EXAM #1: INFLAMMATORY BOWEL DISEASE Flashcards

1
Q

What is IBD?

A

Dysregulated response of the intestinal mucosa to otherwise innocuous luminal antigens

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2
Q

What are the two major diseases that make-up IBD?

A

1) Ulcerative Colitis

2) Crohn’s Disease

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3
Q

What are the “other” minor diseases associated with IBD?

A

1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis

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4
Q

What are the characteristic features of UC?

A
  • Diffuse mucosal inflammation

- Limited to colon

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5
Q

What are the characteristic features of CD?

A
  • Patchy transmural inflammation

- May affect any part of the GI tract, but most commonly ileum

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6
Q

What are the alternate causes of colitis other than UC and CD?

A

1) Radiation
2) Ischemia
3) Medications

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7
Q

What environmental factor is protective in UC and a risk factor for CD?

A

Smoking

  • Protective in UC
  • Risk factor for CD
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8
Q

What surgical procedure is protective against UC?

A

Appendectomy

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9
Q

What are the different processes that lead to the development of IBD?

A

1) Persistent infection
2) Defective mucosal integrity
3) Dysbiosis (imbalance between protective and aggressive flora)
4) Dysregulated immune response

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10
Q

What lymphocyte system plays the biggest role in the development of IBD?

A

T-lymphocytes

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11
Q

Which type of T-cell response is associated with CD?

A

Th1

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12
Q

Which type of T-cell response is associated with UC?

A

Th2

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13
Q

What is the genetic influence on IBD?

A

Familial occurrence that is POLYGENIC

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14
Q

Describe the typical clinical presentation of UC.

A
  • Bloody diarrhea= most common symptom
  • Recal discomfort
  • Fecal urgency
  • Abdominal cramping
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15
Q

Where does UC start?

A

Begins in the rectum and extends proximally

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16
Q

What is Proctitis?

A

UC involving rectum only

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17
Q

What is Proctosigmoiditis?

A

UC involving rectum and sigmoid colon

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18
Q

What is Extensive disease in UC?

A

UC extending into transverse colon

19
Q

What is pancolitis?

A

UC involving the entire colon/

20
Q

What is a “lead pipe sign” pathogmnemonic for?

A

UC

21
Q

Are obstruction and fistulization associated with CD or UC?

A

CD

22
Q

Small bowel involvement of IBD leads to what diagnosis?

A

CD

23
Q

Describe the typical clinical presentation of CD.

A
  • Abdominal pain (RLQ)
  • Diarrhea
  • Low grade fever
  • Anorexia
24
Q

What are clinical signs of obstruction seen in CD?

A
  • Post-parandial cramps
  • Abdominal distention
  • Borborygmi
  • Vomiting
  • Weight loss from food avoidance
25
Q

What are clinical signs of an enterovesical fistula?

A

1) Recurrent UTI

2) Pneumaturia (air w/ urination)

26
Q

Describe the gross appearance of CD.

A

“Cobblestone mucosa”

27
Q

What are the distinguishing features of CD?

A

1) Granuloma formation
2) Skip lesions
3) Fistulization
3) Small bowel involvement
4) Perianal disease

28
Q

What are the extraintestinal manifestation of IBD?

A
  • Aphthous stomatitis (CD)
  • Episcleritis and uveitis
  • Arthritis
  • Vascular complications
  • Erythema nodosum
  • P. gangrenosum
29
Q

Why are patients with IBD at risk for osteopenia?

A

1) Inflammation/ cytokines

2) IBD medications i.e. corticosteroids

30
Q

What is primary sclerosing cholangitis?

A

Disease of bile ducts that causes inflammation and obliterative fibrosis

Seen most often with UC

31
Q

What are the major categories of medications that are used to manage IBD?

A

1) Aminosalicylates
2) Corticosteroids
3) Immunomodulators
4) Antibiotics
5) Supportive agents

32
Q

How is remission induced in UC?

A

1) Aminosalicylates
2) Corticosteroids
3) 6MP/ Azathioprine
4) Cyclosporine

33
Q

How is remission maintained in UC?

A

1) Aminosalicylates

2) 6MP/ Azathioprine

34
Q

How does the management of CD significantly differ from UC?

A

Addition of Antibiotics

35
Q

What are the indications for Metronidazole?

A

1) Active Crohn’s
2) Perineal disease
3) Post-op Crohn’s
4) Pouchitis

36
Q

What are the adverse effects of Metronidazole?

A
Nausea 
Metallic taste 
Furry tongue 
Candidiasis 
Peripheral neuropathy
37
Q

What are the indications for topical corticosteroids?

A

Proctitis

Left-sided colitis

38
Q

What are the indications for systemic corticosteroids?

A

Moderate to severe UC or CD

39
Q

What are the indications for parenteral corticosteroids?

A

Severe/ toxic UC or CD

40
Q

What are the adverse effects of 6MP/ Azathioprine?

A

1) Hypersensitivity
2) Bone marrow suppression
3) Opportunistic infection
4) Lymphoma risk

41
Q

What are the indications for surgery in UC?

A

1) Severe bleeding
2) Perforation
3) Cancer/ dysplasia
4) Unresponsive acute disease

42
Q

What are the surgical option is the standard of care for UC today?

A

Ileal pouch-anal anastamosis (most common)

43
Q

What are the indications for surgery in CD?

A

1) Perforation
2) Hemorrhage
3) Cancer/ dysplasia
4) High grade obstruction risk

44
Q

What is the preferred surgical procedure for a stricture in CD?

A

Strictureplasty