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Gastroenterology > 319 IBD > Flashcards

319 IBD Flashcards

1
Q

Two major types of IBD

A

Ulcerative colitis (UC) and Crohn’s disease (CD)

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2
Q

Peak incidence of IBD

A

second to fourth decade of life

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3
Q

Defined as IBD that occurs in children age less than 6 years

A

very early onset IBD (VEOIBD)

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4
Q

Defined as IBD that occurs in children age less than 2 years

A

Infantile IBD

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5
Q

Commonly affected part by VEOIBD and infantile IBD

A

colon, resistant to standard medication and have a strong family history of IBD

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6
Q

True or false. Infectious gastroenteritis with pathogens such as salmonella, shigella, campylobacter, clostridium increases IBD risk

A

true.

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7
Q

True or false. Protective effect of Vitamin D has been reported on risk of CD

A

true.

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8
Q

major host components that function together as an integrated supraorganism

A

microbiota, Intestinal epithelial cells, and immune cells

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9
Q

Current pathogenesis of IBD

A

inappropriate immune response to the endogenous (autochthonous) commensal microbiota within the intestines, with or without some component of autoimmunity

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10
Q

Genetic risk factors that are shared with IBD

A

rheumatoid arthritis, psoriasis, ankylosing spondylitis, type 1 diabetes mellitus, asthma, and systemic lupus erythematosus

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11
Q

True or false. Endogenous commensal microbiota within the intestines plays a central role in the pathogenesis of IBD

A

true.

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12
Q

True or false. The microbiota is considered as a critical and sustaining component of the human organism

A

true.

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13
Q

3 major CD4 T helper cells that promote inflammation

A

TH1 cells, TH2 and TH17

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14
Q

Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon

A

Ulcerative colitis

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15
Q

associated with backwash ileitis

A

Ulcerative colitis

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16
Q

asssociated with skip lesions

A

Crohns disease

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17
Q

mucosa is erythematous and has a fine granular surface that resemble sandpaper

A

Ulcerative colitis

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18
Q

presence of pseudopolyps as a result of epithelial regeneration

A

both UC and CD

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19
Q

in fulminant disease can develop toxic colitis or megacolon where the bowel wall thins and mucosa is severely ulcerated and leads to perforation

A

ulcerative colitis

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20
Q

True or false. In ulcerative colitis, the disease process is limited to the mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease

A

true.

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21
Q

True or false. Pancreatitis is a rare extraintestinal manifestation of IBD

A

True.

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22
Q

agents effective in inducing and maintaing remission in patietn with UC

A

5 ASA agents

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23
Q

effective treatment for mild to moderate UC is occasionally used in Crohns colitis

A

sulfasalazine

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24
Q

contains azo bond mesalamine; it is effective in the colon

A

balsalazide

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25
Q

enteric coated form of mesalamine with the 5 ASA being released at pH more than 7

A

Delzicol and Asacol HD

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26
Q

once a day formulation of mesalamine designed to release mesalamine in colon

A

Lialda

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27
Q

encapsulated mesalamine granules that delivers mesalamine to the terminal ileum and colon

A

Apriso

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28
Q

once a day formation of mesalamine

A

Lialda and Apriso

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29
Q

another mesalamine formation that uses ethylcellulose coating to allow water absorption into small beads containing the mesalamine

A

Pentasa

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30
Q

started in patient with UC unresponsive to 5- ASA

A

prednisone

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31
Q

how are parenteral glucocorticoids given

A

Hydrocortisone 300 mg/d or methyprednisolone 40-60 mg/d

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32
Q

True or false. Antibiotics have no role in the treatment of active or quiescent UC

A

True.

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33
Q

True or false. Pouchitis however responds to treatment with metronidazole and ciprofloxacin

A

True.

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34
Q

what is effective in active inflammatory, fistulizing and perianal CD and what is the dosage

A

metronidazole at 15-20 mg/kg per day divided in 3 doses

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35
Q

beneficial for inflammatory perianal and fistulizing CD but has been associated with tendinitis and tendon rupture

A

ciprofloxacin

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36
Q

purine analogues used as immunosuppresant

A

azathrioprine and 6 mercaptopurine

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37
Q

side effect of azathiorprine and 6 mercaptopurine

A

pancreatitis

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38
Q

used most often concomitantly with biologic therapy to decrease antibody formation and improve disease response; it inhibits dihydrofolate reductase

A

methotrexate

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39
Q

rare complication of methotrexate

A

hypersensitivity pneumonitis

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40
Q

lipophilic peptide with inihibitory efefcts on both the cellular and humoral immune systems and given to severe UC that is refractory to IV glucocorticoids

A

cyclosporing (CSA)

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41
Q

macrolide antibiotic with immunodulatory properties similar to CSA and effective in adults with extensive involvement of the small bowel

A

tacrolimus

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42
Q

initial therapy for patients with moderate to severe CD and UC

A

biologic therapies such as anti TNF therapies

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43
Q

first biologic therapy approved for moderate to severely active CD and UC; chimerici IgG1 antibody against TNF alpha

A

infliximab

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44
Q

recombinant human monoclonal IgG1 antibody containing only human peptides sequences; binds TNF and neutralizes its function

A

adalimumab

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45
Q

pegylated form of anti TNF fab portion of antibody

A

certolizumab

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46
Q

another fully human IgG1 antibody against anti TNF alpha

A

golimumab

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47
Q

side effect of anti TNF therapies leading to increased risk of infusion reactions and a decreased response to treatment

A

development of antibodies

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48
Q

common practice to prevent antibody formation in anti TNF therapies

A

add an immunomodulator such as azathiorprine, 6 mercaptopurine or MTX

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49
Q

True or false. NHL risk in CD is higher than general population and even higher if treated with azathioprine and 6- MP

A

True.

50
Q

True or false. Patients with IBD have a slighter highest risk for psoriasis and melanoma esp if there are on thiopurine

A

True.

51
Q

most frequently performed operation in patient with CD

A

surgical resection of the diseased segment

52
Q

True or false. It is recommended to evaluate for endoscopic recurrence of CD via colonoscopy 6 months after surgery

A

True

53
Q

true or false. Patient should be in remission for 6 months before conceiving

A

True.

54
Q

antibiotics allowed in pregnancy

A

penicillins and cephalosporins

55
Q

when can metronidazole be given in pregnant women

A

second or third trimester

56
Q

can ciprofloxacin be given to pregnant women

A

no due to cartilage lesion

57
Q

true or false. Metothrexate is contraindicated in pregnancy and nursing

A

True.

58
Q

True or false. Patient with long standing UC are at increased risk for developing colonic epithelial dysplasia and carcinoma

A

True,

59
Q

how often is colonoscopy done in patients with more than 8-10 years of colitis or 12-15 years of protosigmoiditis

A

annual or biennial with multiple biopsies

60
Q

two major histologic features suggests chronicity in UC and help distingquish it from infectious or acute self limited colitis

A

first: crypt architecture of colon is distorted; second: basal plasma cells and multiple basal lymphoid aggregates

61
Q

associated with crypt abscesses

A

ulcerative colitis

62
Q

IBD that can affect any part of the GI tract from the mouth to the anus

A

Crohns disease

63
Q

what IBD spares or involves the rectum

A

UC involves the rectum; CD spares the rectum

64
Q

is segmental with skip areas in midst of diseased intestines

A

Crohns disease

65
Q

Associated with perirectal fistula, fissures and anal stenosis

A

crohns disease

66
Q

True or false. Crohns disease is a transmural process

A

true.

67
Q

associated with aphthous ulcers

A

Crohns disease

68
Q

islands demarcate disease and normal mucosa giving the cobbelstone appearance

A

Crohns disease

69
Q

Associated with projections of thickened mesentery encasing the bowel, also known as creeping fat

A

Crohns disease

70
Q

earliest lesions in crohns disease

A

aphthoid ulcer and focal crypt abscesses which form noncaseating granuloma in all layers of the bowel wall

71
Q

glycoprotein present in activated neutrophils and highly sensitive and specific markers for intestinal inflammation

A

fecal lactoferrin

72
Q

present in neutrophils and monocytes and level correlate well with histologic inflammation, predict relapse and detect pouchitis

A

fecal calprotectin

73
Q

True or false. Leukocytosis may be present in IBD but is a specific indicator of the disease

A

true.

74
Q

when is colectomy indicated in IBD

A

When 6-8 units of blood is needed in 24-48 hours

75
Q

defined as a transverse or right colon diameter of more than 6 cm loss of haustrations in patients with severe attacks of UC

A

toxic megacolon

76
Q

Most dangerous of the local complications

A

perforations

77
Q

True or false. Strictures that prevents passage of the colonoscope is presumed malignant until proven otherwise

A

true.

78
Q

two patterns of disease in Crohns disease

A

first: fibrostenotic pattern obstructing pattern or second: penetrating fistulous pattern

79
Q

common site of inflammation in crohns disease

A

terminal ileum

80
Q

what is the usual presentation of ileocolitis

A

chronic history of right lower quadrant pain and diarrhea

81
Q

if a mass is palpated in the RLQ in crohns diseas, what is it composed of

A

mass is composed of inflammed bowel, induration of mesentery and enlarged abdominal lymph nodes

82
Q

sign on barium studies that result from severely narrowed loop of bowel

A

lumen resembles a frayed cotton string thus called string sign

83
Q

presents as dysuria or recurrent bladder infections or less commonly as pneumaturia or fecaluria

A

enterovesical fistulas

84
Q

refers to extensive inflammatory disease assocaited with loss of digestive and absorptive surface resulting in malabsorption and steatorrhea

A

jeujunoilietis

85
Q

what causes diarrhea in jejunoilietis

A

bacterial overgrowth, bile acid malabsorption, intestinal inflammation

86
Q

True or false. Toxic megacolon is rare Crohns disease

A

true.

87
Q

more commonly involved part of the duodenum in crohns disease

A

second portion of the duodenum is more commonly involved in Crohns disease

88
Q

endoscopic features of CD

A

rectal sparing, aphthous ulcers, fistulas and skip lesions

89
Q

what type of strictures respond to endoscopic dilatation

A

strictures less than 4 cm in length and those at anastomotic sites

90
Q

diagnostic imaging in CD which offers more yield than CT or MRI

A

wireless capsule endoscopy

91
Q

danger of WCE in CD

A

stricture could retain the capsule; option is to have a patency capsule which is made of barium and dissolves 30 hr after ingestion; a x-ray is taken 30 hrs after ingestion to see if capsule is still still which indicate stricture

92
Q

earliest macroscopic findings of colonic CD

A

aphthous ulcer

93
Q

in CD, where is the perforation commonly occur? Second site

A

usually in the ileum but occasionally in the jejunum

94
Q

usually in the ileum but occasionally in the jejunum

A

increased titers of anti saccharomyces cerevisiae antibodies (ASCAs)

95
Q

serology test associated with UC

A

increased levels of pANCA

96
Q

makes up 15% of cases of IBD wherein it is impossible to distinguish between UC and CD

A

indeterminate colitis

97
Q

can mimic the endscopic appearance of severe UC

A

campylobacter colitis

98
Q

parasitic infection that can mimic IBD

A

hookworm (necator americanus), whipworm (trichuris trichiuria), strongyloides stercoralis

99
Q

true or false. Diverticulitis can be confused with CD clinically and radiographically

A

true.

100
Q

ulceration observed as large as 5 cm in diameter in the anterior or anterolateral 3-15 cm from the anal verge which may present with abdominal pain, tenemus and diarrhea; can be mistaken as IBD

A

solitary rectal ulcer syndrome

101
Q

where is the solitary rectal ulcer syndrome often found

A

anterior or anterolateral 3-15 cm from the anal verge

102
Q

two common drugs used in the hospital that mimic IBD

A

ipilimumab and mycophenolate mofetil

103
Q

inflammatory process that arises in segments of the large intestines that are excluded from the fecal stream; occurs in patient with ileostomy or colostomy

A

diversion colitis

104
Q

common ocular manifestations of IBD

A

conjunctivitis, anterior uveitis/iritis, episcleritis

105
Q

are hot, red, tender nodules measuring 1-5 cm in diameter and are found on the anterior surface of the lower legs, ankles, calves, thighs, and arms; occurs in 15% of CD

A

erythema nodosum (EN)

106
Q

dermatologic manifestion seen in 12% of CD, begins as pustule and then ulcerate with violaceous edges surrounded by a margin of erythema

A

pyoderma gangrenosum

107
Q

frequent genitourinary complications in IBD

A

calculi, ureteral obstruction, and ileal bladder fistula

108
Q

True or false. All of anti TNF agents are associated with an increased risk of infections particulary reactivation of latent PTB and opportunistic fungal infection

A

True.

109
Q

expressed on the cell surface of leukocytes and serve as mediators of leukocyte adhesion to vascular endothelium

A

integrins

110
Q

recombinant humanized IgG4 antibodies against a4 integrin that has been shown to be effective induction and maintenance of patients with CD

A

natalizumab

111
Q

reason natalizumab is no longer widely used

A

risk for progressive multifocal leukoencephalopathy (PML)

112
Q

most important risk factor for the development of PML

A

exposure to John Cunningham JC polymavirus

113
Q

another leukocyte trafficking inhibitor, a monioclonal antibody directed against against a4B7 integrin specifically and has the ability to convey gut selective immunosuppresion

A

vedolizumab

114
Q

fully human IgG1 monoclonal antibody that blocks the biologic activity of IL-12 and IL-23 through their common p40 subunit

A

ustekinumab

115
Q

oral inhibitor of Janus kinases 1,3

A

tofacitinib

116
Q

Oral agonist of the sphingosine-1-phosphate receptor subtypes 1 and 5 that causes peripheral lymphocyte sequestration

A

ozanimod

117
Q

operation of choice in ulcerative colitis

A

IPAA

118
Q

most frequent complication IPAA

A

pouchitis

119
Q

drug that targets cytotoxic T lymphocyte antigen 4 (CTLA-4) and reverses T cell inhibition is used to treat metastatic melanoma

A

ipilimumab

120
Q

True or false. Patient with IBD and PSC are at increased risk of colon cancer and should be surveyed yearly by colonoscopy

A

True.

Gastroenterology (13 decks)

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