GI - Crohn's and Colitis

Question 1

what does IBS stand for

Answer 1

irritable bowel syndrome

Question 2

does IBS come with inflammation

Answer 2

no

Question 3

what does IBD stand for

Answer 3

inflammatory bowel disease

Question 4

what are 2 types of IBD

Answer 4

ulcerative colitis and crohns disease

Question 5

what is the major difference with IBD and IBS

Answer 5

IBD has inflammation, IBS does not

Question 6

how do IBS epithelial cells function appear

Answer 6

to be normal

Question 6

which subset of population gets more IBS

Answer 6

women before 35

Question 7

is IBS chronic

Answer 7

yes

Question 8

what are 5 possible causes of IBS

Answer 8

food sensitivities, stress, bacterial infection, hormones, alteration of 5-HT reuptake into neurons

Question 9

what does increased GI motility lead to

Answer 9

diarrhea

Question 10

what does decreased GI motility lead to

Answer 10

constipation

Question 11

how do you generally try to treat IBS

Answer 11

symptomatically

Question 12

what are 3 symptom treatments for IBS

Answer 12

diet, stress, laxatives/antidiarrheals

Question 13

what drug do you use for constipation dominant IBS

Answer 13

lubiprostone

Question 14

what is lubiprostone used for

Answer 14

drug for constipation dominant IBS

Question 15

what is the mechanism of lubiprostone

Answer 15

binds to EP4 receptors, increase cAMP, activate CFTR (Cl-), stimulates fluid secretion

Question 16

what is the structure of lubiprostone

Answer 16

analogue of PGE1

Question 17

what does lubiprostone do to transit of gut contents

Answer 17

speeds up

Question 18

how does lubiprostone speed up gut (physically, not like receptor stuff)

Answer 18

increases fluid in stool to stretch gut and speed it up

Question 19

what happens when lubiprostone activates EP4 receptors

Answer 19

increase cAMP and activate epithelial Cl- channels (CFTR) to stimulate fluid secretion

Question 20

how does Cl- channel activation stimulate water secretion

Answer 20

Cl- movement creates an osmotic gradient, H2O and other electrolytes flow passively from the ECF into the lumen through channels

Question 21

why is lubiprostone selective for the gut

Answer 21

because it is poorly absorbed

Question 22

what is ulcerative colitis

Answer 22

inflammatory disorder causing ulcers in the lining of rectum and colon

Question 23

where do ulcers form in ulcerative colitis

Answer 23

where inflammation leads to cell death (cells die in mucosa)

Question 24

what is the main symptom in ulcerative colitis and why

Answer 24

diarrhea because colon inflammation in colon causes frequent emptying

Question 25

which layer gets cell death in ulcerative colitis

Answer 25

in mucosa (closest to lumen)

Question 26

what is the diff with ulcerative colitis and crohns disease

Answer 26

in crohns, inflammation is deeper in intestinal wall and occurs in other parts of GI tract (SI, mouth, esophagus, stomach)

Question 27

does ulcerative colitis associate with increase cancer risk

Answer 27

yes

Question 28

does crohns associate with increase cancer risk

Answer 28

yes

Question 29

how do you treat UC and crohns

Answer 29

long term anti-inflammatories and immunosuppressant drugs | anti-diarrheals for symptoms

Question 30

why do you use anti-diarrheals for UC and crohns

Answer 30

for symptomatic relief, but it does not affect etiology of the disease (doesnt cure)

Question 31

what are glucocorticoids

Answer 31

potent anti inflammatory and immunosuppressant agents

Question 32

how does prednisolone work

Answer 32

binds to members of nuclear receptor superfamily, modifties gene transcription

Question 33

what stages of inflammation does prednisolone inhibit

Answer 33

all of them

Question 34

what is an example glucocorticoids

Answer 34

prednisolone

Question 35

how do you use prednisolone for mild UC

Answer 35

rectal enemas (local inflammation, systemic steroids is not ideal)

Question 36

how do you use prednisolone for severe UC and crohns

Answer 36

it is given orally

Question 37

what is the pro and con for using prednisolone

Answer 37

it can induce remission but long term use is nad

Question 38

what are aminosalicylates used for

Answer 38

maintenance of remission of both UC and crohns disease

Question 39

what is an example of aminosalicylates

Answer 39

sulfasalazine

Question 40

is sulfasalazine absorbed well in the drug

Answer 40

no

Question 41

what happens once sulfasalazine is in the colon and why

Answer 41

5-ASA is released in the colon by bacteria

Question 42

what are the 2 things that sulfasalazine breaks into

Answer 42

5-ASA and sulfapyridine

Question 43

what is a type of person that shouldnt take sulfasalazine + why

Answer 43

antibiotic allergies (cause sulfapyridine)

Question 44

what are 3 things that sulfasalazine does that is good

Answer 44

- localized anti-inflammation - scavenges free radicals - inhibits prostaglandin synthesis

Question 45

what does sulfasalazine do to prostaglandin synthesis + why important

Answer 45

inhibit cause that can cause inflammation

Question 46

what is the mechanism of action of sulfasalazine

Answer 46

localized anti-inflammatory actions including scavenging of free radicals and inhibition of prostaglandin synthesis

Question 47

sulfasalazine cannot be used by persons with allergies to what?

Answer 47

sulphonamides, class of antibiotics

Question 48

what is mesalazine

Answer 48

just 5-ASA on its own

Question 49

what are biologicals

Answer 49

humanized antibodies targeting components of the inflammatory pathway

Question 50

what are 3 main targets for biologicals

Answer 50

- TNF-alpha - anti-alpha4beta7 integrin on T-helper lymphocytes - anti-protein subunit of IL-12 and IL-23