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GI and Nutrition > 3.1.1+2 Protective Mechanisms, Inflammatory Bowel Dz (IBD), Irritable Bowel Syndrome (IBS) > Flashcards

3.1.1+2 Protective Mechanisms, Inflammatory Bowel Dz (IBD), Irritable Bowel Syndrome (IBS) Flashcards

1
Q

A functional disorder absent of histologic and radiologic findings?

A

IBS, irritable bowel syndrome

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2
Q

What typically cures UC?

A

Removal of colon

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3
Q

What are some surgical indications in UC?

A
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4
Q

What the three biolgic therapies used in the treatment of IBD? What do they target?

A

Infliximab (remicade), certolizumab (cimzia), adalimumab (humira); TNF-alpha

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5
Q

What dis b? What is it often associated with?

A

Pseudomembranous colitis; C. Diff infection

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6
Q

IBD increases the risk of what type of cancer?

A

Colorectal cancer

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7
Q

Fill Dis Out, yo

A

Chron is thicka than a sticka

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8
Q

What are the three dz’s included in IBD?

A

UC, Chron’s Dz, Indeterminate Colitis

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9
Q

What is the role of the defensins released by paneth cells?

A

Help defend against food and water borne pathogens

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10
Q

What is one of the diseases associated with chron dz?

A

Perianal Dz

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11
Q

What three factors must be considered when choosing a medical therapy?

A

Dz distribution, dz severity, prior therapy

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12
Q

What is not present histologically in UC that can be present in Chron?

A

Granulomas

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13
Q

What % of patients experience a clinical response to biologics? % of remission?

A

60% response, 30% remission

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14
Q

Inflammation, fibrosis of biliary tree

(assoicated w/ cholangiocarcinoma)

A

Primary Sclerosing Cholangitis; course of dz is independent of course of UC

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15
Q

What type of dz are biologics particularly useful for?

A

Fistulizing dz in CD

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16
Q

What is the pathology of Chrons? How often are granulomas present?

A

Transmural (entire wall) inflammation with neutrophilic abcesses (crypt abscesses, architectural distortion)

15-50%

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17
Q

How might the gut flora be altered in IBS?

A

Reduced: lactobacilli and bifidobacterium

Increased: clostridium

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18
Q

Describe the positive/negative balance that exists in the GI system.

A

Negative: Bad flora, Inflammation, NF-kB, infection

Positive: Good flora, mucus, barrier function, IgA, defensins, B cells, T cells, NF-kB, Acid, Motility, Cell turnover

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19
Q

What are some of the symptoms associated with the different severities associated with UC?

A
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20
Q

What is the typical onset pattern of UC?

A

Slow and insidious (symptom onset to diagnosis is typically 9 months)

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21
Q

What are the three complications of IBD?

A

toxic megacolon, primary sclerosing cholangitis, colon cancer

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22
Q

What are the four different classes of medical therapies for IBD? Their ideal usage?

A

Aminosalicylates (less severe dz cases), GCs (induce remission, not as good for maintaining), Immunomodulators (maintenance of remission); Biologics (induction/maintanence of remission)

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23
Q

Defined as dilation of the colon with fulminant (severe and sudden onset) colitis

A

Toxic megacolon

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24
Q

Where are certain bacteria located along the GI tract? (vaguely know)

A
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25
Q

UC is a chronic inflammatory dz of what?

26
Q

What is the principal protein of motile comensal and pathogenic bacteria implicated in the pathogenesis of IBD? What does it bind to?

A

Flagellin; TLRs

27
Q

Which is which?

A

Left: Chron

Right: UC

28
Q

Fill it out

29
Q

What will you not see with UC that you see in Chron?

A

Fistulas, perianal dz, and abcesses

30
Q

What are the three clinical subtypes (behaviors) of Chron?

A

Stenosis (50%), inflammation, and fistula

31
Q

This is the endoscopic appearence of what?

32
Q

What are the five sources of information that can lead to diagnosis?

A

Clinical findings, radiologic findings, endoscopic findings, histologic findings, stool evaluation

33
Q

What are the main indications for surgery?

A

Complications (perforation, obstruction, abcess/fistula, cancer)

Often have recurrence at site of surgery

34
Q

What effects can flagellin have on the GI tract?

A
  1. Alter the junctional complexes
  2. Modulate innate and adaptive immunity
35
Q

What are the four sites of extraintestinal manifestions?

A

Eyes, skin, joints, and hepatobiliary

36
Q

What are some of the infectious and non-infectious causes that could be included in the differential diagnosis?

37
Q

What the different treatments for the different types of IBS?

38
Q

What % of dz is found to be indeterminate colitis?

39
Q

What are the three sources of functional disorder in IBS?

40
Q

What are some of the antioxidants that can counteract the oxidants which activate NF-kB?

A

Vitamin E and dihydrolipic acid

41
Q

What are some of the different serological markers in IBD?

42
Q

What are some of the defensive mechanisms of the GI tract?

A

Saliva, mucus, immune system, defensins/lysozyme from Paneth cells, acid production, motility, junctional complexes, detoxification by the liver

43
Q

Identify the the two abnormals.

A

Middle: Chron (full thickness)

Right: UC (mucosa only)

44
Q

Where is the highest incidence of IBD?

A

Europe and US

45
Q

What is the therapeutic pyramid for IBD?

46
Q

What type of cell is this? What is its function?

A

Paneth cell; anti-microbial cells releasing lysozyme, defensins, cryptdins

47
Q

What are some of the effects of increased expression of NF-kB?

A

inflammatory cytokines, leukocyte activation and recruitment, NOS, cell adhension molecule expression, viral activation

48
Q

What is the typical disease course of IBD (80%)?

A

Intermittent flares interposed b/t variable periods of remission

(Dz extent may progress over time)

49
Q

Fill it out

50
Q

What are the two newer agents and their target?

A

Vedolizumab, binds integrin in peyer’s patch, gut specific

Ustekinumab binds IL-12/23, activates certain T cells

51
Q

What is invariably involved in UC? Then it can do what?

A

Rectum; Extends in a proximal and continuous fashion

52
Q

There is convincing evidence to associate what with IBD conditions (Chrons Dz and Ulcerative Colitis).

[However, the specifics remain unclear]

53
Q

What is the key way in which IBD is often diagnosed?

A

Colonoscopy

54
Q

Genome Wide Association Studies have found genes and specific gene loci implicated in IBD which are crucial for intestinal homeostasis:

A

Barrier function, epithelial restitution, microbe defense, innate immunity, ROS, autophagy, adaptive immunity, ER stress, metabolic pathways

55
Q

What two types of management? Goals?

A

Medicine or Surgery

Goals: Induce remission, maintain remission, decrease dz, improve quality of life

56
Q

Where does chron occur along the bowel?

A

It can occur at any point along the bowel, but the most common location is the terminal ileum

57
Q

What are the four stages in the pathogenesis of IBD?

58
Q

Reduced expression of defensins by paneth cells has been identified as a potential cause in which subgroup of IBD?

A

Ileal Chron’s Disease

59
Q

What is commonly used to treat C. Diff infections? Has 70-80% success rate.

A

Metronidazole (Flagyl)

60
Q

What plays a key role in the pathogenesis of IBD and genetic suceptibiilty?

A

Intestinal commensal bacteria

61
Q

What are the two age groups that most commonly suffer from IBD?

A

Teens and 20s

50s-60s

62
Q

What are the four surgical options for UC?

A

Conventional ileostomy or ileal pouch-anal anastomosis

GI and Nutrition (57 decks)

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