease?

Small intestine:
Abdominal cramps (peri-umbilical)
Diarrhoea, weight loss
Colon:
Abdominal cramps (lower abdomen)
Diarrhoea with blood
Wt loss
Mouth:
Painful ulcers, swollen lips, angular chielitis
Anus:
peri-anal pain, abscess

17

How can the small bowel be assessed?

Barium follow through
Small bowel MRI
Technetium-labelled white scan

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