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Gastroenterology > 9 - IBD > Flashcards

9 - IBD Flashcards

1
Q

independent colitis

A

نمیشه افتراق داد uc/cd

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2
Q

2 پیک سنی بیماری ibd

A

15-30

60-80

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3
Q

3 بیماری که باعث افزایش احتمال ibd

A

هایپرگاماگلوبولینمیا
کمبود iga
انژیوادم ارثی

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4
Q

عوامل موثر بر تحمل غذایی ؟

A

سلول های t
cd4+
il10 , TNF-alfa

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5
Q

سه سایتوکاین بگو که در ibd افزایش

A

il15
il23
il17

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6
Q

عوامل مهم در شعله ور شدن بیماری /.

A 
پاتوژن های خرجی مثل کمپیلو شیگلا سالمونلا ای کلای
سیکل خواب نا منظم 
استرس های روحی 
IBS
گاستروانتریت حاد
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7
Q

درمان IBD

A

5ASA
Asacol
mesalazine

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8
Q

Ulcerative colitis (UC)

A

type of inflammatory bowel disease that disrupts the mucosal lining of the rectum and colon, resulting in recurrent episodes of abdominal pain and bloody diarrhea.

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9
Q

Smoking is a protective factor.

A

Ulcerative colitis (UC)

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10
Q

patients with ulcerative colitis classically present with symptoms of:

A 
Diarrhea
Abdominal cramping
Rectal bleeding
Rectal mucus discharge
Occasional tenesmus (feeling of incomplete evacuation of stools, despite an empty colon)
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11
Q

Various extraintestinal symptoms have also been associated with ulcerative colitis, such as:

A 
Uveitis (inflammation of the middle layer of eye)
Pyoderma gangrenosum (necrotic ulcerations of legs)
Ankylosing spondylitis (chronic inflammation of the spine)
Primary sclerosing cholangitis (sclerosis of both intrahepatic and extrahepatic bile ducts)
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12
Q

The diagnostic modality of choice for ulcerative colitis is

A

colonoscopy with mucosal biopsy.

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13
Q

Colonoscopy will typically show in UC

A

riable erythematous mucosa, with or without ulcerations, and pseudopolyps, that extends continuously from the rectum to part of or the entire colon.

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14
Q

Biopsy typically reveals in UC

A

inflammation limited to the mucosa, submucosa, and crypt abscesses. The inflammation is not transmural.

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15
Q

Laboratory studies will typically reveal in UC

A

microcytic anemia secondary to iron deficiency, and elevated inflammatory markers (erythrocyte sedimentation rate (ESR) and elevated C-reactive protein).

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16
Q

plain upright x-rays can help diagnose in UC

A

toxic megacolon or colonic perforation

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17
Q

Double-contrast barium enema can be used if ? in UC

and what we see ?

A 
ulcerative colitis is suspected but should be avoided during an acute attack due to the risk of perforation. Characteristic findings on barium enema are as follows:
Microulcerations
Pseudopolyps
Narrowing of luminal wall
Loss of haustra ("lead pipe" appearance)
18
Q

Complications of ulcerative colitis include: in UC

A

Increased risk of colorectal cancer. The risk begins 8-10 years after the initial diagnosis of pancolitis, and 12-15 years after the onset of left-sided colitis. At this time point, colonoscopies every 1-2 years with biopsies for dysplasia are recommended.
Severe bleeding
Strictures
Colonic perforation
Toxic megacolon (colonic diameter ≥6 cm or cecum diameter >9 cm plus the presence of systemic toxicity)

19
Q

Surgery is reserved for patients who: in UC

A

Fail medical treatment
Perforate
Contract colon cancer
Have toxic megacolon

20
Q

Crohn’s Disease (CD)

A

is an idiopathic inflammatory disorder that can affect any portion of the gastrointestinal (GI) tract, resulting in relapsing and remitting episodes of abdominal pain and diarrhea.

21
Q

Patients with CD typically present with

A

“crampy” abdominal pain, diarrhea, fatigue, weight loss, and growth failure.

22
Q

Specific to children,…….. is a particularly important presenting feature of Crohn’s disease

A

, growth failure

23
Q

CD extraintestinal manifestations

A

Ankylosing spondylitis (arthritis of spine)
Uveitis
Pyoderma gangrenosum
Erythema nodosum
Calcium oxalate kidney stones due to increased absorption of oxalate
Gallstones with terminal ileum involvement due to decreased absorption of bile acids

24
Q

The best initial diagnostic tool used in CD

A

endoscopy with mucosal biopsy of the small intestine and colon, which will reveal

skipped areas of inflammation,
cobblestoning of the mucosa,
strictures
pseudopolyps.

Biopsy will also reveal:
transmural inflammation
granulomas,
which are not seen with ulcerative colitis.

25
Q

The major complications seen with CD

A

intestinal perforation,
strictures (narrowing of lumen that leads to bowel obstruction),
fistulas,
sinus tracts, and the
development of cancer in areas of inflammation such as the colon (if involved).

26
Q

Severe CD is treated with

A

steroids and antimetabolites (e.g. azathioprine, 6-mercaptopurine) and methotrexate.

27
Q

Mild to moderate CD is treated with

A

5-aminosalicyclic acid (5-ASA) (mesalamine).

28
Q

high risk patient in CD

A 
Age at initial diagnosis < 30 years
Extensive anatomic involvement
Perianal and/or severe rectal disease
Deep ulcers
Prior surgical resection
Stricturing and/or penetrating behavior
29
Q

Surgical intervention is recommended when any of the following complications are present:

A 
Obstruction
Abscess
Fistula or stricture formation
Bowel perforation
Toxic megacolon
Cancer
30
Q

ANCA

A

UC

31
Q

Procolitis

A

فقط رکتوم uc

32
Q

بافت UC

A 
مرز مشخص بین بافت درگیر و غیر درگیر 
مخاط درگیر میشه نه همه ی لایه ها 
نمای کاغذ سمباده 
مخاط نرم و شکنننده Friable 
سودوپولیپ 
ابسه در کریپت ها
33
Q

دلیل افتراق uc

از کولیت حاد عفونی

A

وجود ابسه در کریپت های uc

34
Q

علائم بالینی UC

A 
اسهال خونی 
مدفوع همراه با چرک  و خون 
tenesmus
دفع موکوس 
درد های کرامپی
علائم دارای فراز و نشیب wax and wane
یبوست 
بی اشتهایی
کم خونی میکروسیتیک 
تهوع 
استفراغ 
تب 
کاهش وزن 
شکم distend 
روی کبد صدای تیمپان
35
Q

ازمایشات سرولوژی و خون و اینا چی نشون میده ؟ UC

A 
کاهش کوبالامین 
افزایش لاکتوفرین 
افزایش کالپروتکتین
افزایش ESR . CRP 
هیپو البومینی 
لکوسیتوز 
کم خونی 
کاهش هموگلوبین
36
Q

یافته های بالینی در UC

A 
ازمایش مدفوع بای باکتری های منفی 
بررسی سیگموئیدسکوپی 
نمونه برداری از مخاط روده بزرگ 
کولونوسکوپی 
رادیوگرافی : کوتاه شدگی کولون و از بین رفتن چین های بزرگ . گرانولوسیتی و ندولاریتی

CT
افزایش ضخامت و دانسیته متجانس در جدار روده ها
افزایش چربی اطراف لگن و رکتوم

37
Q

ASCA

A

CD

38
Q

بافت شناسی CD

A 
همه لایه های مخاطی 
احتمال درگیری لایه عضلانی و سروز 
فیستول به پوست 
منتشر نییییست 
زخم ها به صورت تکه تکه SKIP LESION
زخم های افتوس در کولونوسکوپی
39
Q

علائم بالینی CD

A 
Abdominal mass palpable 
سنگ های اگزالات کلیه 
اسهال (شاید خونی )
اسهال اسموتیک
سنگ های صفراوی کلسترولی 
تنگی روده انسداد 
ابشه شکمی
لنفادنوپاتی مزانتر
سوءجذب اهن ویتامین دی کلسم 
تب 
کاهش وزن 
بی اشتهایی
ترس از غذا خوردن
40
Q

یافته ها در ازمایشگاه برای CD

A 
هایپو البومینی 
لکوسیتوز 
کمخونی 
کاهش کوبالامین 
کاهش کلسیم
کاهش ویتامین دی 
کاهش اهن 
افزایش ESR . CRP
41
Q

در تست های تشخیصی CD

A 
کولونوسکوپی 
اندوسکوپی 
زخم های افتوس و ستاره ای شکل
Cobblestone 
creeping fat 
string sign فیبروز روده

CT>MRI

Gastroenterology (16 decks)

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