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Clinical Med III > Exam 1 - IBD, Celiac Disease > Flashcards

Exam 1 - IBD, Celiac Disease Flashcards

1
Q

What is the definition of IBD?

A

Crohn Disease + Ulcerative Colitis

- Chronic relapsing/remitting inflammatory conditions of the GI tract

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2
Q

What age group is most commonly affected by IBD?

A

15-35 years old, but with bimodal with second peak at 50-80 years old

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3
Q

How does smoking affect the risk of CD versus UC?

A

CD: Increases risk

UC: Decreases risk

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4
Q

Does the following presentation match with CD or UC?

  • Limited to colon, involves rectum
  • Extends proximally with continuous, circumferential involvement
  • Mucosal layer inflammation
A

UC

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5
Q

Does the following presentation match with CD or UC?

  • GI tract from mouth to anus
  • Patchy/skip lesions
  • Transmural inflammation
A

CD

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6
Q

What is the most common extent of involvement in CD?

A

Ileitis (Ileum)

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7
Q

Due to CD being transmural, what can this lead to?

A

Penetrating disease causing ulcers, strictures, fistulas, and abscesses.

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8
Q

What are the different fistulas that can develop from CD?

A
  • Enteroenteric: bowel to bowel
  • Enterovesical: bowel to bladder
  • Enterovaginal: bowel to vagina
  • Enterocutaneous: bowel to skin
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9
Q

Differentiate mild CD from severe CD?

A

Mild: inflammation

Severe: inflammation, strictures, fistula

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10
Q

What is the common symptom associated with CD?

A

Abdominal pain

  • RLQ pain/tenderness
  • Tender, palpable RLQ mass if abscess
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11
Q

What nutritional deficiencies can CD be associated with?

A
  • B12 deficiency (if terminal ileum involvement)

- Iron

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12
Q

What is the most common extra-intestinal manifestation of IBD?

What are some others that are related to CD?

A
  • Arthralgias (most common)
  • Oral aphthous ulcers
  • Episcleritis, iritis, uveitis
  • Erythema nodosum
  • Pyoderma gangrenosum
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13
Q

What should always be ordered for diagnostic evaluation of CD?

A
  • Colonoscopy with TI intubation

- (+/-) EGD

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14
Q

What will be found on colonoscopy to support the diagnosis of CD?

A
  • Skip lesions
  • Ulcerations, cobblestoning
  • Biopsy shows granulomas
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15
Q

What is a hallmark finding on colonoscopy for CD?

A

Ulcerations, cobblestoning

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16
Q

What will be found on UGI with SBFT that is suggestive of CD?

A

String sign

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17
Q

What are some possible complications of CD?

A
  • Colon cancer
  • Intestinal strictures, abdominal and perianal fistulas, abscess
  • Malabsorption (B12, iron)
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18
Q

What should be done in regards to monitoring in a patient with CD and UC?

A

Colonoscopy recommended every 1-2 years beginning 8 years after disease/symptom onset due to risk of colon cancer

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19
Q

Differentiate mild UC from severe UC.

A

Mild: < 4 stools daily, no systemic toxicity

Severe: > 6 stools daily, systemic toxicity

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20
Q

What are some common symptoms associated with UC?

A
  • Abdominal pain (periumbilical/LLQ)
  • Bloody diarrhea
  • Fecal urgency, tenesmus, rectal bleeding
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21
Q

What is the most common extra-intestinal manifestation of IBD?

What are some others that are related to UC?

A
  • Arthralgias (most common)
  • Sclerosing cholangitis (Alk. phos)
  • Episcleritis, iritis, uveitis
  • Erythema nodosum
  • Pyoderma gangrenosum
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22
Q

What should always be ordered for diagnostic evaluation of UC?

A

Flex sigmoidoscopy or colonoscopy

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23
Q

What will be found on Flex sigmoidoscopy or colonoscopy to support the diagnosis of UC?

A
  • Inflammation that begins distally and spreads proximally
  • Continuous circumferential pattern with no skip lesions
  • Superficial inflammation: erythematous, exudate, friability/erosions
  • Biopsy shows crypt abscesses
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24
Q

What are some possible complications of UC?

A
  • Colon cancer
  • Hemorrhage
  • Toxic Megacolon (colonic dilation > 6 cm with signs of toxicity)
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25
Q

What are the medical therapies for IBD?

A
  • Salicylates (5-ASA)
  • Corticosteroids
  • Immunomodulators
  • Biologics
  • Antibiotics (for CD)
26
Q

Salicylates (5-ASA):

MOA?

Indications:

Side effects:

A

MOA: Anti-inflammatory effects

Indications: Mild to moderate UC (primarily) and CD (less efficacy)

SE: Nausea, diarrhea, kidney injury, pancreatitis

27
Q

Corticosteroids:

MOA?

Indications:

Side effects:

A

MOA: Anti-inflammatory effects; suppress immune activity

Indications: Flares in UC and CD (appropriate for short-term use, not maintenance; require slow taper)

Side effects (specifically for Prednisone): weight gain, worsening of DM, increased infection risk, osteoporosis, adrenal insufficiency, psychosis, mood changes

28
Q

If prescribing Prednisone for UC/CD flares, what are some recommendations?

A
  • Consider bone density (DEXA scan) in patients with IBD with lifetime use of steroids for 3 months or more
  • Calcium and Vitamin D supplementation should be administered to help offset concern for osteoporosis
29
Q

Immunomodulators:

MOA?

Indications:

A

MOA: Modifies immune system activity; decreases inflammatory response

Indication: Moderate to severe UC and CD; steroid sparing agent; can be used in combination with biologics to prevent immunogenicity

30
Q

What are the requirements/important notes for the specific immunomodulators?

What is the main side effect of Methotrexate?

A

Thiopurines, Imuran:

  • Systemic risks
  • Optimal response takes 3-6 months
  • Genetic testing required to determine patient metabolism of drug

Methotrexate:

  • Require folate supplementation
  • Tetratogenic
31
Q

What are the systemic risks associated with the immunomodulators: Thiopurines (6MP) and Imuran (Azathioprine)?

A
  • Bone marrow suppression
  • Pancreatitis
  • Hepatotoxicity
  • Non-Hodgkin lymphoma
  • HPV-related cervical dysplasia
  • Non-melanoma skin cancer
32
Q

What are the recommendations associated with the immunomodulators: Thiopurines (6MP) and Imuran (Azathioprine)?

A
  • Frequent monitoring of CBC and liver tests due to risk of bone marrow suppression and hepatotoxicity
  • Annual dermatologic exams due to risk of skin cancer
  • Up to date on cervical cancer screening due to possible cervical dysplasia
  • Avoid live vaccines
33
Q

Biologics (Anti-TNFs):

MOA?

Indications:

A

MOA: Modulates immune response; prevents intestinal inflammation, improves mucosal healing

Indications: Moderate to severe IBD; steroid sparing

34
Q

What are the systemic risks associated with the Biologics (Anti-TNFs)?

A
  • Reactivation of TB and HBV
  • Non-melanoma skin cancer
  • Non-Hodgkin lymphoma
  • Secondary infections
35
Q

What are contraindcations for using Biologics (Anti-TNFs)?

A
  • Active infection
  • History of CHF
  • MS/optic neuritis
36
Q

When are antibiotics indicated for treatment of CD?

Which abx are used?

A

Perianal disease (fistulas, abscess)

Cipro and Flagyl (Metronidazole)

37
Q

What are side affects of Cipro?

A
  • Tendinitis (tendon rupture)
  • Photosensitivity
  • Prolongation of QT interval
38
Q

What are side affects of Flagyl (Metronidazole)?

A
  • Peripheral neuropathy
  • Metallic taste
  • Disulfiram rxn (avoid alcohol while on therapy and 3 days thereafter)
39
Q

What are some IBD red flags indicating a need for emergent evaluation?

A
  • Severe bleeding
  • Severe abdominal pain (peritoneal signs)
  • Inability to tolerate PO
  • Signs of dehydration (creatinine, tachycardia, hypotension)
  • Signs of obstruction
40
Q

What are some indications for surgery for IBD?

A
  • Severe hemorrhage
  • Perforation
  • Dysplasia/Cancer
  • Medical refractory disease
41
Q

What are some important considerations when considering IBD?

A
  • Always check stool studies for those developing diarrhea

- Avoid NSAIDs (can exacerbate disease activity)

42
Q

Colonoscopy reveals ulcerations and cobblestoning. What is the likely diagnosis?

A

CD

43
Q

Biopsy of the colon reveals crypt absccess. What is the likely diagnosis?

A

UC

44
Q

What medication option should be used for flares of UC and CD?

A

Steroids

45
Q

What is the 1st line treatment for mild/moderate UC?

A

Oral and topical 5-ASA

46
Q

What is the treatment for moderate/severe UC and CD?

A

Immunomodulators alone or in combination with biologics

47
Q

Are antibiotics used in CD or UC?

A

CD for intestinal and/or perianal abscess/fistula

48
Q

Are the following complications associated with UC or CD?

  • Toxic megacolon
  • Colon cancer
A

UC

49
Q

Biopsy of the colon revealed granulomas. What is the likely diagnosis?

A

CD

50
Q

Are the following complications associated with UC or CD?

  • Abscess
  • Strictures
  • Fistulas
  • Perforation
  • Obstruction
  • Colon cancer
  • Malabsorption
A

CD

51
Q

What is Celiac disease?

A

Immune-mediate disease triggered by the ingestion of gluten (wheat, rye, barley)

52
Q

Describe the pathophysiology behind Celiac disease.

A

Small intestine exposure to gluten leads to mucosal inflammation, crypt hyperplasia, and villous atrophy. This villous atrophy then leads to loss of absorptive surface capacity and small bowel malabsorption.

53
Q

What are the “classic” symptoms associated with Celiac disease?

A
  • Diarrhea
  • Steatorrhea
  • Flatulance/bloating
  • Weight loss
54
Q

What extra-intestinal manifestationi is pathognomonic of Celiac disease?

A
  • Dermatitis Herpetiformis
55
Q

What are some extra-intestinal manifestations associated with Celiac disease?

A
  • Dermatitis Herpetiformis
  • Nutrient deficiencies (Iron, B vitamins)
  • Osteopenia/Osteoporosis (Vitamin D, Calcium deficiencies)
  • Transaminase elevation
  • Reproductive disorders
  • May see FTT in kids
56
Q

What does the diagnostic evaluation for Celiac disease consist of?

A
  • Serology and Biopsy of the small intestine while on a gluten containing diet
  • EGD with duodenal biopsy
57
Q

What is the gold standard diagnostic study for Celiac disease?

A

EGD with duodenal biopsy

58
Q

What will be seen on Serology and Biopsy of the small intestine which would support the diagnosis of Celiac disease?

A
  • IgA tissue transglutaminase (tTG Ab) (primary)
  • IgA endomysial (EMA Ab titer)
  • Deamidated Gliadin Peptide (DGP)
59
Q

What will be seen on EGD with duodenal biopsy which would support the diagnosis of Celiac disease?

A
  • Villous atrophy
  • Intraepithelial lymphocytes
  • Crypt hyperplasia
60
Q

What is the management of Celiac disease?

A

Gluten free diet (removal of wheat, rye, barley)
- Common foods: fresh fish, meat, poultry, milk, fruits/vegetables

Supplements as needed:
- Folate, iron, zinc, calcium, B12, vitamin D

61
Q

What are some complications associated with Celiac disease?

A

Diseases associated with malabsorption:

  • Iron deficiency anemia
  • B vitamin deficiency
  • Osteoporosis

Slight increased risk of malignancy:

  • Non-Hodgkin lymphoma
  • GI malignancies
62
Q

EGD with duodenal biopsy revealed the following:

  • Villous atrophy
  • Intraepithelial lymphocytes
  • Crypt hyperplasia

What is the likely diagnosis?

A

Celiac disease?

Clinical Med III (12 decks)

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