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Undeleted > IBD > Flashcards

IBD Flashcards

1
Q

def. IBD

A

chronic inflamm of the intestinal tract, variable systemic involvement

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2
Q

location of 2

A

UC - colon and rectum

CD - any portion

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3
Q

peak ages

A

bimodal - 20-30 and 60s

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4
Q

epi

A

more UC

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5
Q

Sx of CD

A
  • abdo pain
  • diarrhea
  • mass in RLQ
  • obstrcution
  • weight loss
  • fever
  • stricture
  • fistula and anal involvment
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6
Q

4 most common extraintestinal

A
  1. eye - episcleritis
  2. skin - erethyma nodosum
  3. mouth ulcers
  4. MSK - arthiritis
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7
Q

4 aspects to patho

A
  1. genes - CD>UC : NOD2 gene
  2. host immune system
  3. luminal bact
  4. env
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8
Q

what is the immune response

A

inappropiate extreme immune response

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9
Q

3 env factors

A
  1. altered mucous
  2. incr. permeability
  3. impaired repair mech.
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10
Q

what is actual path

A

normal>triggers>acute inflammation> not cleared> chronic inflammation

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11
Q

what to ask on Hx

A
  • travel
  • AB use
  • diet
  • sex hx
  • fam hx
  • extra intestinal Sx
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12
Q

labs

A
  • CBC
  • iron
  • folate
  • B12
  • CRP
  • ESR
  • stool WBC
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13
Q

imaging

A

US, CT MR, endo

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14
Q

3 main goals and 2 additional of therapy

A
  1. remission induction
  2. remission maintenance
  3. prevent treat compl.

a. mucoal healing
b. QOL

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15
Q

5 classes of meds

A
  1. 5-ASA
  2. corticosteroids
  3. immunosuppresants - methotrexate
  4. ABs
  5. imunobiologics - mab’s
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16
Q

preps, uses, action, effect, formulation and SE of 5-ASA

A 
preps - mesalamine
uses - UC, mild crohn ilitis
action - oxy free radical scavenger
effect - local only
formulation - oral, rectal
adverse effects - pancreatitis, nephritis
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17
Q

preps, uses, action, effect, and SE of steroids

A

preps - prednisone, budesonide
uses - remission induction, no use for maintenance
action - inhib inflam. cytokines
adverse effects - cushins, ** avasc. necrosis

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18
Q

action, use and SE of azathroprine

A

action - purine analog- DNA syn. inhib
use - remission and maintenance, healing of fistula
SE - bone marrow sup., pancreatitis, lymphoma,

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19
Q

ction, use and SE of methotrexate

A

action - folic acid antag - no DNA, cort. sparing
use - remission and maintenance
SE - liver, leukopenia, N/V, diarrhea, hypersensitivity

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20
Q

action, use and SE of cyclosporine

A

action - inhib of t -cell mediated responses
use - acute and refractory UC
SE - nephrotox, infections, hypertension

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21
Q

action, use and SE of immunobiologics

A

action - antiTNF ABs
use - CD - active and perianal, UC severe
SE - delayed hypersenstivity and lotof others

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22
Q

use of ABs (

A

metronidazole and cipro
- no use in UC
-

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23
Q

what to do when refractory

A

Surgey

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24
Q

2 indications for surg

A
  1. failure of meds

2. disease complications - CA, perfs, stenosis

25
Q

what is surg CD mantra

A
  • do not harm
  • can’t cure
  • preserve function
26
Q

2 gen classes of IBD for a surg

A
  1. fibrosteonitic - obstructive - pain, blaoating,

2. perforative - fistula, abscess, free perf

27
Q

3 main types of surg

A
  1. resection
  2. strictureplasty
  3. diversion alone - rare
28
Q

2 types of resection

A
  1. restorative - +/- protected anastamosis

2. non-restorative

29
Q

what is surg for obstructing terminial illeum CD

A

illeocolic resection with anastamosis

30
Q

**2 keys to a good anastamosis

A
  1. tension-free

2. well-vascularized

31
Q

what is role of the protecting stoma

A

lower leak rates

32
Q

complications of ileo-colic resection

A
  • leak - bad
  • localized abscess
  • diffuse peritonitis
33
Q

how common is recurrence

A

very high over time - esp @ ileocolic jct

34
Q

surg for segmental colon, diffuse colon, anorectal colon

A

segmental - segmental resection
diffuse - subtotal colectomy
anorectal +/- colon - prectectomy

35
Q

3 CD mantra for anal CD

A
  1. control Sx
  2. preserve function
  3. do no harm - don’t injure sphinter
36
Q

gross appearnce of CD

A

stiff, thick walled bowel, linear ulcers

37
Q

patho of CD (5)

A
  1. shallow aphthous ulcers from mouth to anus
  2. full thickness inflammation
  3. fissuring ulcers - epithelium enters
  4. patchy lesions (skip)
  5. granuloma
38
Q

4 common UC sx

A
  1. abo pain
  2. diarrhea, freq, small volume
  3. rectal bleeds
  4. mucous
39
Q

major complications of UC

A

toxic mega colon

40
Q

4 malignant aspects of toxic megacolon

A
  1. duration - 8-10 years
  2. extensive disease
  3. comorbid liver disease
  4. chronic indolent disease
41
Q

3 aspects to guide therapy

A
  1. extent
  2. severity
  3. complications
42
Q

3 extents of disease

A
  1. proctitis - rectum only
  2. severity
  3. complications
43
Q

5 aspects to consider for severty

A
  1. # BM (>6)
  2. rectal bleeds
  3. fever. tachy
  4. anemia
  5. extraintestinal
44
Q

use of ASA for UC

A

remisson and maintenance

45
Q

use of ABs for UC

A

none

46
Q

use of steroids for UC

A

induction only

47
Q

use of innumonosuppression for UC

A

all remission and maintenance - except methotrexate, no maint

48
Q

use of anti-TNF

A

both

49
Q

what to do for severe attack of UC

A

try rescue therapy, and if fails > colectomy

50
Q

2 options for colectomy

A
  1. permanent ileostomy

2. modified pouch attached to the anus

51
Q

complications of colectomy

A
  • bowel obst.
  • infection/leak
  • pouchitis
  • fistula
  • infert and SD
52
Q

classic histo of UC

A
  • diffuse and continuous inflammation the entire length of region affected
  • flat broad based ulcers
  • usually limited to the mucosa
  • crypt abscesses
53
Q

what is prioblem in diagnosing IBD

A
  • not always classical
  • can get illeal backwash in UC
  • ## can get patches in UC after treatment
54
Q

DDX for both IBDs (6)

A
  1. infection! - esp TB
  2. iscemia
  3. diverticular assoc. sigmoid
  4. behcet’s disease
  5. NSAID
  6. tumours
55
Q

what is issue with fulminant

A

can be severe and go deep which makes it hard to diff. between UC and CD

  • most act like UC
  • need to diff. because doing colectomy can be bad in CD
56
Q

4 dysplasia risk factors for UC

A
  1. duration
  2. early age of onset
  3. extent
  4. primary sclerosin cholangitis
57
Q

3 dysplasia risk factors for CD

A
  1. duration
  2. most in colon
  3. 20-500x risk of smal bowel adenocarcinoma
58
Q

what to do with polyps and flat dysplastic lesions

A

polyp - remove endo

flat - consider colectomy

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