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Gastroenterology yr 2 > IBD > Flashcards

IBD Flashcards

1
Q

Ulcers with stellate shapes
-Pyloric metaplasia
granulomas

Suggest

A

Crohn’s disease

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2
Q

what type of cell is often found in crohn’s disease

A
  • Giant cell/multinucleated histiocyte
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3
Q

If IBD affects any portion of the GI tract vs only the colon it is

A

Crohn’s

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4
Q

If disease is limited to the colon and rectum then

A

It is Ulcerative colitis

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5
Q

Type of diarrhea associated with crohn’s disease

A

non-bloody usually

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6
Q

when do you suspect fever in Crohn’s disease

A

if fistula is present

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7
Q

Some clinical manifestations of crohn’s

A
  • RLQ mass
  • obstruction
  • fistula/fever
  • diarrhea
  • abdo pain
  • weight loss!!!
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8
Q

4 disease concordant manifestations of crohn’s disease

A
  • Episcleritis
  • Erythema nodosum
  • mouth ulcers
  • peripheral arthritis
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9
Q

4 disease DISconcordant manifestations of crohn’s disease

A

Pyoderma gangrenosum
axial arthropathy/spondylitis
sacroilitis

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10
Q

what gene attributes susceptibility to CD more so than UC

A
  • NOD2 gene
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11
Q

4 factors involved in the pathogenesis of crohn’s disease

A
  • genetics
  • luminal bacteria
  • dysregulated immune response
  • environmental factors
  • -> acute inflammation leading to chronicity
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12
Q

what labs would you need to do check for crohn’s disease

A
  • CBC, lytes, iron, folate, vit B12, CRP, ESR, stool leukocytes, blood, O and P, C diff
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13
Q

5 medical agents to treat IBD

A
  • 5-ASA - UC not crohn’s
  • steroids
  • abx - not for UC
  • immunosuppressants
  • biologic
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14
Q

5-ASA sulfasalazine is primarily used in

A

Ulcerative colitis - mild crohn’s ileitis

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15
Q

5-ASA only has what type of effect? local?systemic?

A

systemic effect only local

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16
Q

Adverse effects of 5-asa

A

Pancreatitis (within 4 weeks)

Interstitial nephritis

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17
Q

Corticosteroids have NO role where

A

in maintenance therapy

18
Q

Some key adverse effects of steroids

A
  • avascular necrosis of long bone
  • hypertension/diabetes
  • osteoporosis
  • risk of infection
  • glucose intolerance
  • central adiposity
19
Q

6-MP and azathioprine - are unique in that they have -

A

a delayed onset of response 3-4 months to work

but are steroid-sparing agents

20
Q

Adverse effects of 6-MP and azathioprine

A
  • pancreatitis
  • bone marrow suppression
  • lymphoma
  • myalgias/arthralgias
  • abnormal LFTs
21
Q

list 3 steroid-sparing agents

A
  • methotrexate
  • 6-MP
  • Azathioprine
22
Q

Methotrexate in contrast to 6-MP and Azathioprine can be used when?

A
  • as induction AND maintenance therapy
23
Q

Adverse effects of methotrexate

A
  • pneumonitis
  • N/V diarrhea
  • leukopenia
  • Liver enzyme abnormalities
24
Q

Mechanism of action of cyclosporin is to

A

reduce T cell response

25
Q

when do you make use of cyclosporin in treatment ?

A

In acute setting

- and severe steroid refractory UC

26
Q

Cyclosporine can be used to prevent what extraintestinal manifestation

A

Pyoderma gangrenosum

27
Q

Adverse effects of cyclosporines

A

nephrotoxic
infection
hypertension

28
Q

when is TNF-therapy used in CD

A

Active disease

Perianal disease**

29
Q

when are TNFa inhibitors used in Crohn’s disease

A

Crohn’s: active, perianal disease

UC in severe disease

30
Q

For active disease, colonic and perianal what antibiotics should you use?

A

metronidazole in combination with cipro

31
Q

Antibiotics play NO ROLE in which disease

A

In ulcerative colitis!

- mostly for perianal, and colitis

32
Q
  • full thickness/transmural inflammation, patchy, focal, skip lesions
  • fissuring ulcers
  • stiff, thick walls
  • linear ulcers along mucosa
A

Crohn’s

33
Q

Granuloma formation is classic for

A

Crohn’s disease

34
Q

Transmural inflammation is most often seen in

A

Crohn’s disease

35
Q
  • diffuse mucosal inflammation
  • crypt abscess formation
    architectural disarray
A

classic UC path/histo

36
Q

Small volume diarrhea that is more frequent is more indicative of

A

ulcerative colitis

37
Q

Major complication of ulcerative colitis is

A

Toxic megacolon

- febrile, hemo unstable, white count

38
Q

Differences between use of steroid-sparing agents in UC

A
  • Methotrexate limited data in UC

- Use of cyclosporin is helpful

39
Q

Malignancy risk associated with UC

A
  • disease more than 8-10 years-
  • extensive disease (pan colitis)
  • chronic disease
  • if you have PSC
40
Q

If patient with UC is hospitalized, IV steroids, no improvement 3-5 days what is the rescue therapy

A
  • Infliximab -

Cyclosporine acutely

41
Q

shallow ulcers
crypt abscess
mucosal ulcers -
diffuse inflammation

A

Ulcerative colitis

Gastroenterology yr 2 (10 decks)

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