IBD Flashcards
Is there a genetic component to IBD?
Yes, patients with Crohn’s have increased risk of Crohn’s in fam, increased risk of UC relative to general public and vice versa
What is the risk of developing IBD in a child with 2 parents with IBD?
33%
Three genetic diseases that IBD is associated with?
Turner Syndrome
Hermansky-Pudlak Syndrome (oculocutaneous albanism, pulmonary fibrosis, platelet dysfunction)
Glycogen storage disorders
What is Hermansky Pudlak Syndrome
Oculocutaneous albanism
Platelet dysfunction
pulmonary fibrosis
Associated with IBD
Cecal patch?
UC can have an isolated cecal patch even if only left colon is involved
Two classes of meds at can mimic IBD?
Immune checkpoint inhibitors
Anti-IL17 agents (secukinumab, ixekizumab) used to tx psoriasis
Crohn’s mimickers?
NSAID injury
Behcet’s
Small bowel lymphoma (which can cause a stricture)
Which patients are particularly sensitive to yersinia?
Those with iron overload (Hemochromatosis)
Difference of Crohn’s peripheral arthropathy from other immune mediated arthopathies?
No joint erosion, no permanent deformity, seronegative
Episcleritis vs scleritis vs uveitis?
Episcleritis = redness, no visual changes
Scleritis = redness, pain, pain with movement, slightly decreased vision
Uveitis= emergency, pain, photophobia, decreased vision. Can lead to blindness
Screen for osteoporosis in IBD?
Yes, dexa at 65 for women, 70 for men
Which IBD patients need yearly colonoscopy?
Those with PSC, those with severe pseudopolyposis, those with moderate-severe inflammation, those with FDR with CRC <50. Those with IPAA
Which IBD patients need q2-3 year colonoscopy?
Those with mild inflammation, those with fam hx of CRC <50 not in FDR, previously severe colitis
Which IBD patients need q5 year colonoscopy?
Those in remission
Lab to check before starting tofacitanib?
Lipid panel
How to treat mild-moderate UC?
Oral and rectal aminosalicylates
How to use steroids in mild-moderate UC?
Very sparingly, use in flares, but if need multiple courses escalate to steroid-sparing immunosuppressive regimen
How to treat moderate to severe UC?
Vedolizumab, if fails, infliximab and azathioprine together, if fails, then tofacitanib or ozanimod
What does UC success and sonic trial show?
Infliximab and azathioprine/6MP are better than infliximab alone
When is it okay to use a azathioprine/6MP alone?
For maintenance of remission from steroids only
How to treat acute UC in hospital?
IV Methylpred, flex sig to exclude CMV.
If no response, infliximab or cyclosporine.
If no response, colectomy
How to treat mild-moderate Crohn’s disease?
Budesonide ileal controlled release for 6 months in a taper
Can you use mesalamine in mild-moderate Crohn’s?
No! No benefit of mesalamine in mild-moderate Crohn’s
How to treat moderate-severe Crohn’s?
Usually infliximab+thiopurine (for most complex),
adalimumab+thiopurine OR ustekinumab (slightly less complex), then adalimumab mono therapy (less complex still), then vedolizumab mono therapy for least complex.
Can you use methotrexate as induction and maintenance in IBD?
ONLY in CD, IM MTX can be used for induction and maintenance
Sulfasalazine side effect in men?
Oligospermia that is reversible
Other sulfasalazine side effects?
Folate deficiency, anemia if G6PD deficient, SJS-TEN
5-ASA prominent side effects?
interstitial nephritis, pleuritis, pericarditis
6MP metabolism?
6MP metabolized by 3 enzymes: XO, HPRT, TPMT to 6TG and 6MMP
Why is TPMT activity important
If only intermediate activity, causes more 6TG which can be toxic.
If high activity, causes hepatotoxicity from 6MMP
Side effect of high 6MMP?
Hepatotoxicity
Side effect of high 6TG
Marrow suppression
Very rare thiopurine side effect, especially in young men
Hepatosplenic T-cell lymphoma
