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Fall 2020 Exam 2 > Crohns Disease > Flashcards

Crohns Disease Flashcards

1
Q

Crohns Disease

A

transmural inflammation that can affect any part of the GI tract (UC is colon only)

Relapsing/remitting GI infl. episodes

Will see patchy infl. cobblestoning, ulcers, exudates, altered vascular patterns, edema and bleeding

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2
Q

% of patients under 20 years old

A

25%

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3
Q

presentation in kids <6 years

A

“very early onset IBD” VEO-IBD

more severe and refractory

More genetic

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4
Q

cause of Crohns

A

unknown

enviornmental triggers, microbiome, immune response, genetic succeptability

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5
Q

Enviornmental triggers

A

diet, hygiene, smoking, Vit D, stress, depression

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6
Q

dysbiosis

A

disruption of the microbiome balance

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7
Q

IBD is limited to

A

westernized industrial populations

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8
Q

Risk factors

A

smoking, prior appy, stress, depression

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9
Q

Presenting s/s

A

abd pain, diarrhea, rectal bleeding, wt loss, skin tags, peds patients have extensive s/s

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10
Q

Diagnostic lab tests

A

None for IBD or Chrons

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11
Q

CBC

A

leukocytosis, chronic anemia, thrombocytosis

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12
Q

HGB

A

Correlate HGB with MCV to assess chronicity

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13
Q

ESR and CRP

A

elevated inflammatory markers

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14
Q

serum albumin

A

marker of long standing intestinal damage

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15
Q

calprotectin and lactoferrin

A

neutrophil associated proteins

stool sample test for luminal inflammation

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16
Q

Scoping

A

esophagus, stomach, proximal duodenum

mucosal biopsies of upper and lower

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17
Q

Treatment:

Aminosalicytes (2)

A

Sulfasalazine and mesalamine

treat colonic Chrons

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18
Q

Treatments:

corticosteriods

Maintenance therapy or induction of remission?

A

prednisone/prednisilone

methylprednisolone sodium succinate

budesonide

Used to induce remission, NOT for maint therapy d/t serious advers effects

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19
Q

Treatments:

Immunomodulators (3)

Maintenance therapy or remission induction?

A

Azathioprine

6-mercaptopurine

methotrexate

Used to maint. steriod free remission

Use in conbo with biologic to decrease immunogenecity

20
Q

Treatments

Biologic agents (5)

Maintenance or remission induction therapy?

A

nfliximab (infusion), adalimumab (subq)

certolizumab, vedolizumab, natalizumab

“rescue” therapy for severe steriod dependent or steriod refractory disease

Anit TNF agents considered first line depending on situation

Used for either induction or maintenance

Requires monitoring for infectious compl.

must be sure TB neg prior to admin

21
Q

Surgery

A

for fibrotic disease if pharm therapy is not successful

22
Q

Treatments

Antibiotics

A

metronidazole, cipro, rifaximin

controversial use

used in patients with active perianal disease

23
Q

Treatments

Others

A

Calcineurin inhibitor - thalidomide

probiotics, lactobacillus, saccharomyces boulardil

“rescue” therapy for severe steriod dependent or refractory disease

bridging therapy for patients with refractory colitis

recurrent pouchitis p colectomy

role as maint therapy unknown

24
Q

Diet

A

specific carbs, elimination diets, low-sulfur, ayurvedic diets

patients report benefit, no research support

25
Q

supplements

A

ommega 3 fatty acids, probiotics,

aloe- anti-infl, antioxidant, immune stimulatory

herbals- indian ayurveda

accupuncture

26
Q

biobehavioral methods

A

stress alters gut permiability and immune modulation

embarassing for adolescents

increased risk of psyc discorders

relaxation, meditation, prayer

CBT, gut focused hypnotherapy

27
Q

Growth concers

A

impaired lineral growth may preceed GI symptoms- may be only presenting sign of IBD

28
Q

Bone concerns

A

affected by disease and treatment

bone mass defects

nutr def, physical inactivity, infl cytokines and steriods negatively impact bone growth and formation

bone density can be marker of disease

failure to control infl = increased risk of fracture

bone delay may persist despite treatment

29
Q

Vaccinations

A

aviod all live vaccines if immunosupressed or significant protien-cal malnutrition

give flu shot (no mist)

Pneumococcal, HPV- rates higher in immunosupresssed

EBV- higher risk of developing hemophagocytic lymphohistiocystosis ( body makes too many immune cells)

30
Q

What is immunocompromised?

A

prednisone 20mg/day or 2mg/kg/day for two weeks or within 3 moths of stopping

thiopurines, methotetrexate, anti TNF, a agents or other biologics, or within 3 months of stopping

31
Q

Referals- opthomology

A

annual eye exam - slit lamp, IOP meas

conjuctivitis, uveitis (can be asymptomatic), episcleritis

increased IOP from steriods

32
Q

Referals - Derm

A

annual exam, monitor for skin cancer

derm manefestations of IBD - erythema nodosum, pyoderma gangrenosum, psoriasis

higher risk of non-melinoma skin cancer

33
Q

Referral - Joint involvement

A

3 conitions:

ankylosing spondylitis, peripheral arthritis, enthesitis

differentiate between mechanical and infl pain

inspect symmetry and ROM

rheumathology if they have poor response to therapy or have persistant joint complaints after control of GI symptoms

34
Q

Liver

A

transient elevation of liver enzymes, certain anomalies require further workup

35
Q

Dietary and nutrition

A

Nutritional assessment at diagnosis and regularly after

May have decreased appetite

May need supplementation or enteral nutrition

36
Q

iron deficiencies

A

iron deficiency anemia most common type

fatigue, lethargy, dizziness

higher rate of anemia with CD versus UD

37
Q

folate and B12

A

rare in those newly diagnosed

common if patient is on antifolate medication - methotrexate or with terminal ileal disease

38
Q

vitamin D

A

abd in small int to promote bone health

improvinf Vit D status may improve s/s and infl

39
Q

Zinc

A

essential for the immune system

at risk in patients with IBD d/t losses from GI tract

40
Q

Exclusive enteral nutrition (EEN)

A

use of nutritional interv. as antiinfl. therapy

elemental or polymeric formula for 6-8 weeks to induce remission especially in Chrons

guided by dietitian

41
Q

patients with fibrotic strictures

A

may benefit from low residue diet

42
Q

Infl in small intesting reults in

A

protien loosing enteropathy

fat malabsorption

risk of Vit D def

patients with active s/s have poor apetite and low energy

43
Q

Psyc

A

increased risk of depression

med adherance issues

poor sleep quality- may impact school

CBT can be helpful

meds: seratonin and dopamine reuptake inhibitors help with anixety and depressive symptoms

44
Q

Impact 3 questionare

A

for pateints with IBD 10+

45
Q

IBD quality of life index

A

18 years and older

46
Q

Resources

A

GIkids.org

crohnscolotosfoundation.org

Fall 2020 Exam 2 (7 decks)

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