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Clin Med 3 > E1: IBD And Celiac Disease > Flashcards

E1: IBD And Celiac Disease Flashcards

1
Q

What parts of the body are involved in Crohn’s disease?

A

-Can affect the entire GI tract from mouth to anus with skip lesions

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2
Q

What is the most common place for Crohn’s disease?

A

Ileum (ileitis)

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3
Q

What is the severity of Crohn’s disease?

A
  • The disease is transmural and effects the entire thickness of mucosa
  • owes to penetrating disease and may cause ulcer, stricture, fistula, and abscess
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4
Q

What is it called when a fistula goes from bowel to bowel?

A

Enteroenteric

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5
Q

What is it called when a fistula goes from bowel to bladder?

A

Enterovesical

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6
Q

What is it called when a fistula goes from bowel o vagina?

A

Enterovaginal

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7
Q

What is it called when a fistula goes from bowel to skin?

A

Enterocutaneous

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8
Q

What is the difference between mild, moderate, and severe Crohns?

A
  • Mild: inflammation
  • Moderate: inflammation, strictures
  • severe: inflammation, strictures, and fistula
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9
Q

If a patient has T1 involvement of Crohn’s disease, what deficiency are they at increased risk for?

A

B12

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10
Q

What are the extra-intestinal manifestations of Crohn’s disease? Which is most common?

A 
Arthralgia (most common
Oral aphthous ulcers
Episcleritis
Erythema nodosum
Pyoderma gangrenosum
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11
Q

What labs can help diagnose CD?

A
  • CBC, CMP, ESR/CRP, possible IBD specific antibodies

- stool cultures, C diff toxin, and fecal cal protection or lactoferrin

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12
Q

If a patient has evidence of CD on colonoscopy what should you do next?

A

EGD

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13
Q

What can you seen on colonoscopy that is indicative of CD?

A
  • Skip lesions
  • ulcerations, cobblestoning
  • possible fistulas
  • rectal sparing
  • biopsy shows granulomas
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14
Q

What will you see on UGI with SBFT that is indicative of CD?

A

String sign

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15
Q

What are the possible complications associated with CD?

A
  • Colon cancer (colonoscopy recommended very 1-2 years beginning 8 years after disease symptom onset)
  • intestinal strictures, abdominal and perinatal fistula, abscess (may present with SBO and perforation)
  • malabsorption
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16
Q

What areas are involved in UC?

A

Affects the colon only in a continuous circumferential pattern

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17
Q

What is the severity of UC?

A

Disease affects mucosal surface of colon only, can cause friability, erosions, and bleeding

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18
Q

What is the difference between mild, moderate, and severe UC?

A

Mild: 4 stools daily, no systemic toxicity
Moderate: >4 stools daily, anemia, low grade fever
Severe: >6 stools daily, systemic toxicity

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19
Q

What is the clinical presentation of UC?

A
  • possible fever, chills, weight loss
  • possible vomiting
  • periumbilical/LLQ abdominal pain
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20
Q

What are the extra-intestinal manifestations of UC? What is the most common?

A
  • Arthralgias (most common)
  • sclerosing cholangitis
  • episcleritis
  • erythema nodosum
  • pyoderma gangrenosum
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21
Q

What kind of scope is used to diagnose UC?

A

Flex sig or colonoscopy

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22
Q

What can you see on flex sig or colonoscopy that is suggestive of UC?

A
  • Inflammation begins distally, spreads proximally
  • continuos circumferential pattern, no skip lesions
  • superficial inflammation
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23
Q

What will you see on biopsy that is suggestive of UC?

A

Crypt abscesses

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24
Q

What are the possible complications of UC?

A
  • Colon cancer (colonoscopy recommended very 1-2 years beginning 8 years after disease/symptom onset)
  • Hemorrhage
  • toxic megacolon
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25
Q

What is toxic megacolon?

A

-Colonic dilation >6cm with signs of toxicity

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26
Q

What are the pharmacologic treatment options for IBD?

A
  • Salicylates (5-ASA)
  • corticosteroids
  • immunomodulators
  • Biologics
  • Antibiotics (CD with perinatal disease)
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27
Q

What is the MOA of 5-ASA?

A

-Anti-inflammatory effects, used for mild to moderate UC and CD

28
Q

What kind of drugs are sulfasalazine and mesalamine?

A

5-ASA

29
Q

What are the side effects of 5-ASAs?

A

Nausea, diarrhea, kidney injury, and pancreatitis

30
Q

What is the MOA of corticosteroids?

A

-anti inflammatory effects, suppress immune system activity. Flares in UC and CD

31
Q

How are corticosteroids used for UD and CD?

A

Used for flares, appropriate for short-term use, NOT maintenance
-requires slow taper

32
Q

What are the side effects of oral prednisone?

A

-mood changes, insomnia, weight gain, worsening of DM, increased infection risk, osteoporosis, psychosis, adrenal insuffiency

33
Q

What kind of study is recommended for patient with IBD and lifetime use of steroids for ≥ 3 months?

A

DEXA scan

34
Q

What kind of supplementation should be offered with long term prednisone therapy?

A

Calcium and vitamin D

35
Q

What kind of drug is Entocort and what does it treat?

A

Corticosteroid ( Oral budesonide), treats CD ileocecal disease

36
Q

What kind of drug is uceris and what is it used for?

A

Corticosteroid (oral budenoside), treats UC

37
Q

What is the MOA of immunomodulators?

A

-Modifies the immune system activity, decreases inflammatory response

38
Q

How are immunomodulators used in the treatment of UC and CD?

A

-used for moderate-severe UD and CD, steroid sparing agent, and can be used in combo with biologics to prevent immunogenicity

39
Q

What kind of drugs are thiopurines (6MP and azathioprine) , and methotrexate?

A

Immunomodulators

40
Q

What kind of supplementation does methotrexate require?

A

Folate

41
Q

What are the side effects of 6MP and azathioprine?

A

Bone marrow suppression, secondary infection, pancreatitis, hepatotoxicity, non Hodgkin lymphoma, and non-melanoma skin cancer

42
Q

What tests should you frequently test in someone taking 6MP or azathioprine?

A
  • frequent monitoring of CBC and liver tests
  • annual dermatologic exam
  • UTD on cervical CA screening
43
Q

What is the MOA of biologics (Anti-TNF)?

A

-Modulates immune response, prevents intestinal inflammation, improves mucosal healing

44
Q

What kind of drugs are infliximab, adalimumab, golimumab, certolizumab and what are they used for?

A
  • biologics (Anti-TNFs)
  • infliximab (UC and CD)
  • Adalimumab (UD and CD)
  • Golimumab (UC)
  • Certolizumab (CD)
45
Q

What should you test for prior to starting someone on Anti-TNFs?

A
  • PPD, quantierfon TB gold, CXR to assess for TB

- HepBsAg, HepBsAb, to assess for HBV

46
Q

What are the associated risks with Anti-TNFs?

A
  • Secondary infection
  • Risk of reactivating of TB and HBV
  • Malignancies (Non melanoma skin cancer and Non- Hodgkins)
47
Q

What are the contraindications for Anti-TNFs?

A
  • Active infection
  • history of CHF
  • MS/optic neuritis
48
Q

What should you monitor in someone taking Anti-TNFs?

A
  • Check a regular CBC, and CMP

- annual derm exams

49
Q

What is the MOA of Vedolizumab and Ustekinumab?

A

Modulates immune response and prevents intestinal infections

50
Q

What are the indications for Vedolizumab and ustekinumab?

A

Considered in patients with inadequate or loss response to conventional therapies

51
Q

What antibiotics are used for CD in perianal disease?

A

Cipro and flagyl

52
Q

What are the red flag symptoms for IBD?

A

-severe bleeding (anemia), severe abdominal pain (peritoneal signs), inability to tolerate PO, signs of dehydration, signs of obstruction

53
Q

What are the indications for surgery with IBD?

A

-Severe hemorrhage, perforation, dysplasia, and medical refractory disease

54
Q

What medications should people with IBD avoid?

A

NSAIDs, may exacerbate disease activity

55
Q

What is celiac disease?

A

Immune mediated disease triggered by the ingestion of gluten in genetically susceptible individuals

56
Q

What happens when people with celiacs ingest gluten?

A
  • it may cause mucosal inflammation, crypt hyperplasia, and abnormal villus architecture
  • villus atrophy of the small intestine and loss of absorptive surface capacity and small bowel malabsorption
57
Q

What are the genes associated with celiac disease?

A

HLA DQ2 and HLA DQ8

58
Q

What is the clinical presentation of celiac?

A
  • Classic malabsorptive symptoms (diarrhea, flatulence, bloating)
  • Atypical GI symptoms (abdominal pain, constipation, dyspepsia)
  • Silent (may present with extra-intestinal manifestations)
59
Q

What are some of the extra-intestinal manifestations associated with celiac disease?

A
  • Dermatitis herpetiformis
  • nutrient deficiency
  • osteopenia/osteoporosis
  • transaminase elevation
  • FFT in kids
  • reproductive disorders
60
Q

What is dermatitis herpetiformis?

A

A chronic inflammatory diseases that produces lesions that burn and itch intensely.
The lesions are erythematous and slightly popular, form small pustules/vesicles

61
Q

What is the gold standard for diagnosing celiac disease?

A

EDG with duodenal biopsy

62
Q

What blood tests can be performed to test for celiac?

A
  • IgA tissue transglutaminase (tTG Ab) (primary)
  • IgA endomysial
  • Deamidated Gliadin Peptide
  • ** These must be performed while on a gluten containing diet
63
Q

What might you see on EDG that is suggestive of celiac disease?

A

-Villous atrophy , enlarged hyperplastic crypts, and increased infiltration of lymphoid cells in the lamina proprietary and epithelium

64
Q

What is the management of Celiac disease?

A
  • Gluten free diet

- supplementation PRN (folate, Iron, zinc, calcium, B12)

65
Q

What are some complications associated with celiac disease?

A
  • Disease associated with malabsorption (IDA, osteoporsis)

- Slight increased risk of malignancy (non Hodgkins and GI malignancy)

Clin Med 3 (17 decks)

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