Week 142 - Inflammatory Bowel Disease Flashcards Preview

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Flashcards in Week 142 - Inflammatory Bowel Disease Deck (24):
1

What is Crohn's Disease and what is it characterised by?

• Inflammatory disease affecting the whole thickness of the bowel wall across the whole GIT.

• Characterised by :
- Skip lesions
- Granulomatous nature

2

What are the risk factors associated with Crohn's disease?

•Genetic

•Diet

•Smoking

3

What is the pathophysiology of Crohn's disease?

• Abnormal response to normal gut flora.

• Immune response mediated by Th1 cells and macrophages leading to-
- Inflammation (Infiltration of neutrophils and macrophages)
- Tissue damage and fibrosis.
- May lead to metaplasia.

4

What are the macroscopic features of Crohn's disease?

Skip lesions with the development of ulceration.

Fistulaes, fissures and strictures.

 

5

What part of the bowel is most commonly affected by Crohn's disease?

• Ileum and Colon (50%)

• Small bowel only (30%)

• Colon only (20%)

6

What are the GI presenting symptoms of Crohn's Disease?

• Diarrhoea +/- blood

• Abdo pain

• Bloating / Flatulence

• Bowel obstuction

7

What are the associated symptoms of Crohn's Disease?

Anorexia

Fever

Weight loss

Dietary deficiency syndromes

Erythema Nodosum and Pyoderma Gangrenosum

Arthralgia

8

What investigations should be performed for suspected Crohn's disease?

• FBC (Expect Anaemia and B12 deficiency), Inflammatory Markers, Antibody serology.

• X-ray, Barium follow-through, CT, MRI

• Coloscopy +/- biopsy

9

What is the medical treatment for Crohn's disease?

• Glucocorticoids

• 5-ASA drugs

• Infliximab

• Methotrexate

10

What is ulcerative colitis and what is it characterised by?

Inflammatory disease affecting the mucosal layer of the rectum +/- colon only.

• Characterised by:
- Continual distribution, always starting from rectum.
- Non-granulomatous nature.

11

What are the risk factors for ulcerative colitis?

• Genetic factors

• Family history

• Autoimmune disease

• Diet

12

What is the pathophysiology of Ulcerative colitis?

• Abnormal response to normal gut flora.

• Immune response mediated by Th2 cells and B-cells, produce auto-antibodies.

13

What is the presentation of GI symptoms in Ulcerative Colitis?

• Diarrhoea with mixed in blood and mucus

• Abdominal cramping

• Pain

• Tenesmus

14

What are the associated symptoms of Ulcerative Colitis?

• Fever

• Weight loss -less than in Crohn's

• Erythema Nodulosum and Pyoderma Gangrenosum

• Arthralgia

15

What investigations should be performed for ulcerative colitis?

• Stool sample

• Bloods - FBC, inflammatory markers, U&Es, LFT.

• Abdo X-ray

• Colonoscopy and biopsy

16

What is the medical treatment for ulcerative colitis?

• Glucocorticoids

• 5-ASAs

• Infliximab

• Ciclosporin

17

What complications can occur due to Ulcerative Colitis?

• Primary Sclerosing Cholangitis

• Bowel CA

• Toxic Megacolon

18

Which three drugs (or drug categories) are used to induce remission in IBD patients?

• 5-ASAs

• Glucocorticoids

• Infliximab

19

What are 5-ASAs and what is their role in treating IBD?

• Aim to induce remission.

• Slow to work (6-8) weeks.

• Side-effects: Diarrhoea, abdo pain, N & V.

• What are the two forms?
- Sulfasalazine
- Mesalazine

20

What are the two forms of 5-ASAs used in the treatment of IBD and what is the difference?

• Sulfasalazine and Mesalazine

• Mesalazine is coated so does not get absorbed as high and reduces side-effects.

• Side effects of Sulfasalazine include headache, decreased sperm and leukopenia.

21

What is the role of glucocorticoids in the treatment of IBD?

• Induces remision.

• E.g. Prednisolone, Budesonide

• Quick acting but should only be used for short periods.

• Reduces arachidonic acid which reduces cytokines and therefore reduces inflammatory response.

22

What is infliximab? What is it's role in the treatment of IBD?

• Induces and maintains remission, given as an infusion.

• It binds and neutralises to TNF-alpha.

• Side-effects: Immunosupression, increased risk of cardiac failure. Contra-indicated in sepsis, TB, Ca.

23

What is methotrexate? What is its role in treating IBD?

Used for Crohn's disease.

An immunosupressant that reduces IL-1 and causes T-cell apoptosis.

24

What is ciclosporin? What is it's role in treating IBD?

Used in severe ulcerative colitis.

• Immunosupressant, inhibits the action of T-cells.