Celiac Disease & Inflammatory Bowel Disease Flashcards
what is the primary site of absorption?
small intestine
permanent dietary disorder characterized by an inappropriate immunologic response to gluten that results in diffuse damage to proximal small intestines with malabsorption of nutrients and extra-GI symptoms
celiac disease
when does celiac disease become symptomatic?
when gluten stimulates inappropriate response against the intestinal mucosa
a 1 yo patient presents with diarrhea, steatorrhea, weight loss, abdominal distention, weakness, muscle wasting, or growth retardation. Dx?
celiac disease
what 4 symptoms can a child >2 yo or adult present with if they have celiac disease?
chronic diarrhea
dyspepsia
flatulence
malabsorption
what are 9 extra-intestinal symptoms that can present in celiac disease?
fatigue
rash
depression
iron deficiency anemia
osteoporosis
short stature
delayed puberty
amenorrhea
reduced fertility
how does vit K deficiency caused by malabsorption of celiac disease present?
easy bruising
how does calorie deficiency caused by malabsorption of celiac disease present?
loss of muscle and subcutaneous fat
how does iron, folate, and vit B12 deficiencies caused by malabsorption of celiac disease present? (2)
pallor
anemia
how does vit A deficiency caused by malabsorption of celiac disease present?
hyperkeratosis
how does calcium deficiency caused by malabsorption of celiac disease present? (2)
bone pain + osteomalacia
how does vit B1, B12 or vit E deficiencies caused by malabsorption of celiac disease present? (3)
peripheral neuropathy
ataxia
encephalopathy
what is an atypical skin finding in celiac disease?
dermatitis herpetiformis
pruritic, erythematous maculopapular rash over extensor surfaces of extremities, trunk, scalp and neck
what’s important to note about almost all patients with a rash?
have evidence of celiac disease on intestinal biopsy
what is the preferred lab to diagnose celiac disease?
IgA tTG
what is a second choice lab to diagnose celiac disease?
EMA-IgA
levels of IgA tTG and EMA-IgA become undetectable how long after removal of gluten from diet?
3-12 months
what is the confirmatory test for celiac disease in patients with a + serological test?
endoscopic mucosal biopsy of proximal duodenum
when can an endoscopic mucosal biopsy of the proximal duodenum give a false negative?
if the patient has been on gluten-free diet for 3-12 months
what are the treatment options for celiac disease? (2)
removal of all gluten from diet
steroids + immunomodulator meds if refractory
which patients with celiac disease have an increase in intestinal lymphoma and cancers of the mouth, pharynx, and esophagus? (3)
maintain a normal diet
only adhere to reduced gluten diet
have refractory disease
what are the 2 major disorders of inflammatory bowel disease (IBD)?
ulcerative colitis
crohn disease
what are 2 risk factors for IBD?
genetics
NSAID use
cigarette smoking has an increased association with __________
crohn disease
cigarette smoking has a decreased association with __________
ulcerative colitis
diet high in processed, fried, and sugary foods increases the risk for _____
crohn disease
obesity increases _______ severity
crohn disease
insidious, chronic inflammatory condition with transmural inflammation and skip lesions most commonly throughout the ileum and proximal large intestine
crohn disease
a patient presents with fatigue, weight loss, rash, eye problems, SOB, diarrhea +/- blood, abdominal pain, mouth, joint, and anal pain. Dx?
crohn disease
where is abdominal tenderness felt in a patient with crohn disease? why?
RLQ
involves the proximal small bowel
what will labs show in a patient with crohn disease? (3)
electrolyte/nutritional deficiency
elevated CRP/ESR
+ fecal leukocytes
what is the 1st line diagnostic for crohn disease?
colonoscopy
what will a colonoscopy show in a patient with crohn disease?
patchy, skip lesions of inflammation in large and distal small intestine
in which case should a colonoscopy be avoided in a patient with crohn disease and ulcerative colitis?
in severe acute cases d/t possible perforation
what is the 2nd line diagnostic for crohn disease?
CT / MR enterography
what is the diet treatment for crohn disease? (4)
small, frequent meals
refer to nutritionist
avoid fatty foods
maintain hydration
what is the 1st line induction medication for mild-moderate crohn disease of the ileum/proximal colon?
alternative?
PO budesonide (steroid)
PO mesalamine (5-ASA)
what is the 1st line induction medication for mild-moderate crohn disease of the left colon or diffuse colitis?
alternative?
PO prednisone
PO sulfasalazine (pro-5-ASA)
what are the 1st line induction medications for moderate-severe crohn disease? (3)
infliximab + methotrexate +/- PO prednisone
what is the 1st line maintenance medication for mild-moderate crohn disease?
PO mesalamine (5-ASA)
what is the 1st line maintenance medication for mild-moderate crohn disease of the left colon or diffuse colitis?
PO sulfasalazine (pro-5-ASA)
what is the 1st line maintenance medication for moderate-severe crohn disease?
infliximab
what are 5 indications for surgery in crohn disease?
no response to therapy
abscess formation
massive bleeding
fistula
obstructions
what is the recurrence of crohn disease of patients within 1 year post surgery?
60%
chronic inflammatory condition with relapsing and remitting inflammation limited to the mucosal layer of the colon; involves the rectum and extends proximally to involve other parts of the colon
ulcerative colitis
a patient presents with bloody diarrhea, abdominal pain/cramping, fecal urgency and tenesmus, +/- weakness and fatigue from blood loss. Dx?
ulcerative colitis
where would abdominal tenderness be present in a patient with ulcerative colitis?
LLQ
what will labs show in a patient with ulcerative colitis? (4)
anemia
increased CRP + ESR
decreased albumin
+ fecal leukocytes
what is the 1st line diagnostic for ulcerative colitis? what will it show?
colonoscopy
diffuse mucosal inflammation involving the colon
what is a 2nd diagnostic to diagnose ulcerative colitis?
sigmoidoscopy
what is the 1st line induction treatment for mild-moderate ulcerative colitis of the distal colon?
topical mesalamine (5ASA)
what is the 1st line induction treatment for mild-moderate ulcerative colitis of the extensive colon? (2)
topical + PO mesalamine (5-ASA)
what is the treatment for ulcerative colitis that is refractory to 5-ASA?
steroids
what is the treatment for ulcerative colitis that is refractory to steroids?
infliximab
what is the maintenance treatment for ulcerative colitis?
topical mesalamine (5-ASA)
what are 4 complications of ulcerative colitis?
perforation
colon infection
toxic megacolon
colon cancer
what provides complete cure of ulcerative colitis but requires ileostomy?
total proctocolectomy
