Exam 4 - IBD Flashcards
Location of UC vs CD?
UC=Colon/rectum
CD=entire GIT
Depth UC vs CD?
UC=Superficial
CD=Transmural
UC vs CD colonoscopy?
UC=continous inflammation, pseudopolyps
CD=”cobblestone” skip lesions
Rectal bleed, bloody/watery diarrhea in UC or CD?
UC
Fatigue, abd pain, feveral in UC or CD?
CD
Toxic megacolon and colon cancer in UC or CD?
UC
Perianal dz and fistula in UC or CD?
CD
UC or CD and surgery?
UC=cutative
CD=variable, usually not curative
Nicotine makes UC and CD worse or better?
UC=better
CD=worse
Intestinal perf with UC or CD?
UC
Intestinal obstruction with UC or CD?
CD
UC or CD has more extraintestinal manifestations?
UC (bone/joint, eyes, skin, DVT/PE)
What to assess in IBD?
Location and severity
Mild UC vs Fulminant UC bowels/day?
Mild CD <4
Fulminant ≥10
Bloody stools in Mild UC? In Moderate to Fulminant?
Possibly in Mild. Yes in Moderate to Fulminant.
HgB in Mild UC vs Moderate UC?
Mild=normal
Moderate= >10.5
HgB in Severe UC vs Fulminant UC?
Severe= <10.5 Fulminant= <8 (transfuse!)
Chrons Disease Activity Index below 150? Above 450?
<150=Remission. ASx.
>450=Severe/Fulminant. Highly sx despite steroid and biologic tx.
Tx for Fistulizing CD?
Infliximab for cutaneous/external fistula. May need surgery.
Tx for Perianal CD?
Drain abscess if present. Consult GI/surgery. Metronidazole +/- cipro. Use immunosuppressants/biologics.
Tx for Mild-Moderate UC not in entire colon (proctitis, proctosigmoiditis, or distal colitis) to induce remission?
- Topical aminosal
- Caombine w/PO aminosal
- Topical/PO steroid
- Anti-TNF +/- AZA/6MP or MTX
Tx for Mild-Moderate UC in entire colon to induce remission?
- PO Aminosal +/- topical
- Topical/PO steroids
- Anti-TNF +/- AZA/6-MP or MTX
Mild to Moderate UC bowel movements per day?
4-6/day
Severe to Fulminant UC bowel movements per day?
7-10/day
Tx for Severe-Fulminant UC to induce remission?
- IV steroids 3-7 days
- IV Remicade (Anti-TNF) or IV Entyvio (Anti-alpha 4) +/- AZA/6-MP or MTX
- IV Cyclosporine
- Colectomy (last time)
Last-line tx for severe-fulminant UC?
Colectomy
UC maintenance on steroids switch to?
Consider transition from steroids to biologic (Anti-TNF, Anti-alpha-4) +/- immunomodulator (AZA, MTX, Cyclo)
Use Tysabri in UC?
Nope, but can use Entyvio.
When to reassess for symptomatic response in UC?
4-8 weeks
Mild-Moderate CD in Ileum or R Colon? (CDAI 150-220)
- Budesonide
2. PO Aminosal or other PO steroid
Mild-Moderate CD not in Ileum or R Colon?
- PO Aminosal
2. PO Steroid
Inducation for Moderate-Severe CD in Ileum or R Colon? (CDAI 220-450)
- PO steroid for 28 days
- Anti-TNF (Remicaide, Humira, etc)
- Anti-alpha-4 (Entyvo»Tysabri)
Maintenance for Moderate-Severe CD in Ileum or R Colon? (CDAI 220-450)
- Steroid to AZA/6-MP or MTX
2. Continue biologic if used for induction. AZA mono tx bad idea. Inflix +/- AZA good idea!
Severe to Fulminant CD tx?
- IV steroid x3 days
- IV Cyclosporine
- Biologic (no evidence helps)
- Surgery
Tx for Fistulizing CD?
Remicade
Use Tysabri in CD?
No!
What to test before and during Tysabri use? How often retest?
JVC-antibodies.
Test q6m if negative and stop if suddenly positive. If positive at baseline only use for 9-12mo max!
When to d/c Tysabri?
Test positive for JCV at 6 month check.
Only use for 9-12mo max is positive at baseline.
