Lecture 6.1: Inflammatory Bowel Disease (IBD) Flashcards
(68 cards)
1
Q
What are the 2 Types of Inflammatory Bowel Disease?
A
Ulcerative Colitis and Crohn’s
2
Q
Causes of Bowel Inflammation: INVITED MD
A
- Infection
- Neoplasia
- Vascular
- Inflammatory
- Trauma
- Endocrine
- Drugs
- Metabolic
- Degenerative
3
Q
Types of Colitis (4)
A
- IBD
- Microscopic Colitis
- Radiation Colitis
- Infectious Colitis
4
Q
Types of Microscopic Colitis (2)
A
- Lymphocytic Colitis
- Collagenous Colitis
5
Q
Causes of Microscopic Colitis
A
- Medication- e.g. PPIs/ NSAIDs, statins, SSRIs
- Autoimmune disease- e.g Rheumatoid Arthritis, coeliac
disease, psoriasis
6
Q
When does Radiation Colitis develop?
A
Develops 6 months to 5 years post regional radiotherapy
7
Q
What can cause Infectious Colitis?
A
- Viral, parasitic or bacterial infection
- E Coli and Salmonella are common causes
- C Difficile – often antibiotic induced
8
Q
Histological Features found in Crohn’s but not in UC (5)
A
- Granulomas
- Deep Fissuring Ulcers
- Transmural Lymphoid Aggregates
- Small Intestine Involvement
- Crypt Abscesses
9
Q
What is the Cardinal Symptom of UC?
A
Bloody diarrhoea
10
Q
What part of the GI is involved in UC?
A
Affects mucosa of colon and rectum only
11
Q
What part of the GI is involved in Crohn’s?
A
- May involve any part of the GI tract from mouth to
anus - Perianal disease – abscess, fistula
- May be transmural
12
Q
Extra-Intestinal Manifestations (EIMs) of IBD: CLUECLUE
A
- Clubbing
- Large joint arthritis
- Ulcers (pyoderma gangrenosum)
- Erythema nodosum
- Cholangitis (primary sclerosing cholangitis)
- Lower back arthritis
- Ulcers (aphthous ulcers in mouth)
- Eye signs e.g. acute uveitis
13
Q
What IBD is more common?
A
UC is up to 2-fold more common than Crohn’s disease
14
Q
What is seen at Colonoscopy for UC?
A
Continuous inflammation from the rectum
15
Q
What is seen at Colonoscopy for Crohn’s? (2)
A
‘Cobble-Stoning’
‘Skip Lesions’
16
Q
What is the name for inflammation of the lining of the rectum?
A
Procitis
17
Q
What is the name for inflammation of the entire colon?
A
Pancolitis
18
Q
What imaging is done to help diagnose IBD?
A
- CT/MRI enterography can be used to visualise the
small bowel - MRI Pelvis to assess known/ suspected peri-anal
Crohn’s disease - AXR (historically)
19
Q
CD vs UC: Mucosal Involvement
A
CD: Discontinuous
UC: Continuous
20
Q
CD vs UC: Aphthous Ulcers
A
CD: Common
UC: Rare
21
Q
CD vs UC: Surrounding Mucosa
A
CD: Relatively Normal
UC: Abnormal
22
Q
CD vs UC: Longitudinal Ulcer
A
CD: Common
UC: Rare
23
Q
CD vs UC: Cobble Stoning
A
CD: In severe cases
UC: No
24
Q
CD vs UC: Mucosal Friability
A
CD: Uncommon
UC: Common
25
CD vs UC: Vascular Pattern
CD: Normal
UC: Disorted
26
CD vs UC: Transmural Inflammation
CD: Yes
UC: Uncommon
27
What factors are involved in the Pathophysiology of IBD?
* Genetics
* Environment
* Diet
* Smoking
* Stress
* Microbial Factors
* Immune Factors
28
What are pANCA autoantibodies?
Antibodies that stain the material around the nucleus of a neutrophil
29
In what IBD are pANCA autoantibodies seen?
UC
30
Management of IBD (7)
* Amino Salicylates
* Corticosteroids
* Antibiotics
* Immunosuppressants
* Biological Therapy
* Surgery
* Avoid NSAIDs
31
Examples of Amino Salicylates (2)
* Mesalazine
* Sulfasalazine
32
What IBD are Amino Salicylates used to treat?
To induce remission or to maintain remission of mild to moderate UC
33
How do Amino Salicylates help manage IBD?
MOA is unclear butut believed to act by activating a class of nuclear receptors involved in the control of inflammation, cell proliferation, apoptosis and metabolic function
34
When should Amino Salicylates be avoided?
If aspirin allergy
35
Side-Effects of Amino Salicylates (3)
* Renal Impairment
* Diarrhoea
* Hepatitis
36
Examples of Corticosteroids (2)
* Prednisolone
* Budesonide
37
What IBD are Corticosteroids used to treat?
To induce remission of active disease in both UC and CD
38
How do Corticosteroids help manage IBD?
Potent anti-inflammatories through transcription modulation of genes involved in inflammation
39
Side-Effects of Corticosteroids (6)
* Significant so ideally not used long term
* Weight Gain
* Hypertension
* Glucose Impairment
* Osteoporosis
* Adrenal Suppression
* Mood Disturbance
40
When are Antibiotics used to help manage IBD?
Treatment of septic complications and can reduce perianal fistula symptoms
41
Which antibiotics are shown to have effect in colonic CD? (2)
Metronidazole +/- Ciprofloxacin
42
Examples of Immunosuppressants or DMARDs (3)
Thiopurines:
* Azathioprine
* Mercaptopurine
* Methotrexate
43
What IBD are Immunosuppressants or DMARDs used to treat?
To treat refractory or chronic active IBD both UC and CD
44
How do Immunosuppressants or DMARDs help manage IBD?
* Not really understood but reduce inflammation
* Used as steroid-sparing agents to maintain remission
45
Side-Effects of Immunosuppressants or DMARDs (2)
* Hepatoxic
* Bone Marrow Toxicity
46
What are the Types of Biological Therapies to help manage IBD? (4)
* Anti-TNF Therapy
* Ustekinumab
* Vedolizumab
* JAK Inhibitors
47
What IBD is Anti-TNF Therapy used to treat?
To induce remission in moderate to severe UC and
maintenance of remission for UC and CD
48
Examples of Anti-TNF Therapy Drugs? (2)
* Infliximab
* Adalimumab
49
What is the MOA of Anti-TNF Therapy Drugs?
* TNF-α is a chemical messenger (cytokine) and a key
player in the inflammatory process involved in IBD
* Infliximab and Adalimumab are monoclonal antibodies
targeting TNF-α
* They block the interaction of TNF α with its receptors
* They bind to TNF-α and preventing it from binding to
receptors involved in the inflammatory process
50
Side-Effects of Anti-TNF Therapy Drugs (2)
* Opportunistic infections
* Anaphylaxis
51
What IBD is Ustekinumab used to treat?
Maintenance of remission in UC and CD
52
What is the MOA of Ustekinumab?
Blocks interleukin IL-12 and IL-23 which activate certain
T-cells
53
Side-Effects of Ustekinumab (6)
* Dizziness
* Sore Throat
* Arthralgia
* Headaches
* Nausea
* Soreness around injection site
54
What IBD is Vedolizumab used to treat?
Maintenance of remission in CD and UC
55
What is the MOA of Vedolizumab?
* Binds to ɑ4β7 integrin, a mediator of GI.
inflammation
* Decreasing inflammation in the GI tract by blocking
the entry of inflammation- stimulating lymphocytes
56
Side-Effects of Vedolizumab (6)
* Nasopharyngitis
* Upper Respiratory Tract Infections
* Arthralgia
* Headache
* Fatigue
* Pyrexia
57
What IBD are JAK Inhibitors used to treat?
To induce remission in moderate to severe UC and
maintain remission in UC
58
Examples of JAK Inhibitors (2)
* Tofacitinib
* Upadacitinib
59
What is the MOA of JAK Inhibitors?
* Limit the action of Janus kinase enzymes
* Block cytokines from attaching to receptors in the JAK-
STAT pathway
* This reduces the amount of inflammation the immune
system produces
60
Side-Effects of JAK Inhibitors (6)
* Nausea
* Indigestion
* Diarrhoea
* Headaches
* Upper Respiratory Tract Infection
* Increased Cholesterol Levels
61
What should be avoided when taking JAK Inhibitors?
Avoid grapefruit juice as it may enhance the therapeutic
effect and increase risk of side effects
62
What Surgeries can be done to manage CD? (4)
* Colectomy
* Segmental resection
* Stricturoplasty
* Perianal abscess or fistulae
63
What Surgeries can be done to manage UC? (2)
* Colectomy
* Proctocolectomy
64
What percentage of UC patients will need surgery in their lives?
20%
65
What percentage of CD patients will need surgery in their lives?
80%
66
Complications of IBD (5)
* Primary Sclerosing Cholangitis (PSC)
* Colorectal Cancer
* Strictures in CD
* Fistulae in CD
* Toxic Megacolon
67
What gene is strongly associated with a big family of rheumatic diseases called spondyloarthropathies?
HLA-B27
68
What diseases are associated with HLA-B27? (6)
* Inflammatory Bowel Disease (IBD)
* Eye Inflammation Uveitis
* Ankylosing Spondylitis (AS)
* Axial Spondyloarthritis
* Axial Psoriatic Arthritis
* Reactive Arthritis
