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clin med III, exam 1 > IBD > Flashcards

IBD Flashcards

1
Q

inflammatory bowel disease is most common in what patient population

A

Jews

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2
Q

smoking has what affect on risk of inflammatory bowel disease

A
  • smoking increases risk of crohns disease
  • smoking decreases risk of ulcerative colitis
    • pt diagnosed once they quit smoking
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3
Q

Crohns disease affects what portion of the GI tract

A
  • mouth to anus
  • transmural: affects all entire thickness of mucosa
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4
Q

what are possible complications of crohns disease

A
  • ulcer
  • stricture
  • fistula
  • abscess
  • colon cancer
  • obstruction, perforation
  • Nutritional deficiencies (Fe, B12)
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5
Q

most common site of involvement of Crohns disease is

A

distal ileum

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6
Q

What is a fistula

A

tunnel between two epithelial lined organs

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7
Q

Define the following fistulas

  • enteroenteric
  • enterovesicular
  • enterovaginal
  • enterocutaneous
A
  • enteroenteric: bowel to bowel
  • enterovesicular: bowel to bladder
  • enterovaginal: bowel to vagina
  • enterocutaneous: bowel to skin
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8
Q

differentiate between crohns ileitis, ileocolitis, and colitis

A
  • crohns ileitis: disease limited to ileum
  • crohns ileocolitis” disease of terminal ileum and adjacent proximal ascending colon
  • crohns colitis: disease of the colon
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9
Q

clinical presentation

  • highly variable
  • colickly RLQ pain
  • chronic, intermittent diarrhea
    • often noctural
  • rectal bleeding
A

Crohn’s disease

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10
Q

List the extra-intestinal manifestations of Crohn’s disease

A
  • aphthous ulcerations
  • arthralgias, arthritis (primarily large joints)***most common
  • erythema nodosum
  • episcleritis, iritis, uveitis
  • gallstones
  • sclerosing cholangitis
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11
Q

procedure of choice to evaluate suspected crohns disease

A

colonscopy

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12
Q

colonoscopy showing skip lesions and rectal sparing is characteristic of what form of IBD

A

Crohn’s disease

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13
Q

biopsy showing granulomas is diagnostic of what type of IBD

A
  • Crohn’s disease
    • seen in 30% of patients
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14
Q

small bowel follow-through: string sign is seen with what form of IBD

A

Crohn’s disease

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15
Q

list other diagnostic/lab tests (besides colonoscopy) used to assess IBD

A
  • CT scan with contrast
    • inflammation (thickened walls), abscesses, fistulas
  • ESR, CRP: elevated in active disease
  • IBD specific antibodies
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16
Q

long term inflammation caused by IBD increases risk of colon cancer, how often should pt be screened

A
  • colonoscopy ever 1-2 yrs
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17
Q

if patient has IBD, he/she should not take what pain medication

A
  • NSAIDs
    • can cause flare-ups
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18
Q

List tx options for crohns disease

A

step up therapy or top-down

  • salicylates (5-ASA)
  • antibiotics (fistulas, abscesses)
  • corticosteroids (flares)
  • immunosuppressants
  • TNF blockers- remicade
  • surgery
  • nutrition
    • ​**unique to crohns
19
Q

ulcerative colitis affects what portion of GI tract

A
  • colon only
    • almost always involves rectum
    • occurs distal -> proximal (continuous)
  • mucosal surface only
20
Q

proctitis

A

ulcerative colitis limited to rectum

21
Q

left sided colitis

A

ulcerative colitis that extends to but not beyong splenic flexure

22
Q

pancolitis

A

ulcerative colitis that extends to cecum

23
Q

clinical presentation

  • rectal bleeding
  • diarrhea, often bloody and includes mucous,
    • often nocturnal
  • crampy abd pain
  • tenesmus (feeling of constantly needing to pass stools)
A

ulcerative colitis

24
Q

List extra-intestinal manifestations of ulcerative colitis

A
  • arthralgias, arthritis (primarily large joints)***most common
  • erythema nodosum
  • episcleritis, iritis, uveitis
  • sclerosing cholangitis
25
Q

How is ulcerative colitis diagnosed

A
  • flex sig or colonoscopy
    • only colon affected
    • continuous area of involvement, no skip lesions
26
Q

complications of ulcerative colitis

A
  • colon cancer
  • hemorrhage
  • toxic megacolon: colonic dilation > 6 cm with signs of toxicity
27
Q

list tx options for ulcerative colitis

A

step up therapy

  1. salicylates (5-ASA) **first line
  2. corticosteroids (flares)
  3. immunosuppressants
  4. TNF blockers- remicade
  5. surgery
28
Q

first line therapy for IBD

A
  • salicylates (5-ASA)
29
Q

if patient is taking the salicylate (5-ASA) sulfasalazine, he/she must take what

A

folic acid

30
Q

side effects of salicylates (5-ASA)

A
  • nephrotoxicity
  • GI upset
31
Q

When patient with IBD is given corticosteroids, what do you need to know about taking them off

A
  • not used for maintenance, only for flares
  • slow taper
32
Q

What corticosteroid is commonly used for ileal/ rt sided colonic disease

A
  • Budesonide
    • steroid-light-> less systemic side effects
33
Q

side effects of prednisone

A
  • osteoporosis
  • insomnia
  • worsening of DM
  • weight gain
  • adrenal insufficiency
  • psychosis
  • increased infection risk
34
Q

Which abx are commonly used in crohns tx

A
  • ciprofloxin and flagyl (metronidazole)
    • used in acute disease
35
Q

side effects of Flagyl (Metronidazole)

A
  • peripheral neuropathy
  • metallic taste
  • disulfuram rxn (avoid alcohol)
36
Q

side effects of ciprofloxin

A
  • tendinitis (tendon rupture)
  • photosensitivity
  • prolongation of QT interval
37
Q

red flags of IBD

A
  • severe bleeding
  • severe abd pain -> peritoneal signs
  • weight loss
  • signs of dehydration
  • signs of obstruction
  • failure to respond to medical therapy
38
Q

What is celiac’s disease

A
  • immune disorder triggered by environmental exposure
  • gluten is toxic to small intestine
    • causes mucosal inflammation, crypt hyperplasia and villous atrophy
39
Q

celiac disease is prevalent in what patient populations

A
  • whites of northern european ancestry
  • relative with celiacs
  • autoimmune disease
  • DM I
  • thyroid disease
  • down’s syndrome
40
Q

clinical presentation

  • diarrhea with bulky, foul-smelling, floating stool due to steatorrhea, bloating and flatulence
  • Fe deficiency anemia
  • osteopenia
  • dermatitis herpetiformis
  • B vitamin deficiencies
  • elevated LFT
A

celiac’s disease

41
Q

dermatitis herpetiformis is pathonmeumonic for

A

celiac disease

42
Q

how is celiac disease diagnosed

A
  • must do testing while patient is eating gluten
  • small bowel biopsy via EGD is gold standard
    • find villous atrophy
  • blood testing: celiac disease panel
43
Q

tx of celiac disease

A
  • avoid gluten
  • supplement as needed
44
Q

celiac disease complications

A
  • malabsorption
    • Fe deficiency anemia
    • B vitamin deficiency
    • osteoporosis
  • slight increase in
    • non-hodgkins lymphoma
    • GI malignancies

clin med III, exam 1 (5 decks)

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