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Clin Med II - GI Exam > IBD > Flashcards

IBD Flashcards

1
Q

What does IBD stand for?

A

Inflammatory Bowel Disease

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2
Q

Etiology of ulcerative colitis?

A

idiopathic

some genetic tendency

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3
Q

What are the groups in which ulcerative colitis typically presents?

A

Adolescence or young adulthood.

Whites, Jews of Eastern European descent

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4
Q

Presentation of UC?

A 
BLOODY DIARRHEA
ABD PAIN RELIEVED BY BM
fever, anorexia, wt loss, anemia
arthritis
uveitis
jaundice 
skin lesions
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5
Q

What is the most common location effected by UC?

A

Almost always involves distal colon and rectum

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6
Q

What percentage of pt’s go into complete remission?

A

90%

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7
Q

There are 3 disease severities for UC describe all 3

A

Mild-fewer than 4BMS qd, intermittent bleeding Normal labs
Moderate-4-6BMs qd frequent bleeding, HCT drop and ESR 20-30
Severe-more than 6BM’s qd, HCT drop , wt loss greater than 10%, ESR greater than 30

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8
Q

Why is ESR increased during mod-acute attack of UC?

A

sed rate is marker for inflammation

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9
Q

What distinguishes UC from Ulcerative proctitis?

A

limited extent of inflammation, good prognosis and lack of serious complications
relapses are more common

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10
Q

What are the main differences between UC and Crohn’s dz?

A

Crohn’s is chronic

and can effect the entire GI system (and extends through all layers of bowel wall)

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11
Q

What is believed to be the etiology of Crohn’s disease?

A

autoimmune

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12
Q

Peak incidence of Crohn’s occurs at what age?

A

20-40yo

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13
Q

Most common site effected by Crohn’s dz?

A

Distal ileum and Right colon - can involve small bowel (infrequent)

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14
Q

Symptoms of Crohn’s dz?

A 
ABD PAIN 
diarrhea (may be bloody)
wt loss/anorexia
vomiting
feer
perianal discomfort/bleeding
constipation
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15
Q

Describe 3 severities of Crohn’s dz

A

Mild to mod-wt loss less than 10%, no dehydration
Moderate to severe-fever, anemia, wt loss greater than 10%
Severe-fever, obstruction, abscess

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16
Q

What might be seen on PE for Crohn’s

A 
RLQ abd mass
Perianal fistula tract
inflamed joint
erythema nodosum
pyoderma
uveitis
aphthous ulcer
Nephrolithiasis
obstruction
osteoporosis/penia
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17
Q

What does GALS stand for in “only GALS can be Crohn’s”

A

Granulomas
All
Layers
Skin lesions

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18
Q

DX for UC

A 
clinical dx
sigmoidoscopy
colonoscopy 
rectal bx
Seriolgoy-elevated CRP, Leuk, ESR, Platelet, and decrease in HgB and albumin
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19
Q

What additional test should be done to rule out Cause of diarrhea when considering UC?

A

stool for toxins, bacteria O&P

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20
Q

Dx for Crohn’s

A

clinical presntation
rad contrast *UGI, air contrast BE
serology-elevated CRP, Leuks, ESR, Platelet and decrease in HgB and albumin (same as UC)
Endoscopic-rectal sparing, fistulization, skip lesions

21
Q

UC tx options:

A 
Sulfasalazine
Sulfapyridine-Free 5-aminosalicylate agents
oral corticosteroids
immunosuppressives
opiates
physch. support
surgery
screen for ca.
22
Q

What is the first medication typically prescribed for UC moderate-mild symptoms?

A

sulfasalazine

23
Q

What might sulfasalazine be combined with for UC with more severe sx.?

A

steroids.

24
Q

Why might sulfasalazine not be initiated to start with mod-mild UC?

A

some pt’s don’t tolerate it well

25
Q

What is the more expensive and more effective new tx for UC?

A

Sulfapyridine-free 5-aminosalicylates

26
Q

What is the benefit/drawback to prescribing Suflapyridine-free 5-aminosalicylates as opposed to sulfasalazine?

A

Doesn’t have the side effects as sulfasalazine

MUCH MORE EXPENSIVE

27
Q

For distal UC what is an additional alternate to sulfasalazine bat can be used for maintenance of UC and prevents the concern about systemic steroid absorption?

A

5-ASA enemas

28
Q

When is the use of glucocorticosteroids indicated in UC?

A

moderately severe to severe cases

29
Q

For those that require chronic high-dose steroid tx and have had inadequate response to conventional therapies what is an additional modality that can be tried?

A

Immunomodulator agents.

30
Q

What must be monitored in the use of immunomodulator agents?

A

potential side effects of infection, heptotoxicity, bone marrow suppression

31
Q

For those unable to function at all due to diarrhea what may also be prescribed?

A

opiods/opiates

32
Q

What are indications for surgery for UC?

A

high grade dysplasia, toxic megacolon, hemorrhage, obstruction, unresponsiveness to maximal medical management.

33
Q

What screening in necessary for pt’s with UC or crohn’s (but more common in UC)?

A

Colorectal cancer

34
Q

What patients are screened for colorectal cancer with IBD?

A

all pt’s with punctilios of 7 years or more than 12 years after L sided colitis (whichever comes first)
eery 2-3 years until 20yr hx then annual

35
Q

When is Metranidazole given in the presence of Crohn’s dz?

A

2nd step w/ failure to sulfasalazine

36
Q

So Metronidazole - second step tx in ________

and 5-ASA is second step tx in ______

A 
Metronidazole = Crohn's
5-ASA = 5ASA
37
Q

Should pt increase or decrease fiber during Crohn’s flare?

A

decrease fiber

38
Q

Should pt increase or decrease fiber while not experiencing a Crohn’s flare?

A

Increase fiber

39
Q

when do you admit a pt with Crohn’s?

A 
bleeding
toxicity
sever pain or too ill to obtain adequate nutrition orally
bowel rest
nasogastric feeding 
parenteral steroids
surgical consult
40
Q

Define Rome Criteria for IBS

A 
Abd pain/discofort relieved with BM and 2 or more of the following for at least 3 days/mo x 3mos:
change in stool frequency
Change in stool consistency
Difficult stool passage
Sense of incomplete evacuation
Presence of mucus in the stool
41
Q

What age group is IBS more common in?

A

Young (under 45)

42
Q

Sx of IBS

A 
altered bowel habits
flatulence
abd pain
upper GI symptoms
Symptoms are almost always during waking hours
43
Q

Characteristics of Abdominal pain in IBS?

A 
location varies
frequent episodic crampy ache
intensity varies
pain exacerbated by stress
Pain relieved by BM
44
Q

What sx makes you think IBS and not UC?

A

If the pt is able to sleep through the night, no night-time awakenings they probably have IBS.

45
Q

What is the most common pattern of altered bowel habit in IBS?

A

Constipation alternating with diarrhea

46
Q

What percentage of pt’s c/o upper GI problems with IBS?

A

25-50%

47
Q

What does the workup for IBS depend on?

A

onset of symptoms, severity and age of pt.

48
Q

diagnostics for IBS?

A 
diagnosis of exclusion
CBD
flex sig
stook for O&P
older than 40 BE/colonscopy
UGI
dietary (lactose intollerance)
UGI workup 
US gallbladder postprandial RUQ pain
49
Q

tx for IBS?

A 
counseling/dietary
stool bulking agents/high fiber diet
antispasmodics (starting to fall out of fashion)
antidiarrheals (temporary)
antidepressants
Antiflatulence
GI motility enhancers

Clin Med II - GI Exam (14 decks)

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