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GIR Test 2 > B5-044 Inflammatory Bowel Disease > Flashcards

B5-044 Inflammatory Bowel Disease Flashcards

1
Q

deep and linear ulcerations in the terminal ileum and ascending colon with normal islands of tissue inbetween on colonoscopy

A

Crohn’s

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2
Q

transmural inflammation with primarily lymphoid aggregates on histology

A

Crohn’s

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3
Q

feeling of need to evacuate bowels urgently or painfully

A

tenesmus

signals rectal disorder

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4
Q

shallow ulcers in the rectum and descending colon on colonoscopy

none is transverse or ascending colon

A

UC

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5
Q

mucosal and submucosal inflammation with evidence of crypt abscesses on histology

A

UC

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6
Q

blood diarrhea
nocturnal diarrhea
weight loss
+/- improved with defecation

A

inflammatory bowel disease

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7
Q

improves with defecation
emotional triggers
non-bloody diarrhea
daytime only

A

irritable bowel syndrome

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8
Q

IBD is diagnosed clinically with

additional test necessary, 3

A
  • colonoscopy
  • radiography
  • histology
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9
Q

[…] with biopsy should be performed in suspected Crohn’s and UC, and neoplastic pathology

A

ileocolonoscopy

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10
Q

useful for distinguising IBD from IBS

A

fecal calprotectin

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11
Q
  • lesions may occur anywhere from mouth to anus
  • skip lesions
A

Crohn’s

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12
Q

Crohn’s has a higher indicidence in […]

females/male

A

females

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13
Q
  • weight loss
  • abdominal pain
  • nocturnal diarrhea
  • no rectal urgency
A

Crohn’s

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14
Q
  • glossitis
  • cobblestoning of oral mucose
  • perianal disease
  • fistulas
A

Crohn’s

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15
Q
  • non-caseating granulomas
  • full thickness inflammation
A

Crohn’s

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16
Q

extraintestinal manifestations of Crohn’s

lots, but i only listed the 4 she focused on

A
  • aphthous stomatitis
  • anterior uveitis with hypopion
  • erythema nodosum
  • pyoderma gangrenosum
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17
Q

indurated, erythematous nodules in the pre-tibial region

A

eythema nodosum

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18
Q
  • rapidly enlarging hemorrhagic non follicular pustule, surrounded by an erythematous halo
  • very painful
  • quickly ulcerates
A

pyoderma gangrenosum

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19
Q

complications of Crohn’s

4

A
  • strictures
  • fistula
  • abscesses
  • anal fissure

due to transmural inflammation

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20
Q

medication for symptom control in mild-moderate Crohn’s

A

5-ASA products

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21
Q

aim of treatment in Crohn’s

3

A
  • get the inflammatory process into remission
  • minimize negative health impacts of diagnosis and treatment
  • nutrition
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22
Q
  • medication used for symptom management/flairs of Crohn’s
  • start a moderate-high dose and taper
A

corticosteroids

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23
Q

medications used as adjuct Crohn’s treatment with biologics like TNF-a

A
  • thiopurine, azathiopurine
  • methotrexate
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24
Q

anti TNF medications used in achieving remission in Crohn’s

A

adalimumab
infliximab

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25
Q

ant-integrin medications used in achieving Crohn’s remission

A

natalizumab
vedolizumab

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26
Q

anti-interleukin-12/23p40 mediation used in achieving Crohn’s remission

A

ustekinumab

second line agent after failed treatment

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27
Q

test for […] prior to starting the patient on anti-TNF therapy

A

TB

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28
Q

indications for surgery in Crohn’s disease

A

strictures or fistulas

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29
Q

if terminal ileum is resected, what cannot be reabsorbed?

A

bile acids
also issues with B12 absorption

causes steatorrhea and kiney stones

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30
Q

immunosuppressed Crohn’s patients should be screened for

2

A

cervical cancer
pneumococcal vaccines

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31
Q

Crohn’s patients on thiopurines should be screened for

A

skin/urinary tract cancer

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32
Q

Crohn’s patients on corticosteroids should be screened for

A

osteoporosis

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33
Q

CRP and ESR are less likely to be elevated in

34
Q

UC patients are […] likely to have systemic features than Crohn’s patients

less, more, equally

35
Q
  • hematochezia
  • diarrhea
  • abdominal pain
36
Q

contigous disease

37
Q

extraintestinal manifestations of UC

A

primary sclerosing cholangitis

38
Q
  • “onion skin” bile duct
  • beads on a string bile duct
A

primary sclerosing cholangitis

39
Q

primary sclerosing cholangitis increases the risk of what cancers?

2

A

cholangiocarcinoma
gallbladder

start colon cancer screening early

40
Q

course treatment of UC depends on

A

current and previous severity
presence of poor prognostic factors

41
Q

first goal of UC therapy

42
Q

progression of treatment options for UC

where you’d start to where you’d go

A
  1. 5-asa oral/rectal
  2. rectal steroids
  3. oral steroids
  4. thiopurines
  5. biologics
43
Q

poor prognostic factors for UC

A
  • over 40 at dx
  • extensive colitis
  • previous hospitalization for colitis
  • elevated CRP
  • low serum albumin
44
Q

indications for surgery in UC

A
  • toxic megacolon
  • hemorrhage
  • medical intractability
  • malignant degeneration
45
Q

risks of colectomy

A
  • increases risk of infertility
  • alters absorption
46
Q
  • shallow ulcerations
  • friable mucosa
  • may loose haustra
47
Q
  • deep ulcerations
  • cobblestone mucosa
  • creeping fat
  • bowel wall thickening
  • linear ulcers
  • fissures
48
Q
  • transmural inflammation
  • non-caseating granulomas
  • lymphoid aggregates
49
Q

Th1 mediated

50
Q
  • mucosal and sumucosal inflammation
  • crypt abscesses
  • neutrophilic infiltration
  • ulcers
51
Q

Th2 mediated

52
Q

skip lesions
usually rectal sparing

53
Q

contigous from rectum proximally

54
Q

most commonly terminal ileum and ascending colon

55
Q

complications include

  • fistulas
  • phlegmon/abscess
  • strictures
  • perianal disease
56
Q

complications include

fulminant colitis
toxic megacolon
perforation

57
Q

kidney stones
gallstones

58
Q

primary sclerosing cholangitis

59
Q

MPO-ANCA
P-ANCA

60
Q
  • smoking may make symptoms better
  • patients present after cessation
61
Q
  • smoking is a risk factor for developing
  • worsens course
62
Q

anti-saccaromyces cervissiae antibodies

63
Q

smoking cessation is associated with worsening of

64
Q

intracellular gram-negative cocci on proctitis swab

65
Q

proctitis with pustular discharge, rectal pain, and tenesmus

66
Q

remember to include […] on the differential of proctitis

67
Q

mesalamine is used for treatment of

68
Q

pustular proctitis + gram negative cocci =

69
Q

iron is absorbed in the

A

proximal small bowel

70
Q

loss of the ileocecal valve can cause

3

A
  • bacterial overgrowth -> steatorrhea
  • B12 deficiency
  • decreased bile acid absorption
71
Q

choleretic diarrhea occurs secondary to

A

decreased bile acid absorption

terminal ileum resection

72
Q

once a patient has less than […] cm of small bowel, sequelae of short gut syndrome may be seen

73
Q

painful skin ulceration with irregular, raised borders and necrotic bed

A

pyoderma gangrenosum

74
Q

pyoderma gangrenosum is associated with

A

IBD (both UC and crohns)

75
Q

beads on a string

A

primary sclerosing cholangitis

UC

76
Q

primary sclerosing cholangitis is associated with

77
Q

risk factors for the developmental of colorectal cancer in a patient with UC

4

A
  • extent of disease (pancolitis > left sided)
  • hx of colon cancer
  • primary sclerosing cholangitis
  • duration of disease (>after 8-10 years)
78
Q

surgical option for UC with the least risk of infertility

A

subtotal colectomy

79
Q

IBD medication safe to use in pregnancy

A

mesalamine

80
Q

medication widely used for UC but not used for Crohns

A

mesalamine

81
Q

medications that can be used to induce remission in IBD

2

A
  • infliximab
  • prednisone

GIR Test 2 (18 decks)

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