IBD

Question 1

In which of IBD types the risk of cancer is higher?

Answer 1

the risk of cancer is much higher in long-standing UC than in CD

Question 2

a barium enema is contraindicated in both types if

Answer 2

if the patient is having an acute exacerbation of

UC or CD.

Question 3

The main drugs used to treat IBD include

Answer 3

sulfasaluzine, 5-aminosalicylate preparations, olsalazine, prednisone, metronidazole, and azathioprine and its metabolite, 6-mercaptopurine. Methotrexate, cyclosporine, and monoclonal antibodies to TNF-a also available.

Question 4

the active component of sulfasalazine

Answer 4

mesalamine

Question 5

which drug is ineffective for CD of the small bowel?

Answer 5

sulfasalazine

Question 6

what is Sulfapyridine and what is its side effects?

Answer 6

Sulfapyridine is a highly reactive sulfa moiety, which is responsible for most of the side effects of sulfasalazine, such as reversible infertility in men, leukopenia, and headache.

Question 7

what drug is beneficial for perianal abscesses and fistulas in CD?

Answer 7

Metronidazole

Question 8

maintenance therapy for CD

Answer 8

Metronidazole + 5-ASA

Question 9

Mesalamine

Answer 9

(5-aminosalicylic acid, 5-ASA)

Question 10

Long-term use of Metronidazole

Answer 10

neuropathy

Question 11

How much does it take for 6-mercaptopurine and azathioprine (which metabolizes to 6MP) to show an effect?

Answer 11

3–4 months

Question 12

adverse effects of 6-mercaptopurine and azathioprine….what should you do for that?

Answer 12

these 2 drugs have bone marrow suppressive effects, monitor CBC monthly. There is no report of increased malignancy with long-term use of either drug

Question 13

The drugs that decrease the relapse rate in CD and UC?

Answer 13

The drugs that decrease the relapse rate in CD are azathioprine, 6mercaptopurine. and mesalarnine. while all the standard drugs decrease the relapse rate in UC!

Question 14

drugs to Use in pregnancy for IBD

Answer 14

FDA risk category B: Metronidazole, prednisone, and sulfasalazine (and probably its derivatives 5-ASA and olsalazine but these have not been given an FDA risk category yet).

Question 15

p-ANCA and ASCA association with

Answer 15

p-ANCA:UC

ASCA:CD

Question 16

the cause of diarrhea in Crohn patients when < 100 cm of distal ileum is resected & treatment

Answer 16

Bile acid-induced diarrhea

Treat with bile acid scquestrants (e.g., cholestyramine), which bind and inactivate the bile acids.

Question 17

the cause of diarrhea in Crohn patients when > 100 cm of distal ileum is resected & treatment

Answer 17

When > 100 em of distal ileum is resected, the patient gets steatorrhea from greatly decreased proximal gut concentration of bile salts (synthesis does not keep up with GI loss without the distal ileum resorption). Treat these patients with a low-fat diet.

Question 18

in which type prednisolone is more effective?

Answer 18

UC

Question 19

The main symptoms of UC

Answer 19

abdominal pain and bloody diarrhea
BUT
Tenesmus and constipation may be the major symptoms with ulcerative proctitis

Question 20

Extraintestinal manifestations of UC include:

Answer 20

• skin lesions (E. nodosum and pyoderma gangrenosum),
• RF-negative arthritis,
• iritis/episcleritis/uveitis,
• venous thrombosis,
• ankylosing spondylitis,
• pericholangitis, and
• primary sclerosing cholangitis

Question 21

which Extraintestinal manifestation does correlate with UC disease activity?

Answer 21

Skin lesions

Question 22

which complications tend not to improve with improvement or the colitis?

Answer 22

Primary sclerosing cholangitis is also associated with HLA-B8,
whereas ankylosing spondylitis and uveitis are associated with HLA-B27. The complications associated with HLA antigens tend not to improve with improvement of the colitis, whereas the other problems mentioned here usually do get better !

Question 23

what do you think of if a patient with UC develops jaundice?

Answer 23

PSC

Question 24

when to workup for sclerosing cholangitis in UC?

Answer 24

Check LFTs, especially alkaline phosphatase, initially and periodically. If the value becomes 2 x nl and persists, conduct a workup for sclerosing cholangitis

Question 25

risk of cancer in UC

Answer 25

Risk is increased with duration and extent of UC-paneolitis has the highest risk, whereas ulcerative proctitis has no increased risk

Question 26

surgery in UC

Answer 26

UC is cured with surgery! But it is a rough surgery, so reserve it for findings of cancer or dysplasia!