Inflammatory Bowel Disease Overview
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Questions and Answers

Which of the following describes ulcerative colitis?

  • Causes mucosal inflammation and sores in the lining of the colon. (correct)
  • Affects the entire gastrointestinal tract from mouth to anus.
  • Predominantly affects males.
  • Leads to symptoms primarily related to nutritional deficiencies.

    • What is a common clinical manifestation of both ulcerative colitis and Crohn's disease?

  • Chronic fatigue syndrome
  • Nutritional deficiency
  • Hematochezia (correct)
  • Growth retardation

    • Which factor is NOT implicated as a cause of inflammatory bowel disease?

  • Psychological factors like stress
  • Environmental factors like diet
  • Genetic predisposition
  • A viral infection such as HIV (correct)

    • Which diagnostic method is most useful for obtaining biopsies in suspected IBD cases?

    <p>Endoscopy</p> Signup and view all the answers

    What is a common demographic trend of Crohn's disease compared to ulcerative colitis?

    <p>More prevalent in women</p> Signup and view all the answers

    Which of the following statements about dietary and bacterial antigens in IBD is TRUE?

    <p>They activate the immune system leading to inflammation.</p> Signup and view all the answers

    In the context of inflammatory bowel disease, what does hematochezia refer to?

    <p>Blood in the stool</p> Signup and view all the answers

    Which of the following factors has NOT been proven to play a role in the development of inflammatory bowel disease?

    <p>Long-term antibiotic use</p> Signup and view all the answers

    What endoscopic feature is essential in differentiating between Crohn's disease and ulcerative colitis?

    <p>Intervening normal mucosa</p> Signup and view all the answers

    Which blood test marker is most indicative of severe disease activity?

    <p>C-reactive protein levels</p> Signup and view all the answers

    What is the primary purpose of performing a barium enema in diagnosis?

    <p>To identify colonic strictures or fistulae</p> Signup and view all the answers

    What does a positive anti-saccharomyces cerevisiae antibodies (ASCA) test indicate?

    <p>Crohn's disease</p> Signup and view all the answers

    Which condition can be ruled out by examining rectal and colonic biopsies if the macroscopic appearance is normal?

    <p>Infection</p> Signup and view all the answers

    Which treatment option is specifically indicated for severe cases of Inflammatory Bowel Disease?

    <p>Biologics</p> Signup and view all the answers

    What is a common side effect associated with the use of Sulfasalazine?

    <p>Hemolytic anemia</p> Signup and view all the answers

    Which of the following is NOT classified as a type of drug therapy for IBD?

    <p>Mucosal protectants</p> Signup and view all the answers

    What is the primary purpose of corticosteroids in the treatment of Inflammatory Bowel Disease?

    <p>Reduce disease activity</p> Signup and view all the answers

    Which drug is considered a TNF inhibitor used in the treatment of IBD?

    <p>Infliximab</p> Signup and view all the answers

    In cases of frequent relapses, which treatment modality is recommended for patients currently using corticosteroids?

    <p>Initiate immunomodulating therapy</p> Signup and view all the answers

    What is a disadvantage of using immunosuppressive agents for treating IBD?

    <p>Not approved by national health insurance</p> Signup and view all the answers

    What is the role of aminosalicylates in the management of IBD?

    <p>Maintain remission and manage mild flares</p> Signup and view all the answers

    Which feature is commonly associated with Crohn's disease?

    <p>Deep transmural inflammation</p> Signup and view all the answers

    In which disease is Bile duct involvement more commonly observed?

    <p>Ulcerative Colitis</p> Signup and view all the answers

    What is a typical characteristic of the distribution of disease in Ulcerative Colitis?

    <p>Continuous areas of inflammation</p> Signup and view all the answers

    What does the presence of granulomas on biopsy indicate?

    <p>May indicate Crohn's disease</p> Signup and view all the answers

    Which is a common treatment goal when managing Crohn's disease?

    <p>Preventing or reducing complications</p> Signup and view all the answers

    Which of the following dietary recommendations should be followed to improve symptoms?

    <p>Incorporate more omega-3 fatty acids</p> Signup and view all the answers

    What is often the treatment outcome after the surgical removal of the colon for Ulcerative Colitis?

    <p>Permanent cure of the disease</p> Signup and view all the answers

    Which is considered a higher risk factor for developing Crohn's disease?

    <p>Smoking</p> Signup and view all the answers

    Study Notes

    Introduction

    • Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract.
    • IBD is a spectrum of chronic idiopathic inflammatory conditions.

    Classification

    • Ulcerative colitis causes mucosal inflammation and sores (ulcers) in the lining of the large intestine (colon).
    • Crohn's disease is a chronic, relapsing and remitting inflammatory disease of the GI tract, affecting any site from mouth to anus.

    Epidemiology

    • In the US, an estimated 1 - 1.3 million people suffer from IBD.
    • Ulcerative colitis is slightly more common in males, while Crohn's disease is more frequent in women.
    • Diet, oral contraceptives, perinatal and childhood infections, or atypical mycobacterial infections have been suggested, but not proven, to play a role in developing IBD.

    Etiology

    • Infectious Agents
      • Viruses (Measles)
      • Bacteria (Mycobacteria)
    • Genetics
    • Environmental Factors
      • Diet
      • Smoking
    • Psychological Factors
      • Stress
      • Emotional or physical trauma

    Pathophysiology

    • Altered Mucosal Immune Response
      • Dietary and bacterial antigens penetrate the intestinal wall and activate the immune system.
      • This causes increased production of pro-inflammatory mediators, leading to inflammation of the mucosal layer.

    Clinical Manifestations

    • Symptoms are the same in both ulcerative colitis and Crohn's disease.
    • Symptoms include:
      • Diarrhoea
      • Abdominal pain, cramping & bloating due to bowel obstruction
      • Hematochezia: Blood in stool
      • Low fever
      • Decreased appetite
      • Weight loss and anorexia
      • Fatigue
      • Arthritis

    Diagnosis

    • Physical Examination: Look for oral aphtosis, abdominal tenderness and masses, anal tags, fissure and fistulae, nutritional deficiency and growth retardation in children.
    • Endoscopy: Colonoscopy helps determine the severity and pattern of inflammation and allows biopsies to be obtained.
    • Biopsy: Rectal and colonic biopsies are examined to determine the nature of inflammation (ulcerative colitis versus CD).
    • Radiology:
      • Barium Enema: Used to identify colonic strictures or colonic fistulae.
      • Barium Small bowel follow-through X-ray: Used to look for inflammation and narrowing of the small bowel.
    • Blood Test:
      • Anemia may be present due to blood loss, chronic inflammation or B12 malabsorption.
      • Hypoalbuminemia suggests severe disease with denutrition.
      • Elevated C-reactive protein and platelet count are good markers of inflammation severity.
      • Anti-saccharomyces cerevisiae antibodies (ASCA) are positive in 50-60% of CD patients while anti-neutrophil polynuclear antibodies (ANCA) are positive in 50-60% of UC patients.

    Crohn's Disease vs Ulcerative Colitis

    • Terminal ileum involvement: Commonly in Crohn's, Seldom in Ulcerative Colitis
    • Colon involvement: Usually in Crohn's, Always in Ulcerative Colitis
    • Rectum involvement: Seldom in Crohn's, Usually in Ulcerative Colitis
    • Involvement around the anus: Common in Crohn's, Seldom in Ulcerative Colitis
    • Bile duct involvement: No increase in rate of primary sclerosing cholangitis in Crohn's, Higher rate in Ulcerative Colitis
    • Distribution of Disease: Patchy areas of inflammation (Skip lesions) in Crohn's, Continuous area of inflammation in Ulcerative Colitis
    • Endoscopy: Deep geographic and serpiginous (snake-like) ulcers in Crohn's, Continuous ulcer in Ulcerative Colitis
    • Depth of inflammation: May be transmural, deep into tissues in Crohn's, Shallow, mucosal in Ulcerative Colitis
    • Fistulae: Common in Crohn's, Seldom in Ulcerative Colitis
    • Stenosis: Common in Crohn's, Seldom in Ulcerative Colitis
    • Autoimmune disease: Widely regarded as an autoimmune disease in Crohn's, No consensus in Ulcerative Colitis
    • Cytokine response: Associated with T17 in Crohn's, Vaguely associated with T2 in Ulcerative Colitis
    • Granulomas on biopsy: May have non-necrotizing non-peri-intestinal crypt granulomas in Crohn's, Non-peri-intestinal crypt granulomas not seen in Ulcerative Colitis
    • Surgical cure: Often returns following removal of affected part in Crohn's, Usually cured by removal of colon in Ulcerative Colitis
    • Smoking: Higher risk for smokers in Crohn's, Lower risk for smokers in Ulcerative Colitis

    Goals of Treatment

    • Maintain or improve quality of life.
    • Terminate the acute attack and induce clinical remission.
    • Prevent symptoms during chronic symptomatic periods.
    • Prevent or reduce complications.
    • Use the most cost-effective drug treatment.
    • Avoid surgery if possible.
    • Replacement of vitamin A, D, K if necessary in case of malabsorption.

    Non-Pharmacological Treatment

    • Avoid smoking.
    • Reduce alcohol consumption.
    • Avoid NSAIDs.
    • Avoid spicy and fried/oily food.
    • Take fiber-rich diet as tolerated, including tender cooked vegetables, canned or cooked fruits, and starches like cooked cereals and whole wheat noodles and tortillas.
    • Incorporate more omega-3 fatty acids in the diet.

    Inflammatory Bowel Disease: Treatment

    • Severe:
      • Surgery
      • Biologics (e.g., infliximab)
    • Moderate:
      • Corticosteroids
      • Immunomodulators: 6-MP, AZA, MTX
    • Mild:
      • Antibiotics
      • Aminosalicylates

    Pharmacological Treatment

    • Aminosalicylates/5-ASA: Have anti-inflammatory effects, used to maintain remission and induce remission of mild flares of disease.
      • Sulfasalazine and mesalamine: Used to treat mild to moderate disease and to maintain remission induced by corticosteroids.
      • Sulfasalazine is useful for ileocolonic and colonic disease.
      • Side effects include hemolytic anemia & pruritic dermatitis.
      • Pentasa is a sustained-release preparation that delivers 5-ASA to the distal ileum and colon.
    • Corticosteroids: Effective in decreasing disease activity and inducing remission in most patients. However, long-term use is not recommended due to undesirable side effects.
      • Oral or parenteral corticosteroids are indicated for moderate to severe colitis.
      • Adverse effects include cosmetic effects, linear growth suppression in children, and osteopenia.
      • Eg., Prednisolone, Budenoside.
    • Immunosuppressive Agents: Used when it is impossible to taper corticosteroids or frequent relapses occur.
      • Azathioprine and 6-mercaptopurine: Used for steroid-sparing or steroid-reducing effects, since approximately 50% of patients experience adverse effects from corticosteroids.
      • Due to delayed onset of action, these agents are not used to treat acute colitis.
      • Cyclosporine and tacrolimus have been used to treat acute steroid-refractory UC when surgery seemed inevitable.
    • TNF Inhibitors: Inhibit the endogenous cytokine from binding to the cell surface receptor and exerting biological activity.
      • Increased production of inflammatory cytokines, especially tumor necrosis factor alpha (TNF-α), has been described in both normal and inflamed mucosa.

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    Inflammatory Bowel Disease Lecture Notes PDF

    Description

    This quiz covers the essential aspects of Inflammatory Bowel Disease (IBD), including its classifications, epidemiology, and etiology. Learn about the differences between ulcerative colitis and Crohn's disease, as well as factors that may influence their development. Test your understanding of these chronic intestinal disorders and their impact on health.

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