Crohn's & Ulcerative Colitis

Question 1

Compare C and UC population

Answer 1

C: 20-30
UC: bimodal 20-30, 50-75

Question 2

C vs UC endoscopy findings

Answer 2

C: skin lesions anywhere in GI tract, cobblestone appearance
UC: continuous starting at rectum, but stays in colon, pseudopolyps and chronic colitis

Question 3

C vs. UC intestinal inflammation

Answer 3

C: transmural, non caseating, granulomas more common
UC: superficial, crypt abscess, backwash ileitis

Question 4

UC barium enema shows

Answer 4

Loss of haustral markings, thumbprint

Question 5

C vs UC diarrhea

Answer 5

C: watery, weight loss
UC: bloody

Question 6

Which IBD has increased risk of CRC?

Answer 6

UC

Question 7

Extraintestinal manifestations of IBD

Answer 7

OAT LARDS!

Ocular: iritis, uveitis, episcleritis
Arthritis, arthralgias
Thromboembolic disease

Liver disease
Amyloidosis
Renal disease: UTI, stones, obstruction, fistulae
Dermatologic: erythema nodosum, pyoderma gangrenous, aphthous ulcers
Sclerosing cholangitis

Question 8

Curative treatment for UC? Why is it not curative for crohn’s?

Answer 8

Colectomy is curative

If you remove GI tract in crohn’s, disease may recur elsewhere in the GI tract

Question 9

UC Complications

Answer 9

1. Severe bleeding- urgent colectomy indicated
2. Toxic Megacolon- acute dilation of the colon due to involvement of the muscular layers. Urgent colectomy.
3. Perforation

Question 10

Terminal ileum resected, what am I having issues with now?

Answer 10

B12, fat

Question 11

Duodenum resected, what am i having problems with now?

Answer 11

Fe, osteopenia

Question 12

While IBD causes is unknown, it may be linked to what?

Answer 12

Bacteria
Microbiome
Genetics
Virus, worm, parasite

Question 13

UC colonic features

Answer 13

Bloody mucus, diarrhea
Tenesmus
Frequency, urgency, incontinence
Rectal bleeding
Abdominal pain
Fever

Question 14

What bacterial infection do IBD patients get?

Answer 14

C diff

Question 15

Mesalamine (5-ASA) MOA

Answer 15

Inhibits lipoxygenase:

1. Decreases leukotrienes
2. Remove oxygen free radicals
3. Inhibits auto Ab formation

Question 16

First line therapy for mild to moderate IBD

Answer 16

5-ASA Mesalamine

Question 17

What is the multi-matrix system mesalamine (MMX)?

Answer 17

Combines a pH dependent coating with mesalamine to delay release of medication to colon

Question 18

When would I give steroids for IBD?

Answer 18

Induce remission during flare up, but for 6 months or less only

Question 19

Side effects of prednisone

Answer 19

Weight gain
Insomnia
DM
HTN
Osteoporosis

Question 20

6-MP/AZA MOA

Answer 20

Immunosuppressant inhibits purine synthesis necessary for lymphocyte proliferation

Question 21

What drug helps fistula closure and prevents post op recurrence of IBD?

Answer 21

6-MP/AZA

Question 22

Anti-TNF drugs for IBD

Answer 22

Infliximab- Remicade
Adalimumab- Humira
Certolizumab- Cimzia

Question 23

What kind of cytokine is lacking in IBD?

Answer 23

Anti- inflammatory

Question 24

UC pathology

Answer 24

Crypt abscess and crypt branching
Eroding ulceration
Pseudopolyps
Granulomas
Backwash ileitis

Question 25

Which IBD can develop into another?

Answer 25

UC and develop into Crohn's but not the other way around

Question 26

Bowel to bowel fistula

Answer 26

Enteroenteral | Enterocolic

Question 27

Bowel to bladder fistula

Answer 27

Enterovesical

Question 28

Bowel to vagina fistula

Answer 28

Rectovaginal

Question 29

Enterocutaneous fisuta

Answer 29

Perinatal or through the abdominal wall

Question 30

Fecal study for inflammation

Answer 30

Fecal calprotectin Measures WBC breakdown, inflammation in GI tract

Question 31

``` Drug location targets for mesalamine: Asacol Pentasa Colazal Canasa ```

Answer 31

Asacol- colon Pentasa - small intestine Colazal- colon Canasa- rectal

Question 32

Mesalamine side effect

Answer 32

Split causes Cl secreation and induces diarrhea

Question 33

Antibiotics indicated for IBD

Answer 33

Cipro | MTZ

Question 34

What. Nutritional deficiency do you watch out for in IBD?

Answer 34

``` Calcium- if patient avoids lactose in diet Vitamin D Vitamin B12- ileum resection Folate- jejunal resection Iron- blood loss ```

Question 35

IBD diet

Answer 35

Lactose free Low fiber Elemental Probiotic

Question 36

Side effects of anti-TNF

Answer 36

``` Infection: Tb, histoplasmosis HA Abd pain Immunogenicity Obstruction Lymphoma ```