EXAM #1: INFLAMMATORY BOWEL DISEASE Flashcards
What is IBD?
Dysregulated response of the intestinal mucosa to otherwise innocuous luminal antigens
What are the two major diseases that make-up IBD?
1) Ulcerative Colitis
2) Crohn’s Disease
What are the “other” minor diseases associated with IBD?
1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis
What are the characteristic features of UC?
- Diffuse mucosal inflammation
- Limited to colon
What are the characteristic features of CD?
- Patchy transmural inflammation
- May affect any part of the GI tract, but most commonly ileum
What are the alternate causes of colitis other than UC and CD?
1) Radiation
2) Ischemia
3) Medications
What environmental factor is protective in UC and a risk factor for CD?
Smoking
- Protective in UC
- Risk factor for CD
What surgical procedure is protective against UC?
Appendectomy
What are the different processes that lead to the development of IBD?
1) Persistent infection
2) Defective mucosal integrity
3) Dysbiosis (imbalance between protective and aggressive flora)
4) Dysregulated immune response
What lymphocyte system plays the biggest role in the development of IBD?
T-lymphocytes
Which type of T-cell response is associated with CD?
Th1
Which type of T-cell response is associated with UC?
Th2
What is the genetic influence on IBD?
Familial occurrence that is POLYGENIC
Describe the typical clinical presentation of UC.
- Bloody diarrhea= most common symptom
- Recal discomfort
- Fecal urgency
- Abdominal cramping
Where does UC start?
Begins in the rectum and extends proximally
What is Proctitis?
UC involving rectum only
What is Proctosigmoiditis?
UC involving rectum and sigmoid colon
What is Extensive disease in UC?
UC extending into transverse colon
What is pancolitis?
UC involving the entire colon/
What is a “lead pipe sign” pathogmnemonic for?
UC
Are obstruction and fistulization associated with CD or UC?
CD
Small bowel involvement of IBD leads to what diagnosis?
CD
Describe the typical clinical presentation of CD.
- Abdominal pain (RLQ)
- Diarrhea
- Low grade fever
- Anorexia
What are clinical signs of obstruction seen in CD?
- Post-parandial cramps
- Abdominal distention
- Borborygmi
- Vomiting
- Weight loss from food avoidance
What are clinical signs of an enterovesical fistula?
1) Recurrent UTI
2) Pneumaturia (air w/ urination)
Describe the gross appearance of CD.
“Cobblestone mucosa”
What are the distinguishing features of CD?
1) Granuloma formation
2) Skip lesions
3) Fistulization
3) Small bowel involvement
4) Perianal disease
What are the extraintestinal manifestation of IBD?
- Aphthous stomatitis (CD)
- Episcleritis and uveitis
- Arthritis
- Vascular complications
- Erythema nodosum
- P. gangrenosum
Why are patients with IBD at risk for osteopenia?
1) Inflammation/ cytokines
2) IBD medications i.e. corticosteroids
What is primary sclerosing cholangitis?
Disease of bile ducts that causes inflammation and obliterative fibrosis
Seen most often with UC
What are the major categories of medications that are used to manage IBD?
1) Aminosalicylates
2) Corticosteroids
3) Immunomodulators
4) Antibiotics
5) Supportive agents
How is remission induced in UC?
1) Aminosalicylates
2) Corticosteroids
3) 6MP/ Azathioprine
4) Cyclosporine
How is remission maintained in UC?
1) Aminosalicylates
2) 6MP/ Azathioprine
How does the management of CD significantly differ from UC?
Addition of Antibiotics
What are the indications for Metronidazole?
1) Active Crohn’s
2) Perineal disease
3) Post-op Crohn’s
4) Pouchitis
What are the adverse effects of Metronidazole?
Nausea Metallic taste Furry tongue Candidiasis Peripheral neuropathy
What are the indications for topical corticosteroids?
Proctitis
Left-sided colitis
What are the indications for systemic corticosteroids?
Moderate to severe UC or CD
What are the indications for parenteral corticosteroids?
Severe/ toxic UC or CD
What are the adverse effects of 6MP/ Azathioprine?
1) Hypersensitivity
2) Bone marrow suppression
3) Opportunistic infection
4) Lymphoma risk
What are the indications for surgery in UC?
1) Severe bleeding
2) Perforation
3) Cancer/ dysplasia
4) Unresponsive acute disease
What are the surgical option is the standard of care for UC today?
Ileal pouch-anal anastamosis (most common)
What are the indications for surgery in CD?
1) Perforation
2) Hemorrhage
3) Cancer/ dysplasia
4) High grade obstruction risk
What is the preferred surgical procedure for a stricture in CD?
Strictureplasty
