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GI DRx > 02a: IBD, diarrhea > Flashcards

02a: IBD, diarrhea Flashcards

1
Q

UC primarily associated with which symptom?

A

Bloody diarrhea

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2
Q

UC severe attack can be associated with (X), which has significant morbidity and mortality.

A

X = toxic mega colon (dilatation of colon)

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3
Q

UC begins in (X) and spreads (proximally/distally). It (always/sometimes/never) involves entire colon. It is (always/sometimes/never) transmural inflammation.

A

X = rectum
Proximally
Sometimes
Never

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4
Q

T/F: 70% of patients with UC have involvement of entire colon

A

False - 70% don’t have involvement proximal to sigmoid colon

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5
Q

What is proctitis?

A

Inflammation limited to rectum

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6
Q

Patient recently diagnosed with UC asks about his likelihood of needing Colectomy. You tell him that overall, (X)% of UC patients require this procedure.

A

X = 20-25

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7
Q

List the findings you would expect to see on colonoscopy in patient with new UC.

A
  1. Granular erythematous mucosa
  2. Decreased blood vessel markings
  3. Ulcerations (deeper with exudate in severe cases)
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8
Q

What finding on colonoscopy would lead you to believe patient has long-standing UC?

A

Pseudopolyps (islands of normal tissue in region of previous ulceration)

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9
Q

Colonic biopsy reveals (X) in UC.

A

Crypt distortion/abscesses with leukocyte (PMNs, eosinophils, lymphocytes) infiltration

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10
Q

Why is toxic megacolon so dangerous?

A

High risk of perforation

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11
Q

List the 3 patterns of distribution seen in Crohn’s.

A
  1. Ileocolitis (40% of patients)
  2. Confined to small intestine - ileitis/jejunoileitis (30%)
  3. Confined to colon (Crohn’s colitis, 25%)
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12
Q

T/F: Crohn’s can involve esophagus

A

True - any part of GI tract

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13
Q

List the predominant symptoms of Crohn’s.

A

Abdominal pain, diarrhea, weight loss

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14
Q

Patient recently diagnosed with Crohn’s asks about his likelihood of needing surgery. You tell him that within a decade, (X)% of Crohn’s patients require surgical intervention.

A

X = over 60%

And 40% require repeat intervention within 5 y after first surgery

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15
Q

T/F: Crohn’s inflammation is diffuse and transmural.

A

Partly false - focal and transmural

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16
Q

In (Crohn’s/UC), “creeping fat” refers to (X) phenomenon. The mucosa has (Y) appearance due to edema and linear ulceration.

A

Crohn’s
X = mesentery becomes infiltrated with fat
Y = cobblestone

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17
Q

Histological presence of (caseating/non-caseating) granulomas are characteristic of (Crohn’s/UC).

A

Non-caseating

Crohn’s

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18
Q

Malabsorption of (X) and development of megaloblastic anemia is a complication of which IBD?

A

X = vitamin B12

Crohn’s

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19
Q

Development of fistulas is seen in (UC/Crohn’s). What structures can involve this fistula formation?

A

Crohn’s

  1. Enteroenteric
  2. Between colon and other organs (bladder, vag)
  3. Enterocutaneous
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20
Q

Chronic (X) malabsorption in (UC/Crohn’s) puts patients at increased risk for (Y) urinary stone development.

A

X = fat (binds Ca in gut, frees oxalate)
Crohn’s
Y = Ca-oxalate

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21
Q

What is the most common extra-intestinal manifestation of IBD?

A

Arthritis (peripheral or axial)

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22
Q

Patients with (UC/Crohn’s) are 30x increased risk of (X) axial arthritis, (because/despite) HLA-B27 positivity (is/isn’t) increased in this IBD.

A

UC
X = spondyloarthritis
Despite
Isn’t

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23
Q

Which classic dermatological findings would you see in IBD? Name the locations you would likely see these.

A
  1. Erythema nodosum (anterior tibia)

2. Pyoderma gangrenosum (legs)

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24
Q

Routine checkup for patient with UC. Your notice a foot ulcer with necrotic base, called (X). How do you treat?

A

X = pyoderma gangrenosum

Systemic or intralesional steroids

25
Q

Your patient with Crohn’s comes in complaining of blurred vision, headache, and photophobia. Which complication has occurred and which Rx do you propose?

A

Uveitis

Local steroids or atropine

26
Q

List the three major diagnostic techniques used for IBD.

A
  1. Stool studies (rule out infection)
  2. Endoscopy (maybe biopsy)
  3. Radiography (CT/MR)
27
Q

When might videocapsule endoscopy be used to diagnose IBD?

A

In Crohn’s involving small bowel when other imaging techniques aren’t diagnostic

28
Q

Abdominal mass is commonly felt in (Crohn’s/UC).

A

Crohn’s

29
Q

Pseudopolyps are seen in (Crohn’s/UC).

A

Both

30
Q

Presence of perianal disease is characteristic of (Crohn’s/UC).

A

Crohn’s

31
Q

T/F: Rx for IBD is now based on symptoms.

A

False - paradigm shift; now treat based on markers of inflammation

32
Q

Mild IBD Rx includes:

A
  1. Aminosalicylates (sulfasalazine)
  2. Nutritional modification (peds)
  3. Antibiotics
33
Q

Moderate IBD Rx includes:

A
  1. Azthioprine, MTX

2. Corticosteroids

34
Q

Severe IBD Rx includes:

A
  1. IV steroids
  2. Cyclosporine
  3. Surgery
35
Q

T/F: patients with moderate/severe IBD are on corticosteroids for maintenance purposes when in remission.

A

False

36
Q

Diarrhea officially defined as:

A

Stool weight greater than 200g/day

37
Q

Clinically, patients describe diarrhea as change in stool:

A

Frequency, consistency, or volume

38
Q

Chyme is made (hyper/iso/hypo)-tonic in (X) part of gut and remains so throughout the rest of the tract.

A

Isotonic (with plasma, via fluid shifts)

X = duodenum

39
Q

“Dumping syndrome” is the result of resection of (X) part of bowel. Patients have which symptoms and why?

A

X = pyloric sphincter (no regulation of chyme entering small bowel)

Cramps and hypotension after meals (lots of IV volume lost due to fluid shifts when hypertonic chyme enters duodenum all at once)

40
Q

Along intestinal tract, (X) provides driving force for Na (reabsorption/secretion) via which transporters?

A

X = Na/K pump
Reabsorption

  1. Na/glucose symporter
  2. Na/H antiporter
41
Q

Along intestinal tract, Cl is (reabsorbed/secreted) via which transporter?

A

Reabsorbed

Cl/HCO3 exchanger

42
Q

In the colon, Na primarily (absorbed/secreted) via which mechanism?

A

Absorbed

Passive diffusion through channels

43
Q

K is actively (absorbed/secreted) in (small/large) bowel, so stool is (higher/lower) in K than chyme

A

Secreted
Large
Higher

44
Q

Intestinal fluid secretion is highly dependent on (X) (reabsorption/secretion) and relies on (Y) transporter in which intestinal cells?

A

X = Cl
Secretion
Y = Na/K/2Cl (basolateral)
Crypt cells

45
Q

List the three specific second messenger systems have been identified in the secretion of intestinal fluid

A
  1. cAMP
  2. cGMP
  3. Ca (intracellular)
46
Q

Increase in cAMP will (increase/decrease) activity of CFTR and (increase/decrease) Na and Cl absorption.

A

Increase (increase Cl secretion)

Decrease reabsorption

47
Q

T/F: increase in cAMP levels will decrease glucose absorption due to decrease Na/glucose transporter activity.

A

False - doesn’t affect this

48
Q

What’s the prototypical illness leading to marked intestinal secretion and diarrhea? How does this infectious organism work?

A

Cholera

Toxin activates AC and increases cAMP levels

49
Q

An important advance in the treatment of secretory diarrheas such as cholera is the use of (X), which take advantage of (Y) transporters.

A 
X = oral rehydration solutions (ORS)
Y = Na/glucose
50
Q

Oral rehydration solutions (ORS) contain appropriate balance of which solutes?

A

NaCl and simple sugars

51
Q

(X)-secreting pancreatic tumors develop an illness similar to cholera called the (Y) syndrome. What’s the mechanism behind this?

A 
X = VIP
Y = WDHA (watery diarrhea, hypokalemic acidosis)

VIP increases secretions via cAMP-dependent mechanism

52
Q

T/F: E. coli toxin, like cholera, produces watery diarrhea via cAMP mechanism.

A

False - via cGMP

53
Q

Serotonin (increases/decreases) intestinal secretions via which mechanism?

A

Increases

Increases intracellular Ca influx via basolateral membrane

54
Q

Patients who have had resections of their distal ileum are prone to (diarrhea/constipation) due to decrease in (X) reabsorption.

A

Diarrhea

X = bike acids (promote intestinal secretion)

55
Q

What are the two main mechanisms by which osmotic diarrhea occurs?

A
  1. Ingestion of poorly absorbed solutes (laxatives, Mg, sorbitol)
  2. Malabsorption
56
Q

Which clinical methods are used to distinguish between secretory and osmotic diarrhea?

A
  1. 48h fast

2. Measure stool Osm

57
Q

Patient with diarrhea recovers after a 48h fast with IV fluids. She had (secretory/osmotic) diarrhea, and you would expect stool Osm gap to be (X).

A

Osmotic

X = increased (over 100)

58
Q

Calculated stool osmolarity is:

A

2x(Na+K)

GI DRx (11 decks)

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