319 IBD Flashcards
Two major types of IBD
Ulcerative colitis (UC) and Crohn’s disease (CD)
Peak incidence of IBD
second to fourth decade of life
Defined as IBD that occurs in children age less than 6 years
very early onset IBD (VEOIBD)
Defined as IBD that occurs in children age less than 2 years
Infantile IBD
Commonly affected part by VEOIBD and infantile IBD
colon, resistant to standard medication and have a strong family history of IBD
True or false. Infectious gastroenteritis with pathogens such as salmonella, shigella, campylobacter, clostridium increases IBD risk
true.
True or false. Protective effect of Vitamin D has been reported on risk of CD
true.
major host components that function together as an integrated supraorganism
microbiota, Intestinal epithelial cells, and immune cells
Current pathogenesis of IBD
inappropriate immune response to the endogenous (autochthonous) commensal microbiota within the intestines, with or without some component of autoimmunity
Genetic risk factors that are shared with IBD
rheumatoid arthritis, psoriasis, ankylosing spondylitis, type 1 diabetes mellitus, asthma, and systemic lupus erythematosus
True or false. Endogenous commensal microbiota within the intestines plays a central role in the pathogenesis of IBD
true.
True or false. The microbiota is considered as a critical and sustaining component of the human organism
true.
3 major CD4 T helper cells that promote inflammation
TH1 cells, TH2 and TH17
Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon
Ulcerative colitis
associated with backwash ileitis
Ulcerative colitis
asssociated with skip lesions
Crohns disease
mucosa is erythematous and has a fine granular surface that resemble sandpaper
Ulcerative colitis
presence of pseudopolyps as a result of epithelial regeneration
both UC and CD
in fulminant disease can develop toxic colitis or megacolon where the bowel wall thins and mucosa is severely ulcerated and leads to perforation
ulcerative colitis
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
true.
True or false. Pancreatitis is a rare extraintestinal manifestation of IBD
True.
agents effective in inducing and maintaing remission in patietn with UC
5 ASA agents
effective treatment for mild to moderate UC is occasionally used in Crohns colitis
sulfasalazine
contains azo bond mesalamine; it is effective in the colon
balsalazide
enteric coated form of mesalamine with the 5 ASA being released at pH more than 7
Delzicol and Asacol HD
once a day formulation of mesalamine designed to release mesalamine in colon
Lialda
encapsulated mesalamine granules that delivers mesalamine to the terminal ileum and colon
Apriso
once a day formation of mesalamine
Lialda and Apriso
another mesalamine formation that uses ethylcellulose coating to allow water absorption into small beads containing the mesalamine
Pentasa
started in patient with UC unresponsive to 5- ASA
prednisone
how are parenteral glucocorticoids given
Hydrocortisone 300 mg/d or methyprednisolone 40-60 mg/d
True or false. Antibiotics have no role in the treatment of active or quiescent UC
True.
True or false. Pouchitis however responds to treatment with metronidazole and ciprofloxacin
True.
what is effective in active inflammatory, fistulizing and perianal CD and what is the dosage
metronidazole at 15-20 mg/kg per day divided in 3 doses
beneficial for inflammatory perianal and fistulizing CD but has been associated with tendinitis and tendon rupture
ciprofloxacin
purine analogues used as immunosuppresant
azathrioprine and 6 mercaptopurine
side effect of azathiorprine and 6 mercaptopurine
pancreatitis
used most often concomitantly with biologic therapy to decrease antibody formation and improve disease response; it inhibits dihydrofolate reductase
methotrexate
rare complication of methotrexate
hypersensitivity pneumonitis
lipophilic peptide with inihibitory efefcts on both the cellular and humoral immune systems and given to severe UC that is refractory to IV glucocorticoids
cyclosporing (CSA)
macrolide antibiotic with immunodulatory properties similar to CSA and effective in adults with extensive involvement of the small bowel
tacrolimus
initial therapy for patients with moderate to severe CD and UC
biologic therapies such as anti TNF therapies
first biologic therapy approved for moderate to severely active CD and UC; chimerici IgG1 antibody against TNF alpha
infliximab
recombinant human monoclonal IgG1 antibody containing only human peptides sequences; binds TNF and neutralizes its function
adalimumab
pegylated form of anti TNF fab portion of antibody
certolizumab
another fully human IgG1 antibody against anti TNF alpha
golimumab
side effect of anti TNF therapies leading to increased risk of infusion reactions and a decreased response to treatment
development of antibodies
common practice to prevent antibody formation in anti TNF therapies
add an immunomodulator such as azathiorprine, 6 mercaptopurine or MTX
True or false. NHL risk in CD is higher than general population and even higher if treated with azathioprine and 6- MP
True.
True or false. Patients with IBD have a slighter highest risk for psoriasis and melanoma esp if there are on thiopurine
True.
most frequently performed operation in patient with CD
surgical resection of the diseased segment
True or false. It is recommended to evaluate for endoscopic recurrence of CD via colonoscopy 6 months after surgery
True
true or false. Patient should be in remission for 6 months before conceiving
True.
antibiotics allowed in pregnancy
penicillins and cephalosporins
when can metronidazole be given in pregnant women
second or third trimester
can ciprofloxacin be given to pregnant women
no due to cartilage lesion
true or false. Metothrexate is contraindicated in pregnancy and nursing
True.
True or false. Patient with long standing UC are at increased risk for developing colonic epithelial dysplasia and carcinoma
True,
how often is colonoscopy done in patients with more than 8-10 years of colitis or 12-15 years of protosigmoiditis
annual or biennial with multiple biopsies
two major histologic features suggests chronicity in UC and help distingquish it from infectious or acute self limited colitis
first: crypt architecture of colon is distorted; second: basal plasma cells and multiple basal lymphoid aggregates
associated with crypt abscesses
ulcerative colitis
IBD that can affect any part of the GI tract from the mouth to the anus
Crohns disease
what IBD spares or involves the rectum
UC involves the rectum; CD spares the rectum
is segmental with skip areas in midst of diseased intestines
Crohns disease
Associated with perirectal fistula, fissures and anal stenosis
crohns disease
True or false. Crohns disease is a transmural process
true.
associated with aphthous ulcers
Crohns disease
islands demarcate disease and normal mucosa giving the cobbelstone appearance
Crohns disease
Associated with projections of thickened mesentery encasing the bowel, also known as creeping fat
Crohns disease
earliest lesions in crohns disease
aphthoid ulcer and focal crypt abscesses which form noncaseating granuloma in all layers of the bowel wall
glycoprotein present in activated neutrophils and highly sensitive and specific markers for intestinal inflammation
fecal lactoferrin
present in neutrophils and monocytes and level correlate well with histologic inflammation, predict relapse and detect pouchitis
fecal calprotectin
True or false. Leukocytosis may be present in IBD but is a specific indicator of the disease
true.
when is colectomy indicated in IBD
When 6-8 units of blood is needed in 24-48 hours
defined as a transverse or right colon diameter of more than 6 cm loss of haustrations in patients with severe attacks of UC
toxic megacolon
Most dangerous of the local complications
perforations
True or false. Strictures that prevents passage of the colonoscope is presumed malignant until proven otherwise
true.
two patterns of disease in Crohns disease
first: fibrostenotic pattern obstructing pattern or second: penetrating fistulous pattern
common site of inflammation in crohns disease
terminal ileum
what is the usual presentation of ileocolitis
chronic history of right lower quadrant pain and diarrhea
if a mass is palpated in the RLQ in crohns diseas, what is it composed of
mass is composed of inflammed bowel, induration of mesentery and enlarged abdominal lymph nodes
sign on barium studies that result from severely narrowed loop of bowel
lumen resembles a frayed cotton string thus called string sign
presents as dysuria or recurrent bladder infections or less commonly as pneumaturia or fecaluria
enterovesical fistulas
refers to extensive inflammatory disease assocaited with loss of digestive and absorptive surface resulting in malabsorption and steatorrhea
jeujunoilietis
what causes diarrhea in jejunoilietis
bacterial overgrowth, bile acid malabsorption, intestinal inflammation
True or false. Toxic megacolon is rare Crohns disease
true.
more commonly involved part of the duodenum in crohns disease
second portion of the duodenum is more commonly involved in Crohns disease
endoscopic features of CD
rectal sparing, aphthous ulcers, fistulas and skip lesions
what type of strictures respond to endoscopic dilatation
strictures less than 4 cm in length and those at anastomotic sites
diagnostic imaging in CD which offers more yield than CT or MRI
wireless capsule endoscopy
danger of WCE in CD
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
earliest macroscopic findings of colonic CD
aphthous ulcer
in CD, where is the perforation commonly occur? Second site
usually in the ileum but occasionally in the jejunum
usually in the ileum but occasionally in the jejunum
increased titers of anti saccharomyces cerevisiae antibodies (ASCAs)
serology test associated with UC
increased levels of pANCA
makes up 15% of cases of IBD wherein it is impossible to distinguish between UC and CD
indeterminate colitis
can mimic the endscopic appearance of severe UC
campylobacter colitis
parasitic infection that can mimic IBD
hookworm (necator americanus), whipworm (trichuris trichiuria), strongyloides stercoralis
true or false. Diverticulitis can be confused with CD clinically and radiographically
true.
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
solitary rectal ulcer syndrome
where is the solitary rectal ulcer syndrome often found
anterior or anterolateral 3-15 cm from the anal verge
two common drugs used in the hospital that mimic IBD
ipilimumab and mycophenolate mofetil
inflammatory process that arises in segments of the large intestines that are excluded from the fecal stream; occurs in patient with ileostomy or colostomy
diversion colitis
common ocular manifestations of IBD
conjunctivitis, anterior uveitis/iritis, episcleritis
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
erythema nodosum (EN)
dermatologic manifestion seen in 12% of CD, begins as pustule and then ulcerate with violaceous edges surrounded by a margin of erythema
pyoderma gangrenosum
frequent genitourinary complications in IBD
calculi, ureteral obstruction, and ileal bladder fistula
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
True.
expressed on the cell surface of leukocytes and serve as mediators of leukocyte adhesion to vascular endothelium
integrins
recombinant humanized IgG4 antibodies against a4 integrin that has been shown to be effective induction and maintenance of patients with CD
natalizumab
reason natalizumab is no longer widely used
risk for progressive multifocal leukoencephalopathy (PML)
most important risk factor for the development of PML
exposure to John Cunningham JC polymavirus
another leukocyte trafficking inhibitor, a monioclonal antibody directed against against a4B7 integrin specifically and has the ability to convey gut selective immunosuppresion
vedolizumab
fully human IgG1 monoclonal antibody that blocks the biologic activity of IL-12 and IL-23 through their common p40 subunit
ustekinumab
oral inhibitor of Janus kinases 1,3
tofacitinib
Oral agonist of the sphingosine-1-phosphate receptor subtypes 1 and 5 that causes peripheral lymphocyte sequestration
ozanimod
operation of choice in ulcerative colitis
IPAA
most frequent complication IPAA
pouchitis
drug that targets cytotoxic T lymphocyte antigen 4 (CTLA-4) and reverses T cell inhibition is used to treat metastatic melanoma
ipilimumab
True or false. Patient with IBD and PSC are at increased risk of colon cancer and should be surveyed yearly by colonoscopy
True.
