IBD

Question 1

When would it be hard to differentiate between Crohns and UC?

Answer 1

If Crohns is only in the colon/rectum, it can look like UC.

Question 2

Differences between location of UC and Crohns.

Answer 2

UC- only in large intestine.

Crohns- anywhere from mouth to anus can have a skipping pattern.

Question 3

Characteristics of UC.

Answer 3

Rectum and colon only. 
Ulcers common but not perforation. 
Mucosa and submucosa
Higher risk of colon CA
Can be "cured"

Question 4

Characteristics of Crohn’s disease.

Answer 4

Any Part of GI tract. 
All layers of the mucosa. 
No cure
High risk of CA
Cobbling?

Question 5

What is the #1 and other s/s of IBD?

Answer 5

Diarrhea

PEM, FTT, malnutrition anemia, food intolerances, high infection risk, less wound healing

Question 6

How are UC and Crohns assessed?

Answer 6

UC- True Love and Witts Criteria

Crohn’s Dis Activity Index (CDAI) : shows current disease severity

Question 7

What are CDAI scores and stages?

Answer 7

Mild-moderate (150-200):can eat without severe problems
Moderate-severe (220-450): major s/s or fail to tx
Severe-fulminant (>450): biologics or steroids do not work
Remission: no s/s

Question 8

Bodily signs of UC

Answer 8

Rectal bleeding (starts in recrum)
15-30 yo but peak 50-60 yo
Malabsorption, blood stool, abd pain, urgency to poo, bacterial translocation
Colon usually removed

Question 9

Bodily signs of Crohns

Answer 9

Usually colon and distal ileum affected
Inflamed areas are separated
Cramping, steatorrhea, wt loss, abd pain
Need multiple surgeries b/c they do not cure disease

Question 10

What is the specific pathogenesis r/t cytokines?

Answer 10

The gut barrier is altered so pathogens invade gut mucosa. Immune response of CD4 TH1 and TH2 altered.
More TNF alpha (pro-inflame) than TNF beta (anti-inflame)
Drugs target TNF alpha

Question 11

What are risks with ileum resection in Crohns?

Answer 11

Bile salt deficiency- fat sol Vit deficiency and steatorrhea
B12 deficiency b/c absorbed in ileum

Question 12

What is soap formation?

Answer 12

Unabsorbed ffa bind with divalent cations (minerals)
Ca, Mg, Zn
These minerals will be deficient with steatorrhea b/c fat malabsorption.

Question 13

Define IBD.

Answer 13

Chronic, autoimmune, idiopathic, inflammatory condition of GI.
Caused by environment, genetics, Microflora, and abnormal immune response.

Question 14

Problems with fat Vit deficiencies

Answer 14

A- night blind, hyperkeratosis
D- hypocalcemia, rickets, hypophosphatemia, osteoporosis
E- neuropathy, hemolytic anemia
K- long PTT, easy bruise, osteopenia

Question 15

What is a fissure?

What is a fistula?

Answer 15

Anus lining tear

Abnormal passage between 2 organs. Can have drainage from it. Common in Crohns. Enterocutaneous= gut to skin

Question 16

Why are obstructions common with IBD?

Answer 16

Flare ups cause a wound, which is then repaired. Scar tissue builds and the lumen shrinks, which can become obstructed.

Question 17

What are management goals for IBD?

Answer 17

Remission- no s/s
Maintain- Tx to control inflammation
Active- inflame, fistula, manage pain and raise nutritional status
Inactive- fibrosis, submucosal thickening, scarring, obstruction

Question 18

MNT for IBD

Answer 18

Prevent malnutrition
Decrease stress on hurt areas
Normal growth in kids 
Heal the intestine  
Fix deficiencies

Question 19

What kind of diet do you use if TPN or TF isn’t used during active IBD?

Answer 19

Low fat, low residue, low fiber, low lactose, small frequent meals
*no nutrient reserves to use for repair.

Question 20

Energy and protein needs for IBD?

Answer 20

MSJ or HB with 1.3-1.5 SF
Sepsis: BEE*1.5-1.7 or 35-45 kcal/kg
Fever is common!

1-1.5 g/kg/d
2-2.5 g/kg/d for infants, kids, adolescents

Question 21

Common supplements needed in IBD?

Answer 21

Everyone needs M/V daily 
If deficiencies- 1-5x normal DRI 
Corticosteroids- Vit D and Ca
Ileum resection- B12 supp and MCT
5-ASA- folate 
Diarrhea- Mg, Ca, Zn

Question 22

When should MCT be used as kcal supp for IBD?

Answer 22

If ileum is rescected or gone because there is no bile to absorb fats

Question 23

Diet during Crohns remission? Flare ups?

Answer 23

Fermentable Fiber make SCFA
Mod to high fiber (soluble)

Low residue diet, white bread, refined, no fresh F/V, nuts, skins, seeds

Question 24

Good foods for IBD transition to remission from flare up.

Answer 24

Dilute juices, applesauce, canned fruit, oatmeal, plain meats, cooked eggs, mashed potatoes, rice, noodles, white/sourdough bread

Question 25

If needed, what kind of TF should be used in severe IBD?

Answer 25

Low fat, low fiber, no lactose
Elemental formula
(TPN for Crohns fistula)

Question 26

Main drug during acute phase IBD?

Answer 26

Corticosteroids (prednisone)

Question 27

3 drug types to maintain remission of IBD?

Answer 27

Anti-inflame: 5-ASA or corticosteroids
Immunosuppressants: cyclosporine
Antibiotics: Flagyl, Cipro

Question 28

Flagyl

Cipro

Answer 28

Metronidazole

Ciprofloxacin

Question 29

What do aminosalicylates do?

Answer 29

5-ASA 
Minimize GI inflammation 
Need to continue using even when feeling good 
Ok during pregnancy but contain sulfa
(Sulfasalazine)

Question 30

3 5-ASA drugs w/o sulfapyridine? What to supplement with these?

Answer 30

Mesalamine

Olsalazine

Balsalazide

Need folate

Question 31

What class of drugs inhibits TNF alpha?

Answer 31

Biologics (Humira and remicade)

Question 32

What to drugs significantly increase risk of cancer?

Answer 32

When used together, Humira (biologics) and 6MP (immunosuppressive)

Question 33

Define SBS. When does it commonly happen?

Question 34

When is malabsorption most severe in SBS?

Answer 34

When colon is gone or 70% GI tract gone.