3 MTB Step 3 - Inflammatory Bowel Disease (IBD) Flashcards
Cards Complete:
GENERAL
What are the (2) Disorders that are in the category of Inflammatory Bowel Disease (IBD)?
Crohn Disease (CD)
and
Ulcerative Colitis (UC)
PRESENTATION
What are (5) common Presenting signs/symptoms in Inflammatory Bowel Disease (CD & UC)?
- Fever
- Abdominal Pain
- Diarrhea
- Blood in the Stool
- Weight Loss
PRESENTATION
What are the (2) Most Common presenting signs/symptoms in Ulcerative Colitis (UC) specifically?
Abdominal Pain
and
Bloody Diarrhea
PRESENTATION
What are (4) Extraintestinal Manifestations of Inflammatory Bowel Disease (IBD)?
- Joint Pain
- Eye findings (Iritis, Uveitis)
- Skin findings (Pyoderma Gangrenosum, Erythema Nodosum)
- Sclerosing Cholangitis
PRESENTATION
What are (11) Clinical Features more common to Crohn Disease (CD)?
- Calcium Oxalate kidney stones
- Cholesterol Gallstones
- Fistulae
- Hypocalcemia (from fat malabsorption)
- Masses
- Obstruction
- Perianal Disease
- Skip Lesions
- TransMURAL Granulomas
- Upper & Lower GI involvement
- Vitamin B12 Malabsorption from Terminal Ileum involvement
ASSOCIATED DISORDERS
- What Disorder can both Ulcerative Colitis (UC) and Crohn Disease (CD) that involves the Colon lead to?
- How do you Screen for this disorder?
- Colon Cancer
- Screening Colonoscopy every 1 - 2 years AFTER 8 - 10 years of Colonic involvement.
DIAGNOSIS
- Which (2) Diagnostic Tests are the Best INITIAL Tests for Inflammatory Bowel Disease (IBD)?
- When the diagnosis is not clear from the best initial tests, what test should be performed next?
- Endoscopy and Barium Studies
- Blood Tests: Antisaccharomyces Cerevisiae (ASCA) and Antineutrophil Cytoplasmic Antibody (ANCA)
DIAGNOSIS
- What are the (2) Blood Test findings in a patient with Crohn Disease (CD)?
- What are the (2) Blood Test findings in a patient with Ulcerative Colitis (UC)?
-
Crohn Disease (CD):
- ASCA +
- ANCA -
-
Ulcerative Colitis (UC):
- ASCA -
- ANCA +
TREATMENT
What is the Best INITIAL Therapy for both Crohn Disease (CD) or Ulcerative Colitis (UC)?
Mesalamine
TREATMENT
What (3) Adverse Effects are the reason why the drug Sulfasalazine is NOT the best initial therapy for either Crohn Disease (CD) or Ulcerative Colitis (UC)?
- Hemolytic Anemia
- Interstitial Nephritis
- Rash
TREATMENT
What Drug Therapy can be used to control Acute Exacerbations of Inflammatory Bowel Disease (IBD)?
Budesonide
(a steroid)
- Budesonide is a Glucocorticoid that can be used to control acute exacerbations of IBD.*
- Has limited systemic adverse effects.*
TREATMENT
When would Azathioprine and 6-Mercaptopurine be used to treat Inflammatory Bowel Disease (IBD)?
SEVERE Disease
+
Recurrent Symptoms when Steroids (ie, Budesonide) are stopped
Azathioprine & 6-MP are used to wean a patient off of steroids.
TREATMENT
Which Class of Medications are the Most Useful in controlling Crohn Disease (CD) associated with Fistula formation?
TNF Inhibitors
(ie, Infliximab)
REMEMBER: Screen for TB before treating with TNF Inhibitors
- TNF is what maintains a granuloma in place
- Plant a PPD. If positive, give Isoniazid prior to Infliximab use
- TNF Inhibitors can reactivate TB by releasing dormant TB from granulomas
- You DON’T have to wait 9 months to start the TNF Inhibitor drug though
TREATMENT
When would you use the antibiotics Metronidazole and Ciprofloxacin in a patient with Crohn Disease (CD)?
PERIANAL Involvement
TREATMENT
When is Surgery used for the treatment of Inflammatory Bowel Disease (IBD)?
- Surgery is CURATIVE in Ulcerative Colitis (UC) by removing the colon.
- Crohn Disease (CD) will recur at the site of the surgery.
