IBD Flashcards
Medical Treatment for UC and Crohn’s
How do you approach TDM in anti-TNF therapy?
Considerations for using small molecules in UC.
Tofacitinib
Upadacitinib
Ozanimod
Colon biopsy
low grade dysplasia
Chronic colitis
altered crypt architecture (branching crypts)
microabcesses
Mayo score?
Mayo score?
Mayo score?
Definition of mild, mod, severe UC.
Describe the AZA, 6MP enzyme pathway.
6MMP- leads to hepatotoxicity
6 TGN leads to bone marrow toxicity.
If high 6MMP, normal 6TGN, then given allopurinol to stop the shunting
high levels of both= toxicity
low levels of both= non-compliance
Sacrolititis
Ankylosing spondylitis
normal spine
normal SI joint
Sweet syndrome
Acute febrile neutrophilic dermatosis
skin nodules, fever, vision changes, and desquamating rash
treat underlying IBD w/ steroids
Rutgeert’s score?
How do you managed post-op therapy for CD who undergoes ileocolonic resection?
if <5 apthous ulcers in neoTI or ulcers confined to the anastomosis then ok to defer treatment
Which EIM track with IBD luminal disease activity?
type 1 peripheral arthropathy (<5 joints, large joints)
Erythema nodosum
+/- Pyoderma Gangrenosa
episcleritis
scleritis
peristomal PG
+/- tracks with luminal disease
treatment with (in escalating order)- topical steroid, oral steroids, anti-TNF, surgery
pathology with neutrophils
Crohn’s like disease of the pouch
pre-ileal stricture, pre-pouch ileitis
UC s/p colectomy and IPAA
Cuffitis
RF- >2cm cuff remaining, refractory disease
treat with mesalamine suppositories
then anti-TNF
acute pouchitis - definition and treatment
chronic antibiotic refractory pouchitis - definition and treatment and RF
acute pouchitis- ciprofloxacin 500 mg every 12 hours for 2 weeks
no response–> give cipro +flagyl
chronic antibiotic refractory pouchitis- abx >4 weeks with no response; treat with hydrocortisone or mesalamine enemas and if fails then biologic
RF- PSC or IgG4 disease (would then favor budesonide)
who qualifies for maintenance therapy for pouchitis?
respond to therapy but relapse >3 times per year
treat with VSL #3 or rifampin, low dose cipro
which biologics can treat IBD and central arthropathy like sacroilitis?
anti-TNF and JAK inhibitors
how do you manage invisible dysplasia
repeat colonoscopy by expert with spray chromo
if no visible lesion, then extensive nontargeted biopsies in area of prior dysplasia
if unresectable visible dysplasia or multifocal dysplasia or HGD –> colectomy
if no dysplasia then repeat at surveillance intervals
when do you get dexa for steroid exposure
> 3 months cumulative exposure
how should you manage medications around surgery?
no change to medication, specifically AZA, MTX, 6-MP or anti-TNF
increased risk of post-operative infection with pred
ARM
what is the diagnosis?
There is an adequate rise in rectal pressure and corresponding relaxation of the external anal sphincter (diagonal line with red end markers) on the anorectal manometry image. Chronic straining can cause rectal mucosal intussusception seen in the anorectal manometry with rectal mucosa descending into the anal sphincter complex.
how can you reduce calcium oxalate stones in IBD?
reduced dietary oxalate, increased calcium, and lower fat