Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GIR Test 3 > B5.044 Inflammatory Bowel Disease > Flashcards

B5.044 Inflammatory Bowel Disease Flashcards

1
Q

symptoms of dehydration that may accompany IBD

A

orthostatic hypotension

tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

differential diagnosis for IBD

A 
infectious diarrhea
autoimmune disease
gynecological condition
irritable bowel syndrome
inflammatory bowel disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

red flags that support an IBD diagnosis

A

blood in stool
nocturnal diarrhea
young age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

lab test results of IBD

A

leukocytosis
low hemoglobin
intermediate ESR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

important negative finding of IBD on stool culture

A

negative bacterial culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CT abdomen findings in IBD

A

thickening of the sigmoid colon and descending colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

colonoscopy findings in IBD

A

diffuse mucosal granularity, erythema, exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ulcerative colitis histology findings

A 
distortion of crypt architecture
crypt abscesses (inflammatory cells in crypts)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some indications to consider ischemic colitis

A

young female on HRT
watershed areas (limited blood supply in splenic flexure and rectosigmoid junction)
sparing of the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what parts of the colon are supplied by the SMA

A

terminal ileum

right side of the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what parts of the colon are supplied by the IMA

A

left side of the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is CMV colitis and how do you tell it from UC?

A

looks the same as UC on colonoscopy
found only in immunocompromised patients
biopsy is diagnostics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

symptoms of UC

A 
bloody diarrhea
abdominal pain
fecal urgency
disease is limited to the colon
rectum is involved
inflammation is limited to mucosa and submucosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the pathogenesis of IBD

A

complex immunological disorder with complex pathogenesis

chronic idiopathic intestinal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 main types of IBD

A

crohn’s disease

ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

epidemiology of IBD

A

bimodal peak- 15-25 or 50-70
more common among Ashkenazi Jews
overlap with autoimmune conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

environmental influences associated with IBD

A

UC- nonsmokers
crohn’s disease- smokers
more common in colder climates and in developed countries
“hygiene hypothesis”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how much water gets reabsorbed from the small intestine

A

6 L per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how does colonic reabsorption of water vary

A

1.8 L with maximal absorptive capacity of 4.5-5 L per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how much water is lost in the stool

A

<0.2 L per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

normal intestinal electrolyte absorption

A

sodium absorption( electrogenic or electroneutral NaCl absorption)
potassium secretion and absorption
chloride secretion
short chain fatty acid absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is secretory diarrhea

A

excess input of NaCl into bowel lumen with water following

massive volume of plasma like fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is inflammatory diarrhea

A

Na absorption is diminished
Cl secretion is increased
inflammatory mediators affect apical membrane transport proteins causing water to flow into lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why does defective Na transport occur in inflammatory diarrhea

A

change in properties of inflamed colonocytes
reduced Na pump activity
high concentrations of inflammatory cytokines (TNF) result in gene depression of enterocyte cellular transport function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
things that can cause diarrhea in IBD that are NOT inflammation of the mucosa
``` bile induces fatty diarrhea short bowel syndrome concurrent c-diff CMV small intestinal bacterial overgrowth celiac sprue untreated lactose intolerance NSAID associated enteropathy IBS ```
26
progression of inflammatory diarrhea
minimal or severe inflammation > enterocyte damage or death > malabsorption and secretion
27
proposed pathogenesis of IBD
host genetics + immune system + gut microbes all play a role | possible excessive immune reactivity or inadequate immune responses to intestinal microbiota
28
microbiome
ecological community of pathogenic microorganisms and us
29
microbiota
microorganisms alone
30
discuss the human gut flora
largest number of bacteria and greatest # of species compared to other areas of the body established at 1-2 years of age 150 species of bacteria in the colon
31
why can bacterial species in the gut change over time
mode of delivery environment illness and antibiotic exposures
32
what organisms dominated the microbiota of the gut
bacteriodetes | firmicutes
33
positive role of microbes
nutrition energy metabolism proper conditioning of the intestinal peripheral immune systems
34
negative role of microbes
microbial derived factors may promote IBD in the context of underlying genetic immune defect
35
what can happen as a result of changes in communities of intestinal bacteria
can dysregulate talk between host and microbes inappropriate response to microbes by immune system can contribute to development of inflammation
36
what are components of the mucosal immune system
intact intestinal epithelium secretion of protective factors innate immune system acquired immune system
37
what are some ways that the epithelial barrier can be dysregulated
alteration in intestinal mucus high numbers of bacteria within mucus increased intestinal permeability (enhanced exposure to intestinal bacteria) abnormalities in paneth cells
38
discuss the process of homing
recruitment of neutrophils from the blood vessels to the mucosa leukocytes "roll" along endothelium chemokines secreted from the tissue activate adhesion molecules, resulting in firm adhesion
39
discuss diapedesis
leukocytes transverse the endothelium after adhering
40
IBD dysregulation of immune cells
enhanced expression of adhesion molecules on leukocytes and endothelial cells, increased chemokines, and increased leukocytes binding to vascular endothelial cells
41
alpha 4 beta 7 integrin heterodimer function
important for mediating lymphocyte trafficking to the lamina propria
42
IBD dysregulation in secreted mediators
abnormal levels of immunoregulatory and inflammatory cytokines correlate with active IBD CD4+ lymphocytes secrete large amounts of IFNy and TNF
43
therapeutic strategies targeting secreted mediators
anti-TNF alpha in Crohns
44
discuss the genetic susceptibility in IBD
more than 100 genes NOD2 found in 17% of Crohns 70% of genes are shared between Crohn and UC
45
what is NOD2
protein responds to bacterial peptidoglycan, which then activates signaling pathways that lead to cytokine production and clearance of bacteria
46
discuss the relationship between NOD2 and Crohns
first susceptibility gene identified, greatest risk of developing Crohns with this gene earlier age of development ileal and fibrostenosing Crohns worse outcomes for UC
47
what is autophagy
process that mediates resistance to intracellular pathogens
48
autophagy mutations in Crohns
mutation in ATG16L1 - changes in Paneth cells and goblet cells - decreased ability to clear bacteria - increased secretion of cytokines
49
examples of IBD imitators
``` infections affecting the terminal ileum -tuberculosis -Yersinia vasculitides -bechet's disease -churg strauss syndrome ischemic colitis solitary rectal ulcer syndrome colitis cystica profunda colonic endometriosis infectious proctitis segmental colitis associated with diverticulosis ```
50
clinical picture of Yersinia enterocolitica
``` weeks of diarrhea sore throat may have reactive arthritis involved terminal ileum and cecum mesenteric adenopathy ```
51
clinical picture of bechet's disease
systemic vasculitis | Asian ancestry
52
colonoscopy findings in Crohns
deep ulcers | skip lesions
53
Crohn's distribution
50% ileocolic 30% ileal 20% colic
54
orofacial crohns
granulomatous cheilitis and glossitis furrows on tongue aphthous ulcers in the oral cavity
55
Crohns histology
``` granulomas in mucosa deeper inflammation (sometimes not seen if biopsy is too shallow) ```
56
what is CDAI
crohns disease activity index combo of objective and subjective measurements >150 active disease >450 severe disease
57
difference between crohns and UC on colonoscopy/histo
``` Crohns -cobblestoning -fat wrapping -thickened wall -fissures UC -crypt distortion -loss of haustra -pseudopolyps of surviving mucosa -ulceration ```
58
complications of crohns
``` transmural inflammation strictures fistulas abscess anal fissures ```
59
symptoms of Crohns
``` abdominal pain diarrhea weight loss transmural inflammation symptoms depend on location of disease skipped lesions granulomas ```
60
skin manifestations in IBD
erythema nodosum | pyoderma gangrenosum
61
erythema nodosum
more common in women painful nodular lesions on the trunk and anterior shins improves with disease treatment usually lower extremities
62
pyoderma gangrenosum
nectrotizing, painful lesion can be anywhere on the body including the face pathergy- avoid surgical debridement independent of intestinal disease progression
63
extraintestinal manifestations of IBD (independent course)
uveitis axial arthropathy pyoderma gangrenosum PSC
64
extraintestinal manifestations of IBD ( during active IBD)
episcleritis peripheral arthropathy erythema nodosum
65
relationship between pancreatitis and IBD
medications related IgG-4 related autoimmune pancreatitis duodenal Crohns affecting pancreatic duct
66
medications related to development of pancreatitis
mesalamine | AZA
67
thromboembolic risk in IBD
increased 3 times | likely due to cytokines
68
nutritional issues related to IBD
``` can be due to small bowel disease or diminished absorptive area due to surgeries vit B12 def bile acid absorption vit D def zinc def ```
69
symptoms of zinc def
seborrheic rash on legs and face scaling around the nose and mouth diarrhea
70
short bowel syndrome
<200 cm of small bowel decreased absorptive surface due to repeated surgeries
71
possible outcome of transmural crohns disease
penetration or fistula formation
72
treatment for mild IBD
topical corticosteroids antibiotics aminosalicylates (5-ASA_
73
treatment for moderate IBD
immunomodulators | oral corticosteroids
74
treatment for severe IBD
surgery | biologics
75
anti-TNF biologics
adalimumab certolizumab infliximab
76
anti integrin biologics
natalizumab
77
immunomodulator agents
azathioprine cyclosporine methotrexate
78
corticosteroids
budesonide hydrocortisone prednisone
79
antibiotics for IBD
ciprofloxacin | metronidazole
80
aminosalicylates
mesalamine | sulfasalazine
81
optimal location of aminosalicylate action
large intestine
82
adverse effects of aminosalicylates
``` occur in 10-45% of patients some are dose related (headache, nausea, fatigue, bone marrow suppression) allergic reactions inhibits folate absorption olsalazine- diarrhea mesalamine- interstitial nephritis ```
83
serious side effects of anti-TNF therapy
``` T cell lymphoma, hepatosplenic lymphoma -absolute risk very low -more likely with concurrent thiopurins -young male NHL is rare: 4 in 10,000 opportunistic infections infusion reaction/serum sickness ```
84
what is PML
Progressive multifocal leukoencephalopathy demyelinating disease, leads to severe disability or death associated with Natalizumab
85
what is a way to give drugs gut selective effects
target the alpha 4 beta 7 integrin
86
goals of surgery in UC
cure disease | prevent cancer
87
indications for surgery in UC
toxic megacolon hemorrhage medical intractability malignant degeneration
88
options for surgery in UC
colectomy | ileal pouch anal anastomosis
89
surgery in Crohns
75% of crohns patients require surgical intervention | fistula or structures
90
colon cancer screening and surveillance in IBD
18 colon cancer risk after 30 years
91
risk factors for colon cancer in IBD
``` age of onset < 15 disease extent duration (>8 years) severity (strictures) inflammatory complications PSC familial history of CRC ```
92
colitis associated neoplasms
proto-oncogenes: activation of k-ras, c-src tumor suppressor genes: loss or mutation p53, APC DNA repair genes cell cycle related genes chromosomal instability and microsatellite instability
93
special characteristic of colitis associated neoplasms
inflammation > multifocal dysplasia > cancer
94
what is a chromoendoscopy
used for surveillance in IBD every year for 8-9 years after diagnosis dye on colonic wall helps illuminate dysplasia

GIR Test 3 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions