IBD

Question 1

Ulcerative colitis is an inflammatory bowel disease which causes ulcers of the _ and _ layer

Answer 1

Ulcerative colitis is an inflammatory bowel disease which causes ulcers of the submucosa and mucosa

Question 2

UC is associated with continuous colonic lesions starting in the _

Answer 2

UC is associated with continuous colonic lesions starting in the rectum
* Extends to the cecum

Question 3

The chronic inflammation of the colon and rectum in UC is mediated by _ and _

Answer 3

The chronic inflammation of the colon and rectum in UC is mediated by Th2 cells and cytokines

Question 4

UC can cause pain in _ quandrant

Answer 4

UC can cause LLQ pain

Question 5

Describe the diarrhea in UC

Answer 5

Chronic bloody diarrhea

Question 6

UC can cause inflammation of the eye, resulting in pain and blurry vision called _

Answer 6

UC can cause inflammation of the eye, resulting in pain and blurry vision called uveitis

Question 7

UC can cause extraintestinal sx such as uveitis, arthritis, aphthous ulcers, and skin lesions like _ and _

Answer 7

UC can cause extraintestinal sx such as uveitis, arthritis, aphthous ulcers, and skin lesions like erythema nodosum and pyoderma gangrenosum

Question 8

Ulcerative colitis is also associated with a chronic liver disease that causes the bile ducts to become inflammed and scarred called _

Answer 8

Ulcerative colitis is also associated with a chronic liver disease that causes the bile ducts to become inflammed and scarred called primary sclerosing cholangitis

Question 9

UC is also associated with an inflammatory disease of the spine that can lead to fusion of vertebrae called _

Answer 9

UC is also associated with an inflammatory disease of the spine that can lead to fusion of vertebrae called ankylosing spondylitis

Question 10

UC patient presents with abdominal distention, bloody diarrhea, fever, and signs of shock what should you be concerned for?

Answer 10

UC patient presents with abdominal distention, bloody diarrhea, fever, and signs of shock what should you be concerned for? Toxic megacolon

Question 11

Toxic megacolon is associated with severe septic shock and lots of air inside the peritoneal space which we call _

Answer 11

Toxic megacolon is associated with severe septic shock and lots of air inside the peritoneal space which we call pneumoperitoneum

Question 12

Very severe UC which involves lots of stools per day and an accumulation of sores/ulcers is called _

Answer 12

Very severe UC which involves lots of stools per day and an accumulation of sores/ulcers is called fulminant colitis

Question 13

Colorectal cancer is associated with UC and often involves early _ mutations and late _ mutations

Answer 13

Colorectal cancer is associated with UC and often involves early p53 mutations and late APC mutations

Question 14

UC may be identified on imaging with _ sign

Answer 14

UC may be identified on imaging with lead pipe sign

Question 15

UC on histology will reveal _ and _

Answer 15

UC on histology will reveal crypt distortion and abscesses with neutrophils

Question 16

UC can be identified on colonoscopy by _

Answer 16

UC can be identified on colonoscopy by friable inflammatory pseudopolyps

Question 17

UC is associated with _ genetic marker

Answer 17

UC is associated with HLA-B27

Question 18

UC will be _ ANCA pos/neg

Answer 18

UC will be pos for p-ANCA

Question 19

Two inflammatory markers on CBC that will be elevated in UC are _ and _

Answer 19

Two inflammatory markers on CBC that will be elevated in UC are ESR and CRP
* These are also elevated in Crohn’s

Question 20

_ and _ are two products made by neutrophils that indicate inflammation (seen in IBD)

Answer 20

Lactoferrin and Calprotectin are two products made by neutrophils that indicate inflammation (seen in IBD)

Question 21

We can treat UC with 5-ASA compounds like _ and _

Answer 21

We can treat UC with 5-ASA compounds like mesalamine and sulfasalazine

Question 22

We can treat UC flares with _

Answer 22

We can treat UC flares with:
* Steroids
* Infiliximab
* Adalimumab
* 6-mercaptopurine

Question 23

Crohn’s disease is chronic inflammation mediated by _ and cytokines

Answer 23

Crohn’s disease is chronic inflammation mediated by Th1 cells and cytokines

Question 24

Crohn’s disease can involve _ lesions from mouth to anus

Answer 24

Crohn’s disease can involve “skip lesions” from mouth to anus

Question 25

The most commonly affected site in Crohn's disease is the _

Answer 25

The most commonly affected site in Crohn's disease is the **terminal ileum**

Question 26

Crohn's disease is associated with a mutation in _ gene

Answer 26

Crohn's disease is associated with a mutation in *NOD2*

Question 27

The *NOD2* receptor normally binds to _ to trigger _ pathway

Answer 27

The *NOD2* receptor normally binds to **LPS** to trigger **NF-kB** pathway activation * Decreased alpha definsin production * Impaired innate immune response

Question 28

Crohn's disease is associated with (inc/dec) innate immune response and (inc/dec) adaptive immune response

Answer 28

Crohn's disease is associated with *decreased* innate immune response and *increased* adaptive immune response

Question 29

Describe the pathogenesis of fistulas in crohn's disease

Answer 29

Transmural inflammation --> epithelialization across bowel wall --> sinus tract formation --> fistulas

Question 30

Smoking increases the risk of _ IBD but decreases the risk of _

Answer 30

Smoking increases the risk of **Crohn's** but decreases the risk of **Ulcerative colitis**

Question 31

Crohn's disease is associated with _ genetic marker

Answer 31

Crohn's disease is associated with **HLA-B27**

Question 32

Explain the pathogenesis of strictures in crohn's disease

Answer 32

Chronic inflammation --> fibrosis, wall thickening --> narrowing of the lumen

Question 33

Crohn's disease is associated with _ quandrant pain

Answer 33

Crohn's disease is associated with **RLQ** pain

Question 34

Malabsorption is more of a concern in (UC/ Crohn's)

Answer 34

Malabsorption is more of a concern in **Crohn's** * Concern for B12 and fat-soluble vitamin malabsorption

Question 35

Name three types of fistulas that may occur from Crohn's complications

Answer 35

* Enteroenteric * Enterocutaneous * Enterovesical

Question 36

Extraintestinal complications of Crohn's include:

Answer 36

Extraintestinal complications of Crohn's include: * Uveitis * Arthritis * Erythema nodosum * Pyoderma gangrenosum

Question 37

(Crohn's/UC) is associated with perianal disease, gallstones, nephrolithiasis, increased risk for colorectal cancer

Answer 37

**Crohn's** is associated with perianal disease, gallstones, nephrolithiasis, increased risk for colorectal cancer * Prone to calcium oxalate stones because calcium binds to fat that is not being properly absorbed

Question 38

Crohn's disease is associated with _ and _ on histology

Answer 38

Crohn's disease is associated with **lymphoid aggregates** and **noncaseating granulomas** on histology

Question 39

Crohn's disease is associated with _ sign on X-ray

Answer 39

Crohn's disease is associated with **string sign** on X-ray (ileum)

Question 40

_ is associated with knife-like fissures, creeping fat, and cobblestone mucosa

Answer 40

**Crohn's disease** is associated with knife-like fissures, creeping fat, and cobblestone mucosa

Question 41

Management for Crohn's disease may include:

Answer 41

Management for Crohn's disease may include: * **Corticosteroids, TNF-a inhibitors** (infiximab) * **5-ASA** (mesalamine, sulfasalazine) * **Immunosuppressors** (6-mercaptopurine) * **Colectomy, ileectomy**