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1. Clin Med III > 1- IBD & Celiac Disease > Flashcards

1- IBD & Celiac Disease Flashcards

1
Q

What age ranges does IBD mainly affect?

A

Bimodal. 15-35 yo & 50-80 yo

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2
Q

What role does smoking play in CD & UC?

A

Increases risk in CD. Decreases risk in UC

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3
Q

What IBD involves the GI from mouth to anus, has patchy/skip lesions and transmural inflammation?

A

Crohns Disease

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4
Q

What IBD is limited to the colon, involves the rectum, extends proximally with continuous circumfrential involvement and has inflammation of the mucosal layer only?

A

Ulcerative colitis

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5
Q

What will impact the clinical presentation, diagnostic evaluation, management and associated complication of IBD?

A

Extend and severity of involvement

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6
Q

What part of the GI tract is most commonly impacted by CD?

A

Ileum → ileitis

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7
Q

What would you expect to find on exam of a pt w/ Crohns perianal disease?

A

Abscess, fistula

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8
Q

What does transmural mean?

A

Affects the entire thickness of mucosa

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9
Q

Ulcer, stricture, fistual, and abscess can also result from what?

A

Penetrating Crohn’s disease

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10
Q

What is a fistula?

A

tunnel/ abnormnal communication b/w 2 epitheal lined organs

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11
Q

What two organs are connected by an enterovesical fistula?

A

bowel and bladder

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12
Q

T or F: CD and UC have an incidious onset and alternates b/w periods of exacerbations and relative remission?

A

TRUE

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13
Q

What determines severity of Crohn’s disease?

A

Mild → inflammation. Moderate → inflamation, strictures. Severe → inflammation, strictures, fistula

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14
Q

PE on pt w/ abdominal pain reveals RLQ tenderness w/ palpable mass, anal fissues, and B12 deficiency. What disease are you concerned about?

A

Crohns Disease

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15
Q

What is the most common estra-intestinal manifestation of CD?

A

Arthralgias (also: oral apthous ulcers, occular manifestations, erythema nodosum, pyoderma gangrenosum)

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16
Q

What imagind should be ordered if suspicious for CD?

A

Colonoscopy w/ TI intubation. If w/ evidence of CD then order EGD

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17
Q

When would you not order a capsule endoscopy?

A

In pts w/ suspected intestinal strictures

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18
Q

What tests will indicate inflammation?

A

ESR/CRP, Fecal calprotectin and lactroferrin

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19
Q

What are skip lesions?

A

Areas that are disease free

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20
Q

What colonoscopy results would you expect in pt w/ CD?

A

skip lesions, ulcerations, cobblestoning, rectal sparing (in most pts), +/- fistula

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21
Q

If biopsy is taken from a pt w/ CD, what would you expect to see?

A

Granulomas and chronic inflammation

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22
Q

What finding on UGI w/ SBFT (Upper GI Series / Small Bowel Follow-through) would you expect in pt w/ CD?

A

String sign

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23
Q

What would CT or MRI show in pt w/ CD?

A

mucosal inflamnmation, strictures, abscess, fistula

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24
Q

Colon CA, intestinal strictures, abdominal and perianal fistuala, abscess, and malabsorption are complications associated w/ what disease?

A

Crohns Disease

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25
Q

When is a colonoscopy recommended in pts w/ IBD?

A

Every 1-2 yrs starting 8 yrs after disease/sx onset

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26
Q

In CD pt w/ intestinal strictures, fistula or abscess. How might they present?

A

Will small bowel obstruction and perforation

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27
Q

Pt w/ CD might have what nutritional deficiencies?

A

Iron and B12

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28
Q

What disease only affects the colon in a continuous circumfrential pattern?

A

Ulcerative colitis

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29
Q

What portion of the colon is affected in ulcerative proctitis?

A

Rectum

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30
Q

What portion of the colon is affected in ulcerative proctosigmoiditis?

A

Rectosigmoid

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31
Q

What portion of the colon is affected in left-sided or distal UC?

A

Extends to but not beyond splenic flexure

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32
Q

What portion of the colon is affected in extensive colits?

A

Extends beyond splenic flexure but not to cecum

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33
Q

What portion of the colon is affected in panoctitis?

A

Disease that extends to cecum

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34
Q

Friability, erosions or bleeding to the mucosal surface of the colon only is concerning for what disease?

A

Ulcerative colitis

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35
Q

How is the extent and severity of UC determined?

A

Mild →<4 stools/day, no systemic toxicity. Moderate → >4 stools/day, anemia, low grade fever Severe →> 6 stools/day, systemic toxicity

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36
Q

Pt presents w/ abdominal pain and diarrhea w/ fecal urgency. ON exam you find perimbilical & LLQ tenderness, rectal bleeding, tenesmus, and iron deficiency anemia. What disease are you concerned about?

A

Ulcerative colitis

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37
Q

If pt w/ Proctitis will they have diarrhea or constipation?

A

Constipation

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38
Q

What are the most common extra-intestinal manifestions of UC?

A

Arthralgias & Sclerosing cholangitis (also: occular manifestations, erythema nodosum, pyoderma gangrenosum)

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39
Q

What imaging should you order in pt w/ UC?

A

Flex sigmoidoscopy or colonoscopy, +/- CT A/P

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40
Q

What tests should you order when evaluating stools samples in pts w/ IBD?

A

Stool cultures, C. Diff toxin, ova, & parasites. Fecal calprotectin or lactoferrin

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41
Q

Flex sig shows loss of vascular markings, erythema, exudate, friability/erosions and inflammation that begins distally and spreads proximally. What disease are you concerned about?

A

Ulcerative collitis

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42
Q

What will biopsy show in pt w/ UC?

A

Crypt abscesses

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43
Q

Colon CA, hemorrhage, and toxic megacolon are complications of what disease?

A

Ulcerative collitis

44
Q

What disease will show colonic dilation > 6 cm w/ signs of toxicity?

A

Toxic megacolon

45
Q

What are the medical therapies for IBD?

A

Salicylates, corticosteroids, immunomodulators, biologics, ABX (CD)

46
Q

Tx for IBD requires what?

A

multidisciplinary team support (PCP, GI, nutrition, surgeon)

47
Q

When would you use a step-up approach for the tx of a pt w/ IBD?

A

Low risk pts w/ mild disease

48
Q

When would you use a step-down approach for the tx of a pt w/ IBD?

A

High risk pts w/ moderate to severe disease

49
Q

What is the indication for Salicylates (5-ASA)?

A

Mild to moderate UC > CD

50
Q

What are the side effects of salicyclates (5-ASA)?

A

Diarrhea, kidney injury, pancreatitis

51
Q

What is the indication for corticosteroids?

A

Flares in UC and CD

52
Q

What are the cautions associated w/ corticosteroid use?

A

Short term use only, exit strategy to avoid dependence, requires slow taper

53
Q

What are the SEs of oral prednisone?

A

mood changes, insomnia, weight gains, worsening DM, increased infection risk, osteoporosis, cataracts, psychosis, adrenal insuffiency

54
Q

What itest is recommended if pt is going to take oral prednisone ≥3 months?

A

DEXA scan

55
Q

What supplemntation should a pt on chronic oral prednisone take?

A

Ca and Vit. D

56
Q

What is the indication for immunomodulators?

A

Moderate to severe UC & CD, steroid sparing agent, used in combo w/ biologics to prevent immunogenicity

57
Q

What immunomodulator produces the optimal response in 3-6 months, requires gnetic testing, & has systemic risks?

A

Thiopurines

58
Q

What immunomodulators requires folate supplementation and is teratogenic?

A

Methotrexate

59
Q

What are the SEs of thiopurines (immunomodulator)?

A

bone marrow suppression, hepatoxicity, non-melanoma skin CA, (Other: seconday infection, pancreatitis, non-hodgkin lymphona, HPV related cervical dysplasia)

60
Q

What is recommended for pt taking a thiopurines (immunomodulator)

A

Frequent monitoring of CBC and liver tests, annual derm exam, cervical CA screening, avoid live vaccine

61
Q

What is the indication for biologics (Anti-TNFs, -umabs) in the tx of IBD?

A

moderate to severe IBD, steroid sparing

62
Q

What biologic has a risk of inusion reaction?

A

Infliximab

63
Q

What are the SEs of biologics (Anti-TNFs)

A

reactivation of TB and HBV, non-melanoma skin CA (other: secondary infection, non-hodgkin lymphoma)

64
Q

What medication is contrainidicated if active infection, hx of CHF, MS/optic neuritis?

A

Anti-TNFs

65
Q

What labs should you run before starting a biologic (Anti-TNF)?

A

Quantiferon TB gold, HepB labs

66
Q

What clinical monitoring is recommended w/ use of Biologics/Anti-TNFs?

A

Regular CBC, CMP, annual derm exam

67
Q

When are other biological agents used?

A

Inadequate or loss of response to conventional therapies

68
Q

What are the indications for use of ABX (Cipro & Flagyl) in pt w/ IBD?

A

Perianal disease (fistula, abscess)

69
Q

What are the SEs of Cipro?

A

Tendinits, photosensitivity, prolongation of QT interval

70
Q

What are the SEs of Flagyl?

A

Peripheral neuropathy, metallic taste, disulfiram rxn (avoid ETOH)

71
Q

What are the red flag sx of IBD?

A

Severe bleeding/significant anemia, severe abd pain/peritoneal signs, unable to tolerate POs, dehydrations, signs of obstruction

72
Q

Severe henomrrhage, perofation, dysplasia/cancer, and medical refractory disease all all indications for what with regard to IBD?

A

Surgery

73
Q

High risk anatomic locations, extensive disease, penetrating/fistula disease, steroid resistance/dependence, sever disease activity, and young age all are risk factors for what?

A

Agressive IBD

74
Q

As a PCP, in pts w/ IBD that are developing diarrhea (change from baseline), what do you always want to check?

A

Stool studies

75
Q

As a PCP, what medication should you avoid in IBD?

A

NSAIDs (can exacerbate disease activity)

76
Q

Immunization, CA screening, osteoporosis/anxiety/smoking cessation screening and routine labs are all apart of what?

A

Health maintenance screen performed by PCP for Pts w/ IBD

77
Q

UC, CD or Both: Pt presents w/ strictures, fistula, abscess?

A

UC

78
Q

UC, CD or Both: Mucosal layer only?

A

UC

79
Q

UC, CD or Both: Toxic megacolon?

A

UC

80
Q

UC, CD or Both: Mouth to anus?

A

CD

81
Q

UC, CD or Both: Estra-intestinal manifestations (arthlagias most common)

A

BOTH

82
Q

UC, CD or Both: Transmural?

A

CD

83
Q

UC, CD or Both: Continuous circumferential involvement?

A

UC

84
Q

UC, CD or Both: NSAIDs may worsen sx/

A

Both

85
Q

UC, CD or Both: colon only?

A

UC

86
Q

UC, CD or Both: Skip lesions?

A

CD

87
Q

UC, CD or Both: Insidious onset, chronic?

A

BOTH

88
Q

Celiac disease is aka what?

A

Gluten enteropathy, celiac sprue

89
Q

Celiac disease is classical a disease of what age group?

A

Infants

90
Q

What is an immune mediate disease triggered by the ingestion of gluten in genetically susceptilble individuals?

A

Celiac disease

91
Q

In celiac disease gluten is considered toxic to the small intestine. This causes what disease progression?

A

Mucosal inflammation → villous atrophy → small bowel malabsorption

92
Q

What disease has the following associations? HLA DQ genes (genetic predisposition), autoimmune diseases, down syndrome?

A

Celiac disease

93
Q

What are the “classic malabsorptive sx” associated w/ celiac disease?

A

Diarrhea, steatorrhea, flatulence/bloating, weight loss

94
Q

What are the “atypical” GI sx associated w/ celiac disease?

A

Abd pain, constipation, dyspepsia

95
Q

What are the slient sx associated w/ celiac disease?

A

Extra-intestinal sx: dermatitis herptiformis rash, ion/B12 deficiency, lethary/fatigue, osteopenia/osteporosis (vit D and Ca defiencies), neuropsychiatric sx, FFT in kids, reproductive disorders

96
Q

Pt presents with skin lesions that are erythematous, papular and forms small pustles & vesicles. What are you concerned about?

A

Dermatitis herpetiformis

97
Q

What is required for serology and biopsy of the small intestine when diagnosis celiac disease?

A

Pt must be on gluten containing diet

98
Q

What AB will be positive in pt w/ celiac disease while on gluten diet?

A

tTG AB (IgA tissue trasglutaminase) Other: EMA Ab titer, DGP (total IgA level must be normal for test to be valid)

99
Q

What is gold standard for dx of celiac disease?

A

EGD w/ duodenal biopsy

100
Q

What will biopsy show in pt w/ celiac disease?

A

villous atrophy, hyperplastic crypts and increased infiltration of lymphoid cells in lamina propria and epithelium

101
Q

What is the tx for celiac disease?

A

Gluten free diet

102
Q

What is the goal of celiac disease tx?

A

alleviate sx, reverse nutrition deficiencies, encourage gluten free diet from naturally occuring foods, caution against hidden sources of gluten (sauces, cosmetics, meds)

103
Q

Folate, Iron, Zinc, Ca, B12, and Vit. D are supplemented as needed for what disease?

A

Celiac disease

104
Q

What does “CELIAC” stand for in the regards to the management of celiac disease?

A 
Consult w/ dietition, 
Educate about the disease, 
Lifelong gluten free diet, 
Identity and tx nutritional defiencies, 
Access to resources/support 
Continuous long term follow up
105
Q

Malabsorption (Fe deficiency anemia, B vitamine deficiency, osteoporosis) and increased risk of non-hodgkin lymphoma and GI malignancies are complications assocaited w/ what disease?

A

Celiac disease

106
Q

How quickly after starting celiac diet will serology levels change in pt w/ celiac disease?

A

3-6 months

1. Clin Med III (29 decks)

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