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GI 2 > Clin Med - Inflammatory Bowel > Flashcards

Clin Med - Inflammatory Bowel Flashcards

1
Q

IBD

- diff types

A 
Main
- Ulcerative Colitis
- Crohn's Disease
Also
- Indeterminant
- Microscopic
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2
Q

Description of colon

  • UC
  • Crohn’s
A
  • inflammation, red, loss of blood vessel

- inner layer, fissures, deep layer, ulcers

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3
Q

Histology shows granulomas - Crohn’s or UC?

A

Crohn’s

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4
Q

Histological findings UC

A
  • inflammation limited to mucosa
  • crypt distortion
  • cryptitis
  • crypt abscesses
  • loss of goblet cells
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5
Q

Histological findings Crohn’s

A
  • submucosal or transmural
  • deep fissuring ulcers
  • fistulas
  • patchy changes
  • granulomas
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6
Q

What ages do UC and Crohn’s generally show up

A
  • early: 16-26

- late: 76-85

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7
Q

Pathogenesis of IBD - four parts

A
  1. luminal microbes
  2. genetic susceptibility
  3. immune response
  4. environmental triggers
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8
Q

Describe immune response cause of IBD

A
  • harmful gut bacteria in body
  • activates immune system
  • kills bacteria by releasing inflammatory proteins
  • normally the host proteins will stop but in IBD the “off switch” is broken and immune response continues, damages intestinal wall
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9
Q

what gene is major landmark of IBD pathogenesis

  • what chromosome
  • risk if homozygous
  • risk of heterozygous
  • what does it do
A

NOD2/CARD15

  • chromosome 16
  • 40 fold relative risk of CD if homozygous
  • 7 fold relative risk of CD if heterozygous
  • intracellular bacterial sensor in monocytes and enterocytes
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10
Q

how is smoking related to IBD

A

negative relation between smoking and UC

  • if stop smoking, likely to get UC sx within a year
  • resuming smoking does not “cure” UC
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11
Q

Pathogenesis pearls

  • what mediates chronic inflammation
  • what drives gut inflammation
  • what promotes chronic inflammation
  • what modulates disease severity and phenotype
A
  • T cells
  • commensal enteric bacteria - provide antigenic and adjuvant stimulation
  • defective immuno-regulation
  • genetic background
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12
Q

Clinical features of UC

A
  • continuous inflammation
  • superficial inflammation
  • lead pipe appearance
  • colon only (possible terminal ileum)
  • variable extent
  • cancer risk
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13
Q

where is the most common site of UC

A

rectum

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14
Q

where is UC pain generally felt?

A

LLQ

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15
Q

Bowel changes in UC

A
  • bloody diarrhea

- urgency

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16
Q

What is teh main extra intestinal manifestation of UC

A

primary sclerosing cholangitis

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17
Q

clinical features of Crohn’s disease

A
  • patchy inflammation
  • full-thickness inflammation
  • cobblestone appearance
  • mouth to anus
  • fistulas
  • strictures
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18
Q

what is the most common site of Crohn’s

A

terminal ileum

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19
Q

Where is Crohn’s pain generally felt

A
  • RLQ
20
Q

What are the extra intestinal manifestations of Crohn’s?

A
  • kidney stones: calcium oxalates

- rash: erythema nodosum

21
Q

What vitamin deficiency should increase suspicion for Crohns

A

Vitamin B12

- absorbed in terminal ileum

22
Q

Difference in UC and Crohn’s: spacing of disease in colon

A
  • UC: starts at anus and works proximally

- Crohn’s: skip lesions

23
Q

Top four clinical presentation of Crohn’s

A
  • abdominal pain
  • diarrhea
  • weight loss
  • fever
24
Q

top four clinical presentation of UC

A
  • Urgency
  • increased defecation
  • tenesmus
  • hard or formed stools
25
Q

Disease behavior in IBD

A
  • four diff presentations:
  • severe then mild
  • mild then severe
  • chronic continuous
  • chronic intermittent
26
Q

How approach pharm treatment of IBD based on disease behavior of IBD

A
  • hit HARD at beginning of sx
  • look at graph titled
  • even if sx decrease, underlying damage exists that can lead to surgery
  • “disease behavior in IBD”
27
Q

Colectomy rate and surgery rate graphs

A

Check out slides

28
Q

What are four cardinal sx of IBD in children

A
  • blood in stool
  • diarrhea
  • failure to grow
  • fever
29
Q

Extra-intestinal manifestations of IBD (5)

A
  • skin
  • eye
  • bones and joints
  • kidney
  • hepatobiliary
30
Q

2 types of skin lesions in IBD

A
  1. pyoderma gangrenous: rapidly enlarging, very painful ulcer
  2. erythema nodosum: reddish, painful, tender lumps most commonly located in the front of the legs below the knees
31
Q

What is a third type of skin lesion seen in IBD that is caused by pharm therapy

A

paradoxical reaction for example to Humira (get psoriasis)

32
Q

Non invasive markers that indicate inflammation

A
  • CDAI (crohn’s disease activity index)
  • leukocytosis
  • CRP
  • lactoferrin (stool)
  • calprotectin
  • IBD serology
33
Q

major differentiation between IBD and IBS

A
  • IBS sx without inflammation

- IBS won’t have inflammation markers

34
Q

What two imaging studies are recommended for IBD

A
  • MRI with PEG oral contrast

- CT enterography

35
Q

Goals of IBD therapy

A
  1. induce clinical remission
  2. endoscopic healing
  3. prevent relapse
  4. decrease hospitalization
  5. cancer prevention
  6. improving quality of life
36
Q

5 types of IBD drug therapy

A
  1. aminosalicylates
  2. corticosteroids
  3. antibiotics
  4. immunomodulators
  5. Supportive agents

**list of exact meds in slides :)

37
Q

what are the ADR steroids

A
  • weight gain
  • osteoporosis **
  • moon face
  • hyperglycemia
  • DM
  • cataracts
  • adrenal gland suppression
  • thinning skin
  • acne
  • mood changes
  • sleep disturbances
  • myopathies
38
Q

What is major cancer risk in IBD

A

colorectal cancer

39
Q

What are the two cancer risks in IBD due to immunosuppressive drugs

A
  • cervical dysplasia

- lymphoma risk

40
Q

Risk factors for colorectal cancer in IBD

A
  • ***primary sclerosing cholangitis
  • longer duration of dz
  • greater extent of dz
  • family hx of colorectal ca
  • increased histological inflammation

*similar in UC & crohn’s

41
Q

What other major risk is associated with IBD

A

thromboembolism

  • longer hospital stay
  • higher hospital charges
42
Q

High yield (hearted) stuff for Crohn’s

A
  • transmural inflammation from mouth to anus
  • cobblestoning mucosa and skip lesions
  • risk: fam hx, Ashkenazi Jews
  • B12 deficiency
  • erythema nodosum, uveitis, arthritis, kidney stones
  • prednisone for acute flare
  • anti TNF for perianal fistulas
43
Q

Crohn’s 4 major sx

A
  • abdominal pain
  • diarrhea
  • oral ulcers
  • perianal fistulas
44
Q

High yield (hearted) stuff for UC

A
  • continuous, superficial mucosal inflammation starts at rectum and spreads proximally
  • backwash ileitis
  • toxic megacolon
  • colon cancer
  • starting med: Mesalamine (Rx)
45
Q

UC two major sx

A
  • blood diarrhea

- fecal urgency

GI 2 (11 decks)

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