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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

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
Disease behavior in IBD
- four diff presentations: - severe then mild - mild then severe - chronic continuous - chronic intermittent
26
How approach pharm treatment of IBD based on disease behavior of IBD
- 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
Colectomy rate and surgery rate graphs
Check out slides
28
What are four cardinal sx of IBD in children
- blood in stool - diarrhea - failure to grow - fever
29
Extra-intestinal manifestations of IBD (5)
- skin - eye - bones and joints - kidney - hepatobiliary
30
2 types of skin lesions in IBD
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
What is a third type of skin lesion seen in IBD that is caused by pharm therapy
paradoxical reaction for example to Humira (get psoriasis)
32
Non invasive markers that indicate inflammation
- CDAI (crohn's disease activity index) - leukocytosis - CRP - lactoferrin (stool) - calprotectin - IBD serology
33
major differentiation between IBD and IBS
- IBS sx without inflammation | - IBS won't have inflammation markers
34
What two imaging studies are recommended for IBD
- MRI with PEG oral contrast | - CT enterography
35
Goals of IBD therapy
1. induce clinical remission 2. endoscopic healing 3. prevent relapse 4. decrease hospitalization 5. cancer prevention 6. improving quality of life
36
5 types of IBD drug therapy
1. aminosalicylates 2. corticosteroids 3. antibiotics 4. immunomodulators 5. Supportive agents **list of exact meds in slides :)
37
what are the ADR steroids
- weight gain - osteoporosis ** - moon face - hyperglycemia - DM - cataracts - adrenal gland suppression - thinning skin - acne - mood changes - sleep disturbances - myopathies
38
What is major cancer risk in IBD
colorectal cancer
39
What are the two cancer risks in IBD due to immunosuppressive drugs
- cervical dysplasia | - lymphoma risk
40
Risk factors for colorectal cancer in IBD
- ***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
What other major risk is associated with IBD
thromboembolism * longer hospital stay * higher hospital charges
42
High yield (hearted) stuff for Crohn's
- 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
Crohn's 4 major sx
- abdominal pain - diarrhea - oral ulcers - perianal fistulas
44
High yield (hearted) stuff for UC
- continuous, superficial mucosal inflammation starts at rectum and spreads proximally - backwash ileitis - toxic megacolon - colon cancer - starting med: Mesalamine (Rx)
45
UC two major sx
- blood diarrhea | - fecal urgency

GI 2 (11 decks)

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