IBD Flashcards
Ulcers with stellate shapes
-Pyloric metaplasia
granulomas
Suggest
Crohn’s disease
what type of cell is often found in crohn’s disease
- Giant cell/multinucleated histiocyte
If IBD affects any portion of the GI tract vs only the colon it is
Crohn’s
If disease is limited to the colon and rectum then
It is Ulcerative colitis
Type of diarrhea associated with crohn’s disease
non-bloody usually
when do you suspect fever in Crohn’s disease
if fistula is present
Some clinical manifestations of crohn’s
- RLQ mass
- obstruction
- fistula/fever
- diarrhea
- abdo pain
- weight loss!!!
4 disease concordant manifestations of crohn’s disease
- Episcleritis
- Erythema nodosum
- mouth ulcers
- peripheral arthritis
4 disease DISconcordant manifestations of crohn’s disease
Pyoderma gangrenosum
axial arthropathy/spondylitis
sacroilitis
what gene attributes susceptibility to CD more so than UC
- NOD2 gene
4 factors involved in the pathogenesis of crohn’s disease
- genetics
- luminal bacteria
- dysregulated immune response
- environmental factors
- -> acute inflammation leading to chronicity
what labs would you need to do check for crohn’s disease
- CBC, lytes, iron, folate, vit B12, CRP, ESR, stool leukocytes, blood, O and P, C diff
5 medical agents to treat IBD
- 5-ASA - UC not crohn’s
- steroids
- abx - not for UC
- immunosuppressants
- biologic
5-ASA sulfasalazine is primarily used in
Ulcerative colitis - mild crohn’s ileitis
5-ASA only has what type of effect? local?systemic?
systemic effect only local
Adverse effects of 5-asa
Pancreatitis (within 4 weeks)
Interstitial nephritis
Corticosteroids have NO role where
in maintenance therapy
Some key adverse effects of steroids
- avascular necrosis of long bone
- hypertension/diabetes
- osteoporosis
- risk of infection
- glucose intolerance
- central adiposity
6-MP and azathioprine - are unique in that they have -
a delayed onset of response 3-4 months to work
but are steroid-sparing agents
Adverse effects of 6-MP and azathioprine
- pancreatitis
- bone marrow suppression
- lymphoma
- myalgias/arthralgias
- abnormal LFTs
list 3 steroid-sparing agents
- methotrexate
- 6-MP
- Azathioprine
Methotrexate in contrast to 6-MP and Azathioprine can be used when?
- as induction AND maintenance therapy
Adverse effects of methotrexate
- pneumonitis
- N/V diarrhea
- leukopenia
- Liver enzyme abnormalities
Mechanism of action of cyclosporin is to
reduce T cell response
when do you make use of cyclosporin in treatment ?
In acute setting
- and severe steroid refractory UC
Cyclosporine can be used to prevent what extraintestinal manifestation
Pyoderma gangrenosum
Adverse effects of cyclosporines
nephrotoxic
infection
hypertension
when is TNF-therapy used in CD
Active disease
Perianal disease**
when are TNFa inhibitors used in Crohn’s disease
Crohn’s: active, perianal disease
UC in severe disease
For active disease, colonic and perianal what antibiotics should you use?
metronidazole in combination with cipro
Antibiotics play NO ROLE in which disease
In ulcerative colitis!
- mostly for perianal, and colitis
- full thickness/transmural inflammation, patchy, focal, skip lesions
- fissuring ulcers
- stiff, thick walls
- linear ulcers along mucosa
Crohn’s
Granuloma formation is classic for
Crohn’s disease
Transmural inflammation is most often seen in
Crohn’s disease
- diffuse mucosal inflammation
- crypt abscess formation
architectural disarray
classic UC path/histo
Small volume diarrhea that is more frequent is more indicative of
ulcerative colitis
Major complication of ulcerative colitis is
Toxic megacolon
- febrile, hemo unstable, white count
Differences between use of steroid-sparing agents in UC
- Methotrexate limited data in UC
- Use of cyclosporin is helpful
Malignancy risk associated with UC
- disease more than 8-10 years-
- extensive disease (pan colitis)
- chronic disease
- if you have PSC
If patient with UC is hospitalized, IV steroids, no improvement 3-5 days what is the rescue therapy
- Infliximab -
Cyclosporine acutely
shallow ulcers
crypt abscess
mucosal ulcers -
diffuse inflammation
Ulcerative colitis
