3 - IBD Flashcards
A patient presents with diarrhea and severe nutritional deficiencies. Which of the following types of CD are you concerned for?
a. ileocolitis
b. jejunoileitis
c. colonic
d. gastrouodenal
b. jejunoileitis
What are the 4 hallmark signs/symptoms of CD?
- non-continuous skip lesions
- transmural inflammation
- not confined to colon
- fistulas, strictures, abscesses
A patient presents with abdominal pain and vomiting. You notice a lesion on the roof of their mouth and they also note they have had trouble swallowing recently. Which of the following types of CD are you concerned for?
a. ileocolitis
b. jejunoileitis
c. colonic
d. gastroesophageal
d. gastroesophageal
What is the relationship between smoking and Crohn vs. UC?
- Crohn = smoking worsens course
- UC = smoking is protective
A patient with a hx of IBD presents with painful skin eruptions with surrounding erythema. He also has a fever and labs reveal leukocytosis. What are you concerned for?
a. Sweet syndrome
b. Erythema nodosum
c. Pyoderma Gangrenosum
d. Ankylosing Spondylitis
a. Sweet syndrome
T/F: There is no role for antibiotics in treatment of UC
True
Sclerosing cholangitis is associated with what form of IBD?
- Ulcerative Colitis
How can you distinguish colonic CD from ulcerative colitis?
- there is significantly less bleeding in colonic CD compared to ulcerative colitis
What is the first step in the treatment of toxic megacolon?
- NG tube for decompression (or rectal tube)
When are corticosteroids indicated for IBD?
- acute flare ups of disease
What are the 2 patterns of Crohn’s disease?
- Fibrostenotic pattern
- Fistulous pattern
Anti-Diarrheal meds have been linked to what live threatening abdominal condition?
- Toxic megacolon
If a patient with UC is suffering from major bleeding what is the criteria that needs to be met for a colectomy?
> 6 units of PRBC in 24 hours
What is toxic megacolon?
- marked dilatation of the colon ( >6cm)
_____ of CD flare involve the small bowel. _____ involve the terminal ileum.
75% of CD flare involve the small bowel. 90% involve the terminal ileum.
What is the serological marker for CD?
- ASCA+
What is pancolitis?
- ulcerative colitis that involves any lesions beyond the splenic flexure
When are antibiotics indicated for IBD?
- only when necessary = abscess, fistula or masses
What is the most common extra-intestinal manifestation of IBD (often in Crohn)?
- Ankylosing Spondylitis or sacroiliitis
What is the difference between Crohn’s and UC as it relates to their histological features?
- Crohn’s = transmural abscesses
- UC = limited to superficial mucosa
What medication class is used in the active treatment or to maintain remission of IBD?
- Anti-inflammatories (e.g. Sulfasalazine)
A patient with toxic megacolon is at risk of perforation if the colon is dilated how much?
> 10 cm
What fraction of UC patients will have relapse within 10 years of diagnosis?
2/3
A patient presents with crampy abdominal pain, most notable in the RLQ that is relieved by defecation. Which of the following type of CD are you concerned for?
a. ileocolitis
b. jejunoileitis
c. colonic
d. gastrouodenal
a. ileocolitis
What vitamins are recommended in patients with extensive small bowel disease?
- Fat soluble vitamins (ADEK)
What drug class if given during the first year of life increases the incidence of IBD by 2.9x?
- antibiotics
What is the difference between Crohn’s and UC as it relates to the pattern of involvement seen in a colonoscopy?
- Crohn’s = skip lesions
- UC = continuous ulcerations
A patient with a hx of vascular problems presents with symptoms consistent with IBD. What is a can’t miss diagnosis that must be added to your differential?
- Ischemic colitis
If you see hematochezia you should be concerned for what type of IBD?
- UC
What surgical procedure is usually curative for UC?
- total colectomy with ileal pouch
Inflammation in the lamina propria, crypts, and crypt abscesses are consistent with what type of IBD?
- UC
What is the 3 step approach to treating IBD?
- aminosalicylates (e.g. Sulfasalazine) [+/- Antibiotics]
- corticosteroids
- immune modifiers
In a patient with UC you need to make sure to obtain stool cultures to test for THIS condition.
- C. diff
A patient with a hx of IBD presents with raised tender lesions on the anterior tibia. What are you concerned for?
a. Sweet syndrome
b. Erythema nodosum
c. Pyoderma Gangrenosum
d. Ankylosing Spondylitis
b. Erythema nodosum
What is the serology marker for Ulcerative Colitis?
- p-ANCA (70% in UC)
Which of the Crohn’s disease pattern causes edema and spasms in the early stages that progresses to stenosis as a result of fibrosis in the later stages which increases the risk of SBO?
- Fibrostenotic pattern
What is the pattern for the age of diagnosis for IBD?
- bimodal
second/fourth to seventh/ninth decade
If a patient is given Sulfasalazine they must also be on this vitamin.
- folic acid
What are the 2 primary indications for surgery in IBD?
- patient with severe complications
- dysplasia/cancer
What treatment is mainly used for small bowel Crohn’s?
- TPN/PPN
What is backwash ileitis?
- colonic UC with terminal ileum inflammation
Which of the Crohn’s disease pattern is seen in severe, chronic disease and is at a higher risk of micro-perforation?
- Fistulous pattern
What is toxic colitis?
- colitis and ulceration without dilatation
When are immune modifiers indicated for IBD?
- used when remission is difficult to maintain with aminosalicylates
