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1. Internal Medicine I > 5. Inflammatory bowel diseases > Flashcards

5. Inflammatory bowel diseases Flashcards

1
Q

What is Inflammatory Bowel Disease?

A

It is a chronic inflammatory condition of the gastrointestinal tract.

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2
Q

What is the age range for diagnosis of Inflammatory Bowel Disease?

A

20-40 years old

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3
Q

What are the two main types of Inflammatory Bowel Disease?

A

Crohn’s disease and Ulcerative colitis.

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4
Q

What is the difference between Crohn’s disease and Ulcerative colitis anatomically?

A
  • Crohn’s disease can affect any part of the gastrointestinal tract, while Ulcerative colitis only affects the colon and rectum.
  • Crohn’s will have skip lesions, whereas UC is continuous inflammation
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5
Q

What are some symptoms of Crohn’s disease at diagnosis?

A
  • Abdominal pain and cramping,
  • weight loss / reduced appetite
  • bleeding,
  • abscess
  • skin problems, mouth sores
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6
Q

What are some symptoms of Ulcerative colitis at diagnosis?

A
  • Bloody diarrhea with or without mucus
  • abdominal pain
  • tenesmus / urgency
  • weight loss, loss of appetite
  • incontinence
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7
Q

What are some extraintestinal symptoms of Inflammatory Bowel Disease?

A
  • Bechterew’s disease / ankylosing spondylitis,
  • erythema nodosum,
  • gangrene
  • episceritis, anterior uveitis
  • primary sclerosing choloangitis
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8
Q

What are some perianal alterations found in IBD?

A
  • INternal / external hemorrhoids
  • Skin tag
  • Anal fissure
  • Perianal fistulas
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9
Q

What is IBD-U?

A

IBD-U is a type of IBD that cannot be classified as either Crohn’s disease or ulcerative colitis.

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10
Q

What is the Montreal classification for Crohn’s disease?

A

The Montreal classification for Crohn’s disease categorizes it into stricturing (B2), inflammatory (B1), and penetrating (B3) types based on the behavior of the disease (+ also has age, location…)

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11
Q

What are the treatmen of mild Crohn’s disease?

A
  • Per os prednisolone, tapered down progressively
  • Diet in children
  • Plan maintenance therapy
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12
Q

What is the treatment of severe Crohn’s disease?

A
  1. IV rehydration / electrolyte replacement
  2. IV steroids (hydrocortisone, methylprednisolone)
  3. Thromboembolism prophylaxis
  4. Stool MC/CDT to make sure there’s no infection
  5. Monitor, consider blood transfusion and nutrition therapy
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13
Q

What is the definition of steroid-resistant Crohn’s disease?

A

Steroid-resistant Crohn’s disease is defined as a lack of response to high-dose systemic corticosteroids (40-60 mg/day prednisolone equivalent) within 14 days.

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14
Q

What is the definition of steroid-dependent Crohn’s disease?

A

Steroid-dependent Crohn’s disease is defined as clinical remission or response to systemic corticosteroids, but relapse within a short time (3-6 months) after tapering.

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15
Q

What are the therapies used in Crohn’s disease? (other than steroids)

A
  • Azathioprine : if refractory to steroids / relapse
  • Biologics : anti TNF alpha, anti integrin, anti IL12/23
  • Surgery : if drug failure or obstruction
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16
Q

What are the most important adverse events associated with azathioprine?

A

The most important adverse events associated with azathioprine are pancreatitis (no need to screen) and myelosuppression (need to screen).

17
Q

What is the surgical treatment for stricturing Crohn’s disease (B2)?

A
  • Heinecke-Mikulicz
  • Finney,
  • isoperistaltic (side-to-side) anastomoses.
18
Q

What is the best medication for perianal Crohn’s disease with perianal lesions?

A

Surgery + anti-TNF drugs.

19
Q

What is a potential treatment option for perianal Crohn’s disease involving stem cells?

A

Mesenchymal stem cell transplantation.

20
Q

What is the Truelove-Witts index used for?

A

It is used to assess the severity of ulcerative colitis.

21
Q

What are the emergency surgical indications for ulcerative colitis?

A

Toxic megacolon, perforation, and bleeding.

22
Q

What are the three surgical options for ulcerative colitis?

A
  • Ileo-anal pouch anastomosis,
  • terminal ileostomy,
  • ileo-rectal anastomosis (in special cases).
23
Q

What is the therapy for mild UC?

A
  • 5-ASA (mesalazine) either PR or PO
  • Topical steroid foams (PR)
  • Prednisolone
24
Q

What is the therapy for moderate UC?

A
  • Oral prednisolone : induce remission
  • Then taper down and use 5-ASA
25
Q

What is the therapy for severe UC?

A
  • IV rehydration / electrolyte replacement
  • IV steroids
  • Thromboembolic prophylaxis
  • Monitor daily : prednisolone PO if it’s getting better, urgent colectomy if it’s getting worse
  • Biological therapy : anti TNF alpha
  • Surgery
  • 5-ASA

1. Internal Medicine I (20 decks)

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