DSA - Inflammatory Bowel Disease (Completed) Flashcards
(50 cards)
1
Q
What two diseases do we consider to fall under the IBD category?
A
- Ulcerative colitis (UC)
- Crohn Disease (CD)
2
Q
What gene do we associate with Crohns?
A
CARD15/NOD2 of chromosome 16p
3
Q
In ulcerative colitis type IBD 70% of patients have what serum marker?
A
Anti-neutrophil cytoplasmic antibodies (ANCA)
4
Q
In Crohn’s disease type IBD 60-70% of patients have what type of antibodies present?
A
Saccharomyces cerevisiae (ASCA)
5
Q
What is the age of peak occurrence for IBD?
A
- 15-30
- 60-80
6
Q
What’s the most likely and least likely ethnicity to develop IBD?
A
Most likely: Jewish
Least likely: asian
7
Q
What is the mainstay therapy for IBD?
A
- 5-aminsalicylic acid derivatives
- corticosteroids
- immunomodulating agents
- biologic agents
8
Q
What are the common extraintestinal manifestations of IBD?
A
- peripheral arthritis
- Erythema nodosum
- pyoderma gangrenosum
- DVTs
- nephrolithiasis w/ urate or calcium oxalate stones in CD
9
Q
Infectious enterocolitis is endoscopically indistinguishable from ulcerative colitis. How do we differentiate the two?
A
- Stool studies
- biopsies
10
Q
Compare and contrast ulcerative colitis from crohns diseases. What are the key characteristics of UC?
A
- pANCA positive
- Effects mucosal layer only
- colon only (terminal ileum, “backwash”)
- continous lesion
- toxic megacolon
- smoking is protective
11
Q
Compare and contrast ulcerative colitis from Crohn’s disease. What are the key characteristics of Crohn’s disease?
A
- ASCA positive, ANCA negative
- skip lesions
- full thickness (transmural)
- string sign (strictures)
- prescence of fissures
- Smoking worsens disease
- cobblestoning
- Segmented ulcerated mucosa of the terminal ileum
12
Q
Crohn’s disease is defined with non-caseating granulomas. What other disease also has this feature?
A
Sarcoids
13
Q
What are the clinical manifestations of ulcerative colitis?
A
- Erythema nodosum
- Frequent bloody diarrhea
- Mucus
- Tenesmus - inclination to evacuate bowel
- Fulminant colitis - rapidly worsening symptoms w/ signs of toxicity
14
Q
What are the clinical manifestations of Crohn’s disease?
A
- Insidious onset
- diarrhea (w/o blood)
- growth retardation in children
- acute ileitis mimicking appendicitis
- anorectal fissures
- fistulas
- abscesses
15
Q
What three clinical courses can Crohn’s disease fall into?
A
- Inflammatory
- stricturing
- fistulizing
16
Q
What complications are associated with ulcerative colitis?
A
- Toxic megacolon
- colonic perforation
- pyoderma gangrenosum
- frequent bloody diarrhea
17
Q
What complications are associated with Crohn’s disease?
A
- Intestinal obstruction
- bile salt malabsorption —> gallstones/oxalate kidney stones
- Abscess
- fistula (ex. Enterovesical fistula)
- fissures
- adhesions
18
Q
What is the relationship between smoking and ulcerative colitis?
A
- Onset of ulcerative colitis often follows cessation of smoking
- UC is more common in non smokers and former smokers
19
Q
What is the relationship between smoking and Crohn’s disease
A
- smoking is correlated with increased risk of developing Crohns disease
- stopping smoking has no effect
20
Q
What influence does appendectomy on development of ulcerative colitis or Crohn’s disease?
A
Appendectomy before the age of 20 for acute apendicitus associated with a reduced risk of developing UC.
No relation to CD development
21
Q
In regards to colon cancer, what considerations need to be taken with ulcerative colitis?
A
- Risk of colon cancer increases with UC that is closer to the rectum
- Ingestion of folic acid reduces risk
- Colonoscopies recommended every 1-2 yrs beginning 8 years after diagnosis of UC
22
Q
What are two rare colon cancers see as a development from Crohn’s disease?
A
- Lymphoma
- Small bowel adenocarcinoma
23
Q
What is the key diagnostic test for UC?
A
Sigmoidoscopy
24
Q
What is the key diagnostic test for Crohn’s disease?
A
- Sigmoidoscopy/colonoscopy
- barium enema
- upper GI and small bowel series
25
What labs are you going to want/see in a patient with CD or UC?
* **Complete blood count**
* **serum albumin**
* **increased ESR (erythrocytes sedimentation rate)**
* **increased CRP**
* **Increased fecal calprotectin (intestinal inflammation)**
* **stool specimen**
* **hypokalemia (UC only)**
26
Sigmoidoscopy is the diagnostic tool of choice for UC. Using this tool how would you characterize the mucosa of this patient?
* edema
* friability
* mucopus
* erosions
27
Colonoscopy is usually performed first in CD to evaluate the colon and terminal ileum. What would you see in the case of CD?
* **Aphthoid linear or stellate ulcers**
* **strictures**
* **segemnetal involvement with areas of normal-appearing mucosa adjacent to inflamed mucosa**
* **shows only the colon and terminal ileum**
**granulomas on biopsy are highly suggestive of Crohn’s disease**
28
If you are having trouble discerning UC from CD what diagnostic test can be used and what does the test tell you?
Capsule Imaging
measures:
* **Autoantibodies to P-ANCA (UC)**
* **Antibodies to yeast saccharomyces cerefisiae (CD)**
29
An **emergent CT of the abdomen** identifies an abscess as a result of complication of Crohn’s disease. What is your course of action?
* adminsiter broad-spectrum antibiotics
* percutaneous drainage or surgery usually required
30
What kind of diet is indicated for patients with CD, especially those with symptoms of intestinal obstruction?
* **Low-roughage diet** (no raw fruits, vegetables, nuts, popcorn)
31
Because of the penetrating nature of Crohn’s disease. What is a major concern?
**Sinus tracts that penetrate through the bowel where they may be contained or form fistula to adjacent structures**
32
A complication of CD is perianal disease. Describe the complications associated with perianal disease.
* painful **skin tags**
* **anal fissures**
* **perianal abscesses**
* **fistulas**
**identified with pelvic MRI**
**treated with oral abs (metronidazole or cipro)**
33
(True/False) unlike ulcerative colitis, severe hemorrhage is unusual in Crohn’s disease
true
34
Which diagnostic study is best for evaluating a patient with CD’s small bowel?
* **CT w/ contrast or MR enterography (most common)**
* **barium upper GI series w/ small bowel follow-through (Barium UGI w/ SBFT)**
35
Why should barium enemas not be performed in acute ulcerative colitis?
**May precipitate toxic megacolon**
**but if performed will show “Lead-pipe” loss of haustra**
36
What is the role of **plain abdominal radiographs** in UC?
**Used in patients with severe colitis to look for significant colonic dilation**
37
**Resection of more than 100 cm of terminal ileum** in the treatment of Crohns Disease may lead to what? What is recommended for this?
**Fat malabsorption**
* **low fat diet recommended**
* **parenteral vitamin B12 recommended**
38
What considerations must be made with **involvement of the terminal ileum in Crohn’s Disease or prior ileal resection**?
**There will be a reduced absorption of bile acids that may induce _secretory diarrhea_ from the colon**
39
**Patients with extensive ileal disease requiring more than 100 cm of ileal resection see what as a consequence?**
**Steatorrhea**
**Severe bile salt malabsorption leading to steatorrhea**
40
**Patients with extensive ileal disease requiring more than 100 cm of ileal resection should not be given what?**
**Bile-salt binding agents because these will exacerbate steatorrhea**
41
**In patients with extensive ileal disease requiring more than 100 cm of ileal resection bile salt-binding agents should not be given because of the tendency to exacerbate steatorrhea.** Why is this the case?
Unabsorbed fatty acids bind w/ calcium, reducing its absorption and enhancing the absorption of oxalate
**Oxalate kidney stones may develop**
**cholesterol gallstones may develop (decrease bile salts)**
42
In severe inflammatory bowel disease glucocorticoids are a treatment. What are the **adverse events** that commonly occur during short-term systemic therapy?
* **Mood changes**
* **insomnia**
* **buffalo hump - edema**
* **weight gain (striae)**
* **Increased serum glucose**
* **acne**
* **moon facies**
43
In the treatment of inflammatory bowel disease **5-ASA** **(mesalamine)** can be used to **maintain UC remission**. What is an important side effect of the compound to be aware of?
**Acute interstitial nephritis**
44
In the treatment of inflammatory bowel disease **AZO compounds (sulfasalazine)** can be used to maintain UC remission. What is important to note about the administration of this drug?
**Always administer with folate**
45
What is a **curative** treatment for ulcerative colitis?
Procto-Colectomy w/ ileostomy
46
What is a biological treatment used in inflammatory bowel disease?
**Monoclonal antibodies to TNF and Integrin**
47
Biological used in the treatment of inflammatory bowel disease include **antibodies to TNF and integrin**. Tests need to be performed prior to okaying the use of these agents in treatment. What tests need to be run?
**Screening for latent tuberculosis (PPD and Chest-XR)**
* Tx: puts patients at increased risk of TB development
**Liver biochemical tests should be monitored**
* Anti-TNF/Integrin can cause severe hepatic reactions leading to _acute hepatic failure_
48
Anti-TNF therapy is one of two biological (anti-integrin) used in the treatment of inflammatory bowel disease. What does administration of **anti-TNF** **(usually combined with thiopurine)** specifically increase the risk of in the patient?
* **Non-melanoma skin cancer**
* **non-Hodgkin lymphoma**
49
Immunomodulators in addition to biologics, sulfasalazine/aminosalicylates, and glucocorticoids can be used to treat inflammatory bowel disease. Immunomodulators such as **azathioprine** or **6-mercaptopurine (6-MP)** are _steroid-sparing_ agents used in the treatment of CD and UC. What must be done prior to treatment?
**Measurement of TPMT thiopurine methyltransferase functional activity recommended prior to initiation**
50
Due to **high risk of** _______ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_, prophylaxis should be administered to all hospitlizaed IBD patients
**High risk of venous thromboembolic disease**
