GI: IBD & Celiac Flashcards
This disease is chronic, relapsing-remitting GI inflammatory disorder.
IBD
Describe the bimodal peaks of age related to IBD
15-35 and 50-80
What three factors are hypothesized to cause IBD?
autoimmune
genetic
environment
5 red flag sxs for IBD…
severe bleeding severe pain dysphagia dehydration obstruction
Crohn or UC?
Mouth to Anus
(+) Skip lesions
Full-thickness, transmural inflammation
Crohn
Crohn or UC?
Colon + Rectum
Extends proximally
(-) skip lesions, continuous
Mucosal layer only
UC
Crohn manifestations in oral cavity…
apthous ulcers
MC Crohn manifestation in ileum…
ileitis
Crohn manifestation in terminal ileum & proximal asc. colon?
ileocolitis
Crohn manifestation in the colon…
crohn colitis
Crohn manifestation in anus/rectum
perianal disease (abscess/fistula)
Crohn is known as a penetrating disease… this means what four complications can occur?
ulcer
stricture
fistula
abscess
Describe the onset of sxs of Crohn disease…
insidious onset, intermittent/relapsing-remitting sxs
Mild/Mod/Severe Crohn:
inflammation + stricture
moderate
Mild/Mod/Severe Crohn:
Inflammation + stricture + fistula
Severe
What is the MC extra-intestinal manifestation of Crohn Disease?
arthralgia
What are three Crohn/UC manifestations that can occur in the eyes?
episcleritis, iritis, uveitis
What are two Crohn/UC manifestations that can occur on the skin?
erythema nodosum, pyoderma gangrenosum
Pt. p/w abd. pain, diarrhea, +/- NV, perianal disease and anemia.
What is this presentation concerning for?
Crohn Disease
What is the best way to Dx crohn disease?
colonoscopy + bx
What would you expect to see on colonoscopy + Bx with Crohn disease?
Colonoscopy: ulcerations/cobblestoning
Bx: granulomas
Describe the effectiveness of 5-ASA on crohn disease?
minimally effective
what can corticosteroids be used for in crohn disease?
acute flares
What two drugs can be used alone or in combo for moderate/severe crohn disease?
immunomodulators +/- biologics
When can Abx (cipro, metronidazole) be used for crohn disease?
if abscess/fistula
The below are complications of crohn or UC?
abscess strictures fistula obstruction colon CA malabsorption
crohn
A pt. p/w the below, concerning for…
lower abd. pain
bloody diarrhea
fecal urgency + tenesmus
+/- anemia/hypovolemia
UC
How can you diagnose UC?
sigmoidoscopy/colonoscopy + bx
the below, found on colonoscopy is concerning for…
diffuse friability
erosions
bleeding
UC
also seen on sigmoidoscopy
Crypt abscesses seen on Bx are suggestive of…
UC
What are two complications of UC?
toxic megacolon
colon CA
What can worsen the sxs of both UC and Crohn Disease and should therefore be avoided?
NSAIDs
What labs can be helpful in dx of UC/Crohn?
CBC, CMP, CRP/ESR
if an IBD patient is developing diarrhea/change in baseline stool habit, what should be ordered?
stool studies
The below are indications for what IBD tx?
severe hemorrhage
perf
CA
refractory disease
surgery
taking Anti-TNF (biologics) drugs can leave patients susceptible to what two diseases, so they must be screened before tx begins?
TB and HBV
imaging is not required for CD dx, but which imaging studies can be ordered/may be helpful?
CT/MR enterography
UGI + SBFT
Capsule endoscopy (C/I if stricture)
(+) String Sign on UGI w. SBFT indicates…
Crohn Disease
What category of UC? Mild/Mod/Sev…
> 4 stools daily + anemia + low grade fever
moderate
What category of UC? Mild/Mod/Sev…
> 6 stools daily, systemic toxicity
severe
What imaging may be helpful in the evaluation of UC?
CT A/P
5-ASA is primarily used for…
mild/mod UC
Thiopurines can take how long to begin working?
3-6 mo
What two genes may genetically predispose somebody for celiac disease?
HLA DQ2 and DQ8
A patient presents with:
diarrhea, steatorrhea, flatulence/bloating and wt. loss
This is concerning for…
malabsorption, celiac disease
What are three atypical sxs of celiac?
abd. pain, constipation, dyspepsia
These are burning, pruritic lesions that are erythematous and papular +/- vesicles. They are assoc. w. celiac disease
dermatitis herpetiformis
What are three main extra-intestinal sxs of celiac disease?
dermatitis herpetiformis
IDA
Osteoporosis
Celiac disease is identified via ________ and confirmed via ________
ID: serology (elevated tTG IgA)
Confirm: duodenal biopsy w. villous atrophy
testing for celiac is done on a gluten free or gluten containing diet?
gluten containing
How is celiac treated?
gluten free diet
What are two main complications of celiac disease?
nutrient deficiency
lymphoma
