IBD Flashcards
When would it be hard to differentiate between Crohns and UC?
If Crohns is only in the colon/rectum, it can look like UC.
Differences between location of UC and Crohns.
UC- only in large intestine.
Crohns- anywhere from mouth to anus can have a skipping pattern.
Characteristics of UC.
Rectum and colon only. Ulcers common but not perforation. Mucosa and submucosa Higher risk of colon CA Can be "cured"
Characteristics of Crohn’s disease.
Any Part of GI tract. All layers of the mucosa. No cure High risk of CA Cobbling?
What is the #1 and other s/s of IBD?
Diarrhea
PEM, FTT, malnutrition anemia, food intolerances, high infection risk, less wound healing
How are UC and Crohns assessed?
UC- True Love and Witts Criteria
Crohn’s Dis Activity Index (CDAI) : shows current disease severity
What are CDAI scores and stages?
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
Bodily signs of UC
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
Bodily signs of Crohns
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
What is the specific pathogenesis r/t cytokines?
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
What are risks with ileum resection in Crohns?
Bile salt deficiency- fat sol Vit deficiency and steatorrhea
B12 deficiency b/c absorbed in ileum
What is soap formation?
Unabsorbed ffa bind with divalent cations (minerals)
Ca, Mg, Zn
These minerals will be deficient with steatorrhea b/c fat malabsorption.
Define IBD.
Chronic, autoimmune, idiopathic, inflammatory condition of GI.
Caused by environment, genetics, Microflora, and abnormal immune response.
Problems with fat Vit deficiencies
A- night blind, hyperkeratosis
D- hypocalcemia, rickets, hypophosphatemia, osteoporosis
E- neuropathy, hemolytic anemia
K- long PTT, easy bruise, osteopenia
What is a fissure?
What is a fistula?
Anus lining tear
Abnormal passage between 2 organs. Can have drainage from it. Common in Crohns. Enterocutaneous= gut to skin
Why are obstructions common with IBD?
Flare ups cause a wound, which is then repaired. Scar tissue builds and the lumen shrinks, which can become obstructed.
What are management goals for IBD?
Remission- no s/s
Maintain- Tx to control inflammation
Active- inflame, fistula, manage pain and raise nutritional status
Inactive- fibrosis, submucosal thickening, scarring, obstruction
MNT for IBD
Prevent malnutrition Decrease stress on hurt areas Normal growth in kids Heal the intestine Fix deficiencies
What kind of diet do you use if TPN or TF isn’t used during active IBD?
Low fat, low residue, low fiber, low lactose, small frequent meals
*no nutrient reserves to use for repair.
Energy and protein needs for IBD?
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
Common supplements needed in IBD?
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
When should MCT be used as kcal supp for IBD?
If ileum is rescected or gone because there is no bile to absorb fats
Diet during Crohns remission? Flare ups?
Fermentable Fiber make SCFA
Mod to high fiber (soluble)
Low residue diet, white bread, refined, no fresh F/V, nuts, skins, seeds
Good foods for IBD transition to remission from flare up.
Dilute juices, applesauce, canned fruit, oatmeal, plain meats, cooked eggs, mashed potatoes, rice, noodles, white/sourdough bread
If needed, what kind of TF should be used in severe IBD?
Low fat, low fiber, no lactose
Elemental formula
(TPN for Crohns fistula)
Main drug during acute phase IBD?
Corticosteroids (prednisone)
3 drug types to maintain remission of IBD?
Anti-inflame: 5-ASA or corticosteroids
Immunosuppressants: cyclosporine
Antibiotics: Flagyl, Cipro
Flagyl
Cipro
Metronidazole
Ciprofloxacin
What do aminosalicylates do?
5-ASA Minimize GI inflammation Need to continue using even when feeling good Ok during pregnancy but contain sulfa (Sulfasalazine)
3 5-ASA drugs w/o sulfapyridine? What to supplement with these?
Mesalamine
Olsalazine
Balsalazide
Need folate
What class of drugs inhibits TNF alpha?
Biologics (Humira and remicade)
What to drugs significantly increase risk of cancer?
When used together, Humira (biologics) and 6MP (immunosuppressive)
Define SBS. When does it commonly happen?
When is malabsorption most severe in SBS?
When colon is gone or 70% GI tract gone.
