Pathophysiology and Symptoms of IBD
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Questions and Answers

What key marker is used to indicate neutrophilic migration into intestinal tissue?

  • CRP
  • Faecal occult blood
  • Liver function tests
  • Faecal calprotectin (correct)

    • Which findings on colonoscopy are indicative of ulcerative colitis?

  • Transmural ulceration
  • Cobblestone mucosa
  • Skip lesions
  • Loss of vascular markings (correct)

    • What is the gold standard investigation for diagnosing inflammatory bowel disease?

  • Stool culture
  • Ultrasound
  • CT scan
  • Colonoscopy with biopsy (correct)

    • What type of inflammation is typically observed in Crohn's disease?

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

    Which conservative management strategy is advised for patients with inflammatory bowel disease?

    <p>Nutritional support</p> Signup and view all the answers

    Which of the following is NOT associated with the diagnosis of ischemic colitis?

    <p>Continuous lesions</p> Signup and view all the answers

    What type of changes are typically seen in colon biopsy findings in Crohn's disease?

    <p>Granulomas and cryptitis</p> Signup and view all the answers

    Which medication is used to induce and maintain remission in patients with ulcerative colitis?

    <p>5-ASA (Aminosalicyclic Acids)</p> Signup and view all the answers

    What is the primary purpose of steroids in the treatment of Crohn's disease?

    <p>To provide short-term relief and manage inflammation</p> Signup and view all the answers

    Which of the following side effects is associated with Azathioprine?

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

    What is a characteristic of the step-up approach in treating patients with Crohn's disease?

    <p>Starting with less potent medications with fewer side effects</p> Signup and view all the answers

    Which immunosuppressant is known to inhibit T lymphocyte response?

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

    What is a notable side effect of anti-TNF biologics?

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

    Under what circumstances is surgery typically considered for patients with inflammatory bowel disease (IBD)?

    <p>In cases of non-responsive serious disease</p> Signup and view all the answers

    Which method of drug administration allows for steroid usage in Crohn's disease?

    <p>IV, PR, or orally</p> Signup and view all the answers

    What is a common risk associated with methotrexate in treatment?

    <p>Nausea and myelosuppression</p> Signup and view all the answers

    What is the final common pathway in the pathophysiology of inflammatory bowel disease (IBD)?

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

    Which age group shows a bimodal distribution for the onset of ulcerative colitis and Crohn's disease?

    <p>2nd and 3rd decades of life, with a second peak in the 60s</p> Signup and view all the answers

    What is the most commonly affected section of the bowel in Crohn's disease?

    <p>Terminal ileum</p> Signup and view all the answers

    Which of the following is a cardinal symptom primarily associated with ulcerative colitis?

    <p>Bloody diarrhea</p> Signup and view all the answers

    What factor is noted for increasing the risk of developing ulcerative colitis?

    <p>Family history</p> Signup and view all the answers

    Which of the following describes the inflammation pattern seen in ulcerative colitis?

    <p>Continuous inflammation starting from the rectum</p> Signup and view all the answers

    What is one of the distinctive complications associated with Crohn's disease?

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

    What is an expected effect of mucosal damage in inflammatory bowel disease?

    <p>Diarrhea due to increased secretion</p> Signup and view all the answers

    What is the estimated percentage of ulcerative colitis patients that may require colectomy?

    <p>20–25%</p> Signup and view all the answers

    What is a primary reason for surgery in patients with Crohn’s disease?

    <p>To address severe complications</p> Signup and view all the answers

    What complication is least likely associated with partial colectomy?

    <p>Bowel perforation</p> Signup and view all the answers

    What is a characteristic feature of strictures caused by Crohn's disease?

    <p>Result from transmural inflammation and fibrosis</p> Signup and view all the answers

    What is the recurrence rate of Crohn’s disease within 5 years after surgery?

    <p>50%</p> Signup and view all the answers

    Which of the following is NOT a specific indication for surgery in Crohn’s disease?

    <p>Mild gastrointestinal upset</p> Signup and view all the answers

    What role does the ileocecal valve play in bowel function?

    <p>Reduces transit time</p> Signup and view all the answers

    What symptom may indicate a bowel obstruction in a patient with Crohn's disease?

    <p>Decreased bowel sounds</p> Signup and view all the answers

    Which type of anaemia is primarily caused by B12 deficiency in Crohn's disease?

    <p>Macrocytic anaemia</p> Signup and view all the answers

    What is a common intestinal complication of Crohn's disease?

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

    Which extra intestinal manifestation is associated with Crohn's disease?

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

    Which laboratory finding is indicative of iron deficiency anaemia?

    <p>Reduced MCHC</p> Signup and view all the answers

    What is the primary cause of B12 deficiency following terminal ileum resection?

    <p>Insufficient absorption</p> Signup and view all the answers

    Which symptom is NOT typically associated with Crohn’s disease?

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

    Which type of anaemia is associated with insufficient absorption of folate?

    <p>Macrocytic anaemia</p> Signup and view all the answers

    Which feature distinguishes Crohn's disease from ulcerative colitis?

    <p>Skip lesions</p> Signup and view all the answers

    What complication of Crohn's disease can occur due to chronic inflammation?

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

    Which of the following is a systemic sign of inflammation related to ulcerative colitis?

    <p>Erythema nodosum</p> Signup and view all the answers

    Which symptom is most commonly associated with inflammation of the terminal ileum in Crohn's disease?

    <p>Abdominal pain in the right lower quadrant</p> Signup and view all the answers

    What is the primary physiological reason for low BMI in patients with Crohn's disease?

    <p>Malabsorption caused by small bowel involvement</p> Signup and view all the answers

    Which ocular condition is less common but more severe than episcleritis in Crohn's disease patients?

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

    What type of anemia is primarily due to iron deficiency in Crohn's disease patients?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    Which gastrointestinal complication is often seen in patients with Crohn's disease?

    <p>Intestinal obstruction</p> Signup and view all the answers

    Which symptom is a result of the inflammatory process and common among patients with Crohn's disease?

    <p>Clubbing of fingers</p> Signup and view all the answers

    Which of the following conditions is strongly associated with ulcerative colitis and can complicate liver function?

    <p>Primary sclerosing cholangitis</p> Signup and view all the answers

    What distinguishes mouth ulcers associated with Crohn's disease from those in ulcerative colitis?

    <p>Inflammatory process and shared antigens</p> Signup and view all the answers

    What type of anaemia is associated with insufficient intake or absorption in Crohn's disease?

    <p>B12 deficiency anaemia</p> Signup and view all the answers

    Which complication of Crohn's disease may lead to obstruction?

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

    Which condition is an extra intestinal manifestation of Crohn's disease?

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

    In which type of anaemia would you expect a hypochromic appearance on a blood film?

    <p>Iron deficiency anaemia</p> Signup and view all the answers

    Which of the following tests would primarily indicate a diagnosis of B12 deficiency?

    <p>Mean corpuscular volume (MCV)</p> Signup and view all the answers

    What is a key characteristic of iron deficiency anaemia in the context of Crohn's disease?

    <p>Decreased RBC count</p> Signup and view all the answers

    Which of the following statements about the complications of Crohn's disease is incorrect?

    <p>Toxic megacolon only occurs in ulcerative colitis.</p> Signup and view all the answers

    What type of deficiency can result from terminal ileum resection?

    <p>B12 deficiency</p> Signup and view all the answers

    Which of the following does NOT describe a typical feature of ulcerative colitis as compared to Crohn's disease?

    <p>Transmural inflammation</p> Signup and view all the answers

    Which extra intestinal manifestation is specifically linked to skin complications of Crohn's disease?

    <p>Erythema nodosum</p> Signup and view all the answers

    What is the primary factor contributing to the pathophysiology of inflammatory bowel disease (IBD)?

    <p>Altered adherence of E.coli to epithelial cells</p> Signup and view all the answers

    Which demographic is observed to have a higher prevalence of inflammatory bowel disease?

    <p>Individuals of Jewish ethnicity, particularly Ashkenazi</p> Signup and view all the answers

    What cardinal symptom is most classical for ulcerative colitis?

    <p>Bloody diarrhoea</p> Signup and view all the answers

    Which pattern of inflammation is characteristic of Crohn's disease compared to ulcerative colitis?

    <p>Transmural inflammation affecting all layers</p> Signup and view all the answers

    Which of the following symptoms is more likely to be experienced in Crohn's disease compared to ulcerative colitis?

    <p>Fistulae formation</p> Signup and view all the answers

    Which of the following describes an appropriate alteration in gut function due to mucosal damage in inflammatory bowel disease?

    <p>Increased luminal antigen exposure</p> Signup and view all the answers

    What is one of the primary immune response triggers associated with leaky epithelium in inflammatory bowel diseases?

    <p>Increased intestinal permeability</p> Signup and view all the answers

    Which age group demonstrates a bimodal distribution for the onset of ulcerative colitis and Crohn's disease?

    <p>Those in their 60s and beyond</p> Signup and view all the answers

    What is a significant reason for considering surgery in ulcerative colitis patients?

    <p>Severe life-threatening complications</p> Signup and view all the answers

    What is the estimated recurrence rate of Crohn’s disease after 10 years post-surgery?

    <p>70-80%</p> Signup and view all the answers

    Which condition is NOT a specific indication for surgery in Crohn’s disease?

    <p>Stable remission</p> Signup and view all the answers

    What is a common complication associated with partial colectomy?

    <p>Anastomotic leak</p> Signup and view all the answers

    What is the primary underlying cause of strictures in Crohn’s disease?

    <p>Transmural inflammation</p> Signup and view all the answers

    Which term describes the condition where bowel narrowing occurs due to scarring in Crohn's disease?

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

    What changes in bowel function may occur due to the absence of the ileocecal valve after surgery?

    <p>Increased transit time</p> Signup and view all the answers

    During an acute attack of Crohn's disease, what type of abdominal symptoms may a patient commonly experience?

    <p>Intermittent cramping abdominal pain</p> Signup and view all the answers

    What is the main reason for using steroid-sparing agents in the treatment of inflammatory bowel disease?

    <p>To reduce potential side effects of prolonged steroid use</p> Signup and view all the answers

    What is a significant side effect of Methotrexate when used as a treatment in inflammatory bowel disease?

    <p>Neural tube defects</p> Signup and view all the answers

    Under what conditions is surgery indicated for patients with inflammatory bowel disease?

    <p>When patients are non-responsive to medical treatment</p> Signup and view all the answers

    Which of the following medications is a JAK inhibitor used in the treatment of inflammatory bowel disease?

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

    In which population is Azathioprine most effective for maintaining remission?

    <p>Patients who are steroid-free</p> Signup and view all the answers

    What is the primary purpose of using a step-up approach in treating inflammatory bowel disease?

    <p>To provide the least potent medications first to avoid serious side effects</p> Signup and view all the answers

    What are the potential risks associated with biologics such as anti-TNF agents in the treatment of inflammatory bowel disease?

    <p>Reactivation of latent tuberculosis and skin cancers</p> Signup and view all the answers

    Which of the following represents a common side effect of antibiotics used in treating inflammatory bowel disease?

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

    Study Notes

    Pathophysiology of IBD

    • Alteration of gut bacteria, increased E. Coli adherence to cells
    • Leaky gut epithelium, more antigens enter the body, causing immune response
    • Resulting inflammation
      • Mucosa disruption
      • Reduced absorption
      • Increased secretion

    Risk Factors of Ulcerative Colitis and Crohn's Disease

    • Family history
    • Smoking cessation
    • Westernized countries
    • Jewish ethnicity (Ashkenazi)

    Cardinal Symptoms of IBD

    • Diarrhoea
      • Over 30 days
      • Bloody in Ulcerative Colitis
      • Urgency, frequency, tenesmus
    • Weight loss
    • Fever
    • Abdominal pain
    • Perianal pain and abscesses (Crohn’s)
    • Fatigue
    • Delayed puberty

    Blood Test for Ulcerative Colitis

    • FBC
    • U&E
    • CRP
    • Folate, B12
    • Iron studies
    • Calcium, magnesium
    • LFTs
    • Albumin

    Stool Sample Tests

    • Faecal occult blood
    • Stool culture (for microorganisms)
    • Faecal calprotectin

    Imaging and Visualisation Studies

    • Endoscopy (gold standard), colonoscopy and OGD
    • SBFT
    • CT colonography
    • CT scan
    • Ultrasound
    • Capsule endoscopy

    Endoscopic Features of Ulcerative Colitis

    • Loss of vascular markings
    • Erythema
    • Petechiae
    • Exudates
    • Edema
    • Erosions
    • Touch friability
    • Spontaneous bleeding
    • Continuous inflammation
    • Mayo score

    Endoscopic Features of Crohn's Disease

    • Deep, transmural ulcerations
    • Aphthous ulcers
    • Cobblestone mucosa
    • Normal rectal mucosa
    • Inflammation of terminal ileum

    Colon Biopsy Findings in Crohn’s Disease

    • Loss of architecture
    • Cryptitis
    • Crypt abscess
    • Granulomas
    • Acute and chronic changes

    Conservative Management of IBD

    • Smoking cessation
    • Nutrition
    • Aminosalicylic acids
    • Antibiotics
    • Steroids
    • Immunosuppressants

    Surgical Management of IBD

    • Avoided where possible
    • Used in severe cases not responding to medical treatments
    • Potentially curative for Ulcerative Colitis
    • Less effective for Crohn’s disease
    • Can be considered as an alternative for localized ileocaecal Crohn’s disease
    • Indications for surgery include abscesses, fistulas, strictures, dysplasia, cancer

    Intestinal Obstruction

    • Differential:
      • Benign stricture
      • Malignant neoplasm

    Complications of Partial Colectomy

    • Acute: anastamotic leak
    • Watery stool
    • Recurrence of disease at sites of anastomosis
    • Terminal ileum resection
      • B12 deficiency
      • Bile Salts, steatorrhoea.

    Types of Anaemia in Crohn’s Disease

    • Vitamin B12 deficiency
    • Folate deficiency
    • Iron deficiency

    Investigations of Anaemia

    • FBC
    • Red blood cell size
    • RBC count, Hb, MCHC
    • Blood film

    Complications of Crohn’s Disease

    • Intestinal:
      • Strictures
      • Fistulas
      • Abscesses
      • Perforation
      • Toxic megacolon
    • Extraintestinal:
      • Eye
        • Uveitis
        • Episcleritis
      • Mouth
        • Stomatitis
        • Aphthous ulcers
      • Liver/biliary tract
        • Steatosis
        • Sclerosing cholangitis
      • Kidneys
        • Stones
        • Hydronephrosis
        • Fistulae
        • Infections
      • Skin
        • Erythema nodosum
        • Pyoderma gangrenosum
      • Joints
        • Spondylitis
        • Sacroiliitis
        • Peripheral arthritis
      • Anaemias
        • Iron, B12, folate deficiency

    Additional Complications

    • Ulcerative Colitis
      • Sclerosing cholangitis
      • Iron deficiency anaemia
      • Dysplasia
    • Crohn’s Disease
      • Erythema nodosum
      • Eye symptoms

    Colorectal Dysplasia in Ulcerative Colitis

    • Colorectal dysplasia in patients with severe colitis over 10 years

    Idiopathic Inflammatory Bowel Disease (IBD) - Pathophysiology

    • Alteration of bacterial flora, increase in E. coli adherence to ileal epithelial cells
    • "Leaky" epithelium, more luminal antigens entering, causing inappropriate immune response
    • Final common pathway is inflammation
      • Impaired integrity of mucosa/mucosal destruction
      • Loss of absorptive function
      • Increased secretory function

    Risk Factors for IBD

    • Family History: Influential, but not the only consideration, multiple susceptibility loci for both disorders - environmental and epigenetic interactions are key
    • Recent Smoking Cessation: Primarily associated with ulcerative colitis (UC)
    • Western/Developed Countries: Prevalence is higher in these areas
    • Jewish Ethnicity: Ashkenazi Jewish individuals have a higher risk of IBD

    Crohn's Disease vs. Ulcerative Colitis

    • Crohn's Disease: Can affect any part of the gastrointestinal tract from the mouth to the anus; discontinuous, patchy inflammation (skip lesion); transmural (full thickness of bowel wall); terminal ileum most commonly affected; often involves fistulae, abscesses, and perianal disease.
    • Ulcerative Colitis: Restricted to the large intestine; continuous inflammation from the rectum working backwards; affects only the mucosa and submucosa layers.

    Cardinal Symptoms of IBD

    • Diarrhoea: Common to both Crohn's and UC, but severity and characteristics vary
      • More than 30 days, range of severity
      • Bloody (UC > CD) - Bloody diarrhoea is the classical presenting symptom of UC
      • Urgency, frequency, tenesmus, pain relieved by defecation (where inflammation affects mostly the rectum and sigmoid colon)
      • Mucous
    • Weight Loss: More pronounced in Crohn's disease than UC, due to catabolism and malabsorption
    • Fever: Common to both diseases
    • Abdominal Pain: More frequent in Crohn's disease
    • Perianal Pain and Abscess: More frequently seen in Crohn's disease
    • Extraintestinal Features: Both illnesses can have extraintestinal manifestations
    • Fatigue: Common to both diseases
    • Delayed Puberty: Can occur in both diseases

    Signs of IBD

    • Low BMI: Associated with malabsorption due to small bowel involvement
    • Clubbing: Unclear mechanism, potentially related to platelet-derived growth factor (PDGF)
    • Pallor of Palmar Creases / Conjunctivae: Anaemia due to blood loss, malabsorption, or vitamin B12 deficiency (terminal ileum inflammation leads to malabsorption of B12)
    • Koilonychia: Iron deficiency anaemia
    • Scleritis / Episcleritis: 2-5% of patients with IBD; burning/itching eyes, injection of ciliary vessels, inflammation of episcleral tissues; thought to be secondary to inflammatory process, antibodies against shared antigens/molecular mimicry
    • Uveitis: Less common than episcleritis (0.5-3%); more severe, frequently bilateral, posterior to the lens, insidious onset, chronic in duration; affects females more than males.
    • Cataracts: Potential side effect of long-term glucocorticoid use

    Additional Signs of IBD

    • Mouth Ulcers: Inflammatory process, antibodies against shared antigens, molecular mimicry, also malnutrition and drug side effects; more common in Crohn's disease than UC
    • Cirrhosis: Strongly associated with ulcerative colitis through primary sclerosing cholangitis (PSC); jaundice, hepatomegaly, splenomegaly may be evident; limited role in Crohn's disease

    Treatment of IBD

    • Antibiotics: Metronidazole, Ciprofloxacin
    • Steroids: Oral, intravenous, rectal; used in short courses due to potential side effects; need to be used with steroid-sparing agents to limit use
    • Immunosuppressants: Azathioprine (thiopurine), Methotrexate, Cyclosporin
    • Biologics: Anti-TNF (infliximab, adalimumab, golimumab), Vedolizumab, Ustekinumab, Tofacitinib
    • Surgery: Used in severe cases unresponsive to medical treatment, potentially curative for UC; less attractive for Crohn's disease due to high likelihood of recurrence

    Truelove and Witt Criteria: Severity Assessment Tool for Acute Severe Ulcerative Colitis

    • Medical Rescue Therapy: Used in severe cases
    • Surgery: Avoided where possible, minimal resections
      • Reserved for serious cases not responding to medical treatment.
      • Potentially curative for UC, but 20-25% of UC patients need colectomy.
      • May be necessary for severe complications (perforation, toxic dilatation, massive hemorrhage), or chronic illness or risk of cancer.
      • Less attractive for Crohn's disease due to high likelihood of recurrence.
      • May be necessary for severe complications (abscesses, complex perianal or internal fistulas, fibrostenotic strictures, high-grade dysplasia, cancer).

    Complications of IBD

    • Intestinal Complications of Crohn's Disease:
      • Strictures
      • Fistulas, sinus tracts
      • Abscesses
      • Perforation
      • Toxic megacolon
    • Extraintestinal Manifestations of Crohn's Disease:
      • Eyes: Uveitis, Episcleritis
      • Mouth: Stomatitis, Aphthous ulcers
      • Skin: Erythema nodosum, Pyoderma gangrenosum
      • Joints: Spondylitis, Sacroiliitis, Peripheral arthritis
      • Liver/Biliary Tract: Steatosis, Sclerosing cholangitis
      • Kidneys: Stones, Hydronephrosis, Fistulae, Infections
      • Anaemias: Iron, Vitamin B12, Folate deficiencies

    Colorectal Dysplasia in Ulcerative Colitis

    • Patients with severe colitis for more than 10 years are at increased risk for colorectal dysplasia.

    Disease-Specific Complications

    • Ulcerative Colitis:* Sclerosing cholangitis, iron deficiency anaemia, dysplasia
    • Crohn's Disease*: Iron, B12, folate deficiency, Erythema nodosum, Eye symptoms

    Anatomy and Pathology of Crohn's Disease and Ulcerative Colitis

    • Crohn's Disease:
      • Transmural inflammation
      • Skip lesions
      • Cobblestone appearance
      • Deep fissures
      • Granulomas
    • Ulcerative Colitis:
      • Superficial continuous inflammation confined to the mucosa and submucosa
      • Crypt abscesses
      • Pseudopolyps
      • Loss of the normal mucosal architecture
    • Note:* The provided text was quite comprehensive, but if you have any specific questions or need further clarification, please don't hesitate to ask!

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    Description

    This quiz covers the pathophysiology, risk factors, cardinal symptoms, and diagnostic tests associated with Inflammatory Bowel Disease (IBD), including Ulcerative Colitis and Crohn's Disease. Test your knowledge on how these conditions affect gut health and the various clinical approaches used in their diagnosis.

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