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Bloc E - GI & Metabolism > Feb21 M1-IBD and Celiac > Flashcards

Feb21 M1-IBD and Celiac Flashcards

1
Q

**ulcerative colitis vs crohn’s: depth

A 
UC = mucosal
crohn's = transmural
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2
Q

**UC vs crohn’s pattern

A 
UC = contiguous
Crohn's = skips areas
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3
Q

**UC vs Crohn’s location

A

UC: rectum

Crohn’s: mouth to anus (rectum spared)

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4
Q

**UC vs Crohn’s rectum involvement

A

UC: rectum involved

Crohn’s: rectum spared

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5
Q

**UC vs Crohn’s ileum involvement

A

UC: none (or rarely backwash)

Crohn’s: common

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6
Q

**UC vs Crohn’s: presence of fistula or abcess

A

UC: no

Crohn’s: yes, can have fistula or abcess

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7
Q

**UC vs Crohn’s: granulomas

A

UC: NO granuloma

Crohn’s: granuloma in 10-30% cases

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8
Q

**UC vs Crohn’s: role of tobacco

A

UC: tobacco may prevent it?

Crohn’s: tobacco causes harm

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9
Q

**mnemonic for extraintestinal manifestations of IBD + meaning

A

C: cholangitis (PSC)
H: hematologic (anemia, amyloid)
E: eye
A: arthrisis (peripheral or axial)
T: thromboembolism
S: skin (nodosum, pyoderma gangrenosum, etc.)
(+ kidney stones, gallstones, osteomalacia, pericarditis)

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10
Q

(EXAM) granulomas in crohn’s or in UC

A

in crohn’s (10-30% of patients)

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11
Q

etiology of IBD

A

genetic predisposition (160 genes) + environmental triggers + immune system

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12
Q

cells of innate immune response

A

macrophages, neutrophils, natural killer cells

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13
Q

cells of adaptive immunity

A

B and T lymphocytes, dendritic cells

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14
Q

important gene in Crohn’s disease and epi

A

NOD2 (cytosolic R for pathogenic bacterial signals). increases risk of CD by 20-40%

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15
Q

main factors influencing microbiome composition

A

**diet, sanitation, hygiene, climate, vitamin D

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16
Q

how microbiome composition affects IBD

A

get diff type of IBD with diff microbiome

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17
Q

pathogenesis of IBD

A
  1. dendritic cells (APCs) sample luminal BACTERIA****
  2. APC present antigens to lymphocytes
  3. lymphocytes release proinflam cytokines (TNF alpha, ILs): IMBALANCE of proinflam molecules
  4. increase in adhesion molecules and vascular permeability
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18
Q

2 factors increasing risk of CD and IBD

A
  1. smoking (CD)

2. lifestyle like developed countries (IBD)

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19
Q

main symptom of IBD + important note

A

diarrhea. **primary etiology of diarrhea is infectious disease

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20
Q

tests for IBD

A
  • CRP, calprotectin (inflam marker in stool), B12, anemia.

- endoscopy

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21
Q

CD is where

A

(upper gut rare)
small bowel alone
small bowel + colon
colon alone

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22
Q

what causes diarrhea in CD

A

inflammation

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23
Q

fibrostenotic lesion def in CD

A

inflamm caused scar tissues: areas of narrowing (distension, nausea, vomiting)

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24
Q

fistulas in CD what and why

A

link between bowel and other bowel or bladder, vagina, etc. bc CD is transmural

25
abscesses in what IBD
CD
26
CD features
diarrhea, abd pain, bleeding (no bleeding in IBS), strictures, fistulas, malabsorption
27
(IMPORTANT) 7 features of CD (MSNDBEE)
1. mucosal erythema (edema) 2. superficial ulcers 3. nodularity from skip areas (cobblestoning) 4. deep linear ulcers on axis 5. bowel wall thickening (string sign) 6. edematous mesentery (fat) 7. extension of fissuring (fistula, abscesses, adhesions, etc.)
28
(IMPORTANT) histo feature of CD
mucosal inflam (crypt abscesses) and chronic mucosal damage, granulomas, ulceration, metaplasia
29
UC 3 stages
-proctitis: few bleeding -less stools -mucous -constipation left-sided colitis pancolitis
30
most severe complication of UC
toxic megacolon (also called Crohn's colitis): toxic damage to muscularis propria (tunica muscularis). dilated and gangrenous colon
31
UC 4 charact on endoscopy
1. mucosal erythema 2. broad ulceration 3. pseudopolyps (regen mucosa) 4. mucosal atrophy
32
meds for induction in IBD
ASA, CS, immunomodulator methotrexate, biologic meds (Abs, anti-TNF)
33
meds for maintenance in IBD
ASA, immunomodulators methotrexate and thiopurines, biological meds
34
only induction meds in IBD
CS
35
only maintenance meds IBD
thiopurines
36
IBD meds induction + maintenance
ASA, methotrexate, biological meds
37
(IMPORTANT) best meds in Crohn's disease
biological meds (Ab, anti-TNF, etc.)
38
meds combo used in IBD + general plan
biological + immunosuppressant | usually: CS + maintenance
39
celiac disease other names
gluten sensitive enteropathy and nontropical sprue
40
celiac pathogenesis
T cell mediated immune disease triggered by gliadin (gluten protein)
41
2 important genetic factors in celiac
HLA DQ2, DQ8 gene loci on chroosome 6
42
how body rx with gliadin
TTG (tissue transglutaminase) modifies gliadin and it rxs with immune system
43
celiac on histo
CD8+ (cytotoxic) T cells infiltration, mucosal inflam, crypt hyperplasia, villous atrophy
44
3 types of celiac
- classic or typical - atypica celiac sprue - asymptomatic celiac
45
charact of typical celiac
steatorrhea, malabsorption, villous atrophy, mucosal lesions
46
atypical celiac charact
minor GI symptoms but many symptoms out of GI (osteoporosis, arthritis, anemia, neuro, ..)
47
asymptomatic silent celiac charact
gluten-sensitive enteropathy found after serology
48
latent celiac def
normal villous structure but positive marker for celiac (TTG positive)
49
refractory celiac def
very bad villous atrophy and not responding to 6 months gluten free diet
50
celiac diseases in order
healthy-latent-silent (asymptomatic)-atypical-typical
51
(IMPORTANT) celiac main symptom
nocturnal and early morning diarrhea (and also steatorrhea)
52
(IMPORTANT) skin condition associated with celiac
dermatitis herpetiformis (pruritic papules) (IgA deposits)
53
(IMPORTANT) gold standard for celiac dx
- IgA tTG (tissue transglutaminase) + order IgA | - if IgA deficient, order IgG TTG
54
celiac endoscopy features
scalloping, absent folds, fissures, mosaicism
55
(IMPORTANT) REAL way to dx celiac (bc IgA TTG not perfect)
biopsy
56
biopsy stages (done in D2) for celiac
0: preinfiltrative mucosa (can't dx) 1: lymphocytes in LP 2. crypt hyperplasia 3. villous atrophy 4. total atrophy
57
(IMPORTANT) celiac treatment
gluten free diet
58
(IMPORTANT) celiac complications
increased risk of: - lymphoma - upper gut and SI malignancy - ulcerative jejunoileitis
59
celiac vs gluten sensitivity
``` celiac = inflammatory sensitivity = allergy to gluten, no enteropathy ```

Bloc E - GI & Metabolism (58 decks)

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