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Colon > IBD > Flashcards

IBD Flashcards

1
Q

Genes associated with CD

A
  1. CARD15/NOD2–> IBD 1 locus
  2. SLC22A4 & SLC22A5 –> IBD 5 locus
  3. HLA-B, HLA-DRB1, HLA-QB1, HLA-DP
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2
Q

Enviomental association with IBD

A
  1. northern latitude
  2. Microbiota
  3. intestinal permeability
  4. diet/obesity
  5. smoking-protective for UC
    6.appendectomy-protective for UC
  6. stress
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3
Q

Reasons for growth failure in IBD

A
  1. decreased intake (major factor)
  2. poor absorption
  3. increased metabolic demand
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4
Q

EIA of IBD -MSK
Give eg

A

Arthralgia
Arthritis
Ankylosing spondylitis (scaroiliitis, more UC)
Osteopenia
Clubbing

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5
Q

what are the types of IBD arthritis?

A

Type 1: <5 large joints, associated with flares
Type 2: multiple small joints, independant

In UC often peripheral, migratory, large joints, non-deforming

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6
Q

Reasons for osteopenia with IBD?

A
  1. malnutrition
  2. malabsorption of Ca and vit D (deficiency)
  3. steroid use
  4. lack of exercise
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7
Q

Dermatologic lesions associated with IBD

A
  1. Erythema nodosum
  2. aphthous stomatitis
  3. pyoderma gangrenosum
  4. metastatic CD: granulomatous lesion, independant of activity
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8
Q

liver & PA association in IBD

A

Pancreatitis
elevated LFTs
PSC
AIH

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9
Q

Ophthalmologic association in IBD

A

uveitis
episcleritis
scleritis

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10
Q

hematologic association in IBD

A

Anemia: iron, Vit B12, folate deficiency, blood loss, hyper-inflammatory state
high PLT
hypercoagulable state: DVT, PE

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11
Q

Renal association with CD

A

ureteral obstruction and hydronephrosis (phelegomon/abscess effect)

enterovesicular fistula

stones: oxalate, urate, phosphate

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12
Q

list markers association with CD?

A

ASCA (88-92% specificity)
PANCA
anti-OmpC
ant-CBir

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13
Q

common histology features in CD

A

Granulomas (non-caseating)
Cryptitis
Crypt elongation and hyperplasia
increase lamina propria cellularity
Decrease goblet cell
Submucosal fibrosis fissures and sinuses
Neuromatous hyperplasia

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14
Q

mechanism of 5ASA

A

anti-inflammatory
inhabit prostaglandin and leukotriene

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15
Q

Side effects of 5ASA

A

HA
Nausea, vomiting, anorexia
Allergic reaction/rash
Pancreatitis
hepatitis
interstitial nephritis
diarrhea
folate deficiency
joint pain

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16
Q

Monitoring while on 5ASA

A

CBC
LFTs,
UA
BUN/Cr

17
Q

mechanism of Cipro/Flagyl in IBD

side effects

A

Reduce luminal bacteria
Alter colon microflora
Reduce bacterial invasion/translocation

Cipro: bone growth
Flagyl: peripheral neuropathy

18
Q

Mechanism of Corticosteroids in IBD

A

Decrease pro-inflammatory mediators
Increase anti-inflammatory mediators
Inhibit NF-κB function–>dec IL1,2
Nitric oxide production–>affect leukocyte interaction
Decreased prostaglandins
Prevent activation of IFN-gamm
promote mucosal healing

19
Q

Side effects of corticosteroids in IBD

A

growth delay
Bone loss/disease
HTN
hyper G
leukocytosis
weight gain
cushingoid faces
infection
mood disturbance
insomnia
cataracts

20
Q

Mechanism of Thiopurines (Azathioprine & 6-Mercaptopurine)

A

Antimetabolite –>immunosupression and
lymphocytotoxicity

21
Q

side effects of thiopurines

A

Nausea, vomiting, diarrhea
Bone marrow suppression
Elevated LFTs
PA
HSTCL
NMSK
Infections
Allergic reaction

22
Q

Monitoring while on thiopurines

A

CBC: 0,2,4,8, WKs and then q3 mo
Varicella titer
TPMT activity

23
Q

Mechanism on Methotrexate in IBD

A

? T-cell apoptosis
not fully understood
more effective CD»UC

24
Q

Monitoring while on Methotrexate

A

CBC: 0,2,4,8, WKs and then q3 mo
Varicella titer

25
Q

side effects of methotrexate

A

Nausea, vomiting, diarrhea
Bone marrow suppression
Elevated LFTs
upper resp. infection/pneumonitis
hypersensitive skin reaction
teratogencity
folate deficiency

26
Q

Mechasnism of Tacrolimus & Cyclosporin in IBD

A

calcineurin inhabitor–>impair IL-2,4 production –> impair T»B cell function

27
Q

Side effects of Tacrolimus & Cyclosporin

A

HTN
HyperG
HyperL
HypoMg
gingival hyperplasia
alopecia (tacro)
hirsutism (cyclo)
seizures
infection
coarse facial features

28
Q

Anti-TNF examples and mechanism

A

Infliximab (chimeric) and Adalimumab (human)
Monoclonal IgG1 antibody to TNF
Neutralize TNF
Inhabit leukocyte migration
Apoptosis of T-cell & monocytes

29
Q

Side effects of anti-TNF

A

Infection
TB
Lymphoma (HSTC)
NMSC
Demyelinating syndrome
Lupus like reaction
Allergic reaction
Psoriasis
elevated LFTs
Cytopenias

30
Q

Mechanism of Vedolizumab & natalizumab

A

Vedo: monclonal IgG1 antibody to alpah 4, beta 7 integrin

Nata: monclonal IgG1 antibody to a4b1 & a4b7

31
Q

Mechanism of Ustekinumab

A

anti-IL12 and IL23

32
Q

Mechanism of EEN

A

Gut rest
Eliminate food antigen
Decrease gut permeability
Alter gut microbiota
Promote growth

Colon (9 decks)

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