Session 8 - Take a (inflammatory) bow(el) Flashcards Preview

Semester 3 - Gastrointestinal > Session 8 - Take a (inflammatory) bow(el) > Flashcards

Flashcards in Session 8 - Take a (inflammatory) bow(el) Deck (43):

Give five types of inflammatory bowel disease

• Ulcerative colitis • Crohn's disease • Diversion colitis • Diverticular colitis Radiation, drugs, infectious diseases, ischaemic colitis


What is ulcerative colitis?

• An inflammatory disorder that affects the rectum and extends proximally, in continuity (no breaks in inflammation!)


Where is the incidence of ulcerative colitis the highest?

• US, UK and northen Europe • Presents in young adults, more commonly young women


What inflammatory cells are found in the mucosa of patients with ulcerative colitis?

• T helper cells, which produce transforming growth factor (TGF and IL-5)


What are the three main symptoms of ulcerative colitis?

• Rectal bleeding • Diarrhoea • Abdominal pain


What is Chrohn's disease?

• A condition of chronic inflammation involving any location of the GI tract from mouth to anus


When are the two peaks of incidence of Chron's disease?

• 1st at 15-30 • 2nd at 60 years


What inflammatory cells are found in the mucosa of Chron's disease patients?

• Th1 helper cells, which produce interferon gamma and IL-2


What does the presentation of Chrohn's disease depend on?

Diseases location


What is the presentation of Chron's disease in someone with upper GI tract involvement?

• Nausea and vomiting • Dyspepsia • Small bowel obstruction • Anorexia, weight loss • Loose stools


What is the presentation of chron's disease in someone with colonic diseasE?

• Diarrhoea • Passage of blood


What happens if terminal ileum is involved in Chron's disease?

• May be pernicous anaemia due to poor absorption of B12


What is hypothesised to cause IBD (of which Chrohn's and UC are two types)

• Genetic presdispostion • Environmental factors


What genetic factors cause IBD?

• IBD1 • NOD2/CARD15 • Having one copy of a risk allele confers 2-4 fold risk for Crohn’s • Two couples of risk allele confers 20-40 fold risk for Crohn’s


What environmental factors cause IBD?

• NSAIDs ○ Altered intestinal barrier due to decreased mucous production • Early Appendectomy ○ Increased UC incidence • Smoking ○ Protects against UC ○ Increases risk of CD


Give 6 triggers of IBD

• Antibiotics ○ Gets rid of normal flora • Diet • Acute infections • NSAIDs • Smoking ○ Increase’s risk of Crohn’s • Stress



Give six methods of investigating inflmamtory bowel disease

• Colonoscopy ○ Biopsies of involved mucosa ○ Ulceration • Stool analysis ○ Parasites ○ Clostridium difficile toxin ○ Culture • Barium radiographs • CT scan • Capsule endoscopy Plain X-Ray if bowel obstruction or perforation suspected


Outline the macroscopic changes found in Chrohn's

• Involved bowel is usually thickened and is often narrowed • Deep ulcers and fissures in the mucosa may produce a cobblestone appearance Fistulae and abcesses may be seen


Outline the macroscopic changes found in Ulcerative Colitis

• Mucosa looks reddened, inflamed and bleeds easily • In severe disease there is extensive ulceration with the adjacent mucosa appearing as inflammatory polyps


Outline the microscopic changes found in chrohn's

• Inflammation through all layers of the bowel (Transmural) • Increase in chronic inflammatory cells • Lymphoid hyperplasia • Granulomas (TH1 Response)


Outline the microscopic changes found in Ulcerative Colitis

• Superficial inflammation • Chronic inflammatory cell infiltrate in the lamina propria • Crypt abscesses • Goblet cell depletion


Outline three ways in which CD and UC can be separated

• Clinical • Radiological data • Histological differences seen in rectal mucosa


When is it difficult to tell difference between CD and UC?

Acute phase, tissues look very much the same


What is CD/UC in acute phase called when it is difficult to tell the difference?

• Colitis of undetermined type and aEitology CUTE


What serological tests can be used to distinguish UC from CD?

• Anti-neutrophil cytoplasmic antibodies in UC • Anti saccaromyces cervisiae antibodies in CD


Give 5 ways in which abnormalities can be seen in Chrohn's disease

• Colonoscopy • Upper GI endoscopy • Small bowel imaging • Perianal MRI or endoanal Ultrasound • Capsule endocscopy


What can a colonoscopy be used to see in Chrohn's disease?

• Performed if colonic involvement is suspected • Mild, patchy surface ulceration à Cobblestoning


How does Upper GI Endoscopy do in a Chrohn's diagnosis?

• Required to exclude oesophageal and gastroduodenal disease in patients with relevant symptoms


Outline the process of small bowel imaging in Crohn's

• Barium follow through • CT scan with oral contrast • Small bowel ultrasound • MRI • Asymmetrical alteration in the mucosal pattern with deep ulceration, and areas of narrowing or structuringr • String sign of Kantor


What does perianal MRI or endoanal ultrasound do?

• Used to evaluate perianal disease


What is capsule endoscopy used for in Chrohn's?

• Used in Chrohn's disease patients who have a normal radiological examination


Give two tests used to define Ulcerative Colitis?

• Colonoscopy • Imaging


What does colonoscopy do in UC?

• Allows biopsy, which is gold standard for UC diagnosis • Allows us to assess disease activity and extent


What does imaging allow to see in UC?

• Plain Abdominal X-Ray to exclude colonic dilation • Other imaging techniques rarely used as endoscopy is preferred • Collar Button Ulcers ○ Ulcer through the bowel mucosa to the muscle, then up and down in a ‘T’ shape


Give three overarching aims of Chrohn's disease treatment?

• Induction of remission • Maintenance of remission • Perianal disease


How is induction of remission initiated in Chrohn's?

• Oral or IV Glucocorticosteroids • Enteral Nutrition • Anti-TNF antibodies (Infliximab)


How is maintenance of remission achieved in Crohn's disease?

• Methotrexate, Azathioprine • Anti-TNF antibodies (Infliximab)


How is perianal disease treated in Crohn's?

• Ciprofloxacin and Metrronidazole • Azathioprine • Anti-TNF antibodies (Infliximab)


What do anti-TNF antibodies do?

• Bind to membrane bown TNF-a and induce immune cell apoptosis


Outline the surgical management of crohn's

• Failure of therapy with acute or chronic symptoms • Complications, e.g. dilation, obstruction, perforation, abscesses • Failure to grow in children despite treatment • Colectomy and ileorectal anastomosis may be performed.


Give three types of UC and their treatment

• Distal Disease (Proctitis) ○ Topical or suppository corticosteroids • Left Sided Colitis ○ Topical corticosteroid enema • Extensive Colitis ○ Oral corticosteroids ○ Infliximab


Outline the surgical management of UC

• Patients with complications / Corticosteroids dependence • In acute disease, subtotal colectomy with end ileostomy and preservation of the rectum is the operation of choice.