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GI > 27. IBD > Flashcards

27. IBD Flashcards

1
Q

What are the two type of IBD?

A

Ulcerative colitis 50%

Crohn disease 50%

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2
Q

What countries have the highest incidence of IBD?

A

US
Canada
Europe

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3
Q

What is UC?

A

Continuous inflammation in the colon only
Limited to the superficial mucosa, LP, submucosa
Increased risk for cancer and has extraintestinal manifestations

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4
Q

What is the clinical presentation of UC?

A 
Diarrhea with blood and mucus
Abdominal pain and tenderness 
Loss of appetite and weight
Fever and fatigue
Urgency for bowel movement
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5
Q

What is the presentation of UC in children?

A

Growth and development failure

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6
Q

What are the endoscopic findings in UC?

A 
Erythema
Loss of fine vascular pattern
Granularity of the mucosa
Friability
Edema
Pseudopolyps
Erosions and ulcers
Spontaneous bleeding
Cecal patch
Backwash ileitis
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7
Q

What is fulminant colitis?

A

Severe UC with:

  • Fever, elevated WBC, and unstabile vitals
  • High risk of preforation
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8
Q

What is Crohn’s disease?

A

Patchy, full thickness inflammation with mouth to anus involvement
Cobblestone appearance
Fistulae, strictures
Extraintestinal manifestations

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9
Q

What area is MC involved in Crohn’s disease?

A

Ileocecal

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10
Q

What is the presentation of Crohn’s in a pediatric patient?

A 
Abdonminal pain **
Diarrhea
Weight loss and anorexia
Vomiting 
Rectal bleeding
Stunted growth
Fevers
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11
Q

What are the three major endoscopic findings that are specific to Crohn’s disease?

A

Aphthous ulcers
Cobblestoning
Discontinuous lesions (skip lesions)

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12
Q

What are 5 findings that favor Crohn’s over UC?

A
  1. Rectal sparing (UC will always affect rectum)
  2. Normal vasculature next to affected tissue
  3. Fistulas or strictures
  4. Isolated involvement of the terminal ileum
  5. Granulomas on biopsy
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13
Q

When is backwash ileus seen?

A

Pancolitis (severe UC)

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14
Q

What are the MC extraintestinal manifestations of IBD?

A 
Acute arthropathy 15-20% **
Erythema nodosum 15% **
Choledocholithiasis 15-30% **
Ocular complications 5-15% **
Sacroilitis 9-11% **
Nephrolithiasis 5-10%
Ankylosing spondylitis 3-5%
Pyroderma gangrenosum 1-2%
PSC 1-2%
Amyloidosis (rare)
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15
Q

What is the main difference of presentation of epischleritis and uveitis, two manifestations of IBD?

A

Episcleritis: white part of the eye is inflamed, but not painful
Uveitis: more painful

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16
Q

What are the goals of management of IBD?

A 
Confirm accurate dx
Induce remission
Maintain remission
Surgery?
Enhance quality of life
Avoid complications
17
Q

What is the best characterized mutation that is associated with Crohns?

A

NOD2

18
Q

What are the 4 potential forms of pathogenesis of IBD?

A
  1. Genetic: NOD2
  2. Mucosal immune responses: Th17 cells
  3. Epithelial defects: in tight junctions
  4. Microbiota
19
Q

What cytokine released from Th1 in IBS is the main target for therapy?

A

TNF

20
Q

Of the penetrating, stricturing, and inflammatory forms of IBD, what do most poeple present with?

A

Inflammatory

can progress to stricturing and penetrating

21
Q

What are the key biologics that are used to treat IBD?

A

Infliximab (anti-TNF)
Certolizumab pegol (anti-TNF)
Adalimumab (anti-TNF)
Natalizumab (anti alpha 4 integrin)

22
Q

What % of patients require maintenence thereapy

A

95%

23
Q

What are the two kinds of microscopic colitis?

A

Collagenous colitis

Lymphocytic colitis

24
Q

What is the presentation of microscopic colitis?

A

Chronic, nonbloody, watery diarrhea without weight loss

Normal radiological and endoscopic findings

25
Q

What happens histologically in collagenous colitis, a type of microscopic colitis?

A

Dense subepithelial collagen layer, increased numbers of intraepithelial lymphocytes, and mixed inflammatory infiltrate within the lamina propria

26
Q

What is found histologically in lymphocytic colitis, a type of microscopic colitis?

A

Subepithelial collagen layer is of normal thickness and the increase in intraepithelial lymphocytes may be greater than in collagenous colitis

27
Q

What diseases is lymphocytic colitis associated with?

A

Celiac

Autoimmune

28
Q

What tx do the microscopic colitises respond to?

A

Budesonide

29
Q

The small intestine is relatively sterile compated to the colon, and is protected by:

A

Gastric acid
ICV
Fast transit

30
Q

What are some things that can lead to small intestinal bacterial overgrowth?

A

Surgery
Antacid
Slow motility

31
Q

Small intestinal bacterial overgrowth is difficult to diagnose–what two tests can be used?

A

Duodenal aspirate

Hydrogen breath test

GI (28 decks)

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