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Clin Med 2 > IBD > Flashcards

IBD Flashcards

1
Q

Patho of IBD

A

Exact mechanism unknown but thought the be a combination of factors including:

  • damage to epithelial mucin proteins and tight junctions
  • breakdown of homeostatic balance between host’s mucosal immunity and enteric microflora
  • genetic polymorphisms in toll-like receptors
  • disrupted homeostatic balance between regulatory and effector T cells
  • Host immune response to own gut flora
  • imbalance and deregulation between regulatory and effector T cells
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2
Q

Where is IBD prevalent and why?

A

W. world due to diet and environment

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3
Q

Two types of IBD

A

ulcerative colitis and Crohn’s disease

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4
Q

Which IBD disease has a higher incidence

A

ulcerative colitis

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5
Q

Age for Ulcerative colitis

A

15-30 and 50-70 (bimodal)

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6
Q

What is most important in ulcerative colitis

A

family history

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7
Q

Who has the highest risk factor of ulcerative colitis

A

Ashkenazi jews

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8
Q

What environmental factors affect ulcerative colitis?

A
  • smoking decreases risk of flares
  • history of prior GI infections (shigella, salmonella, campylobacter) changes gut flora–> chronic inflammatory process
  • weak association btw NSAID/OCP and UC
  • stress is not a trigger
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9
Q

Clinical UC

A
  • symptoms wax and wane
  • rectal bleeding
  • bloody diarrhea
  • fecal urgency
  • tenesmus
  • abdominal pain LLQ and suprapubic pain
  • abdominal tenderness
  • aphthous oral ulcers
  • iritis- severe eye pain and photophobia
  • seronegative arthritis with flares
  • erythema nodosum on lower extrem. and extensors
  • autoimmune hemolytic anemia
  • primary sclerosing cholangitis
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10
Q

Clinical Mild UC

A
  • gradual onset of diarrhea less than 4 days and intermittent bloody mucoid stool
  • urgency and tenesmus
  • LLQ cramping relieved by bowel movement
  • mild fever, anemia, hypoalbunemia
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11
Q

Clinical Moderate UC

A
  • gradual onset of diarrhea less than 6 days and intermittent bloody mucoid stool
  • urgency and tenesmus
  • LLQ cramping relieved by bowel movement
  • mild fever, anemia, hypoalbunemia
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12
Q

Clinical Severe UC

A
  • more than 6 bloody diarrhea stools/day
  • severe anemia, hypovolemia, hypoalbunemia with nutritional deficit
  • abdominal pain and tenderness
  • fulminant colitis
  • pulse over 90
  • fever over 37.5C
  • ESR over 30
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13
Q

What is fulminant colitis

A
  • subset of severe dz which is rapidly worsening symptoms with toxicity
  • distended abdomen, tender leukocytosis, severe diarrhea, fever
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14
Q

Primary sclerosing cholangitis

A
  • life long chronic disease or scarring anti-inflammation of the bile ducts
  • bile ducts scar and narrow
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15
Q

Which UC extraintestinal symptoms improve after colectomy

A
  • arthritis
  • ankylosin spondylitis
  • erythema nodosum
  • pyoderma gangrenosum
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16
Q

Which UC extraintestinal symptoms do not improve after colectomy

A

primary sclerosing cholangitis

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17
Q

Who is more likely to develop primary sclerosing cholangitis

A

HLA-B8 or HLA-DR3

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18
Q

What is increased risk with primary sclerosing cholangitis? What is cure for primary sclerosing cholangitis?

A

colon cancer

liver transplant

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19
Q

Classification of UC

A 
E= extent/location
1- inflammation of rectum (proctitis)
2- inflammation of splenic flexure (left side; distal)
3- inflammation extendes to proximal splenic flexture (pancolitis)
S= severity
0- remision, no sx
1- mild
2- moderate
3- severe
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20
Q

UC and CD dx

A
  • based on clinical symptoms and confirmed by sigmoidoscopic and colonoscopic and histologic examination
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21
Q

If severe pancolitis use what for dx?

A

flex sig

22
Q

UC colonoscopy results

A
  • diffuse confluent disease from dentate line proximal
  • edema, friability of mucosa, mucous, erythema, erosions, ulcerations, and spontaneous bleed
  • only found in the colon
23
Q

Histology UC

A 
distortion of crypt architecture
crypt abscee
infiltration of lamina propria with plasma cells
eosinophils
lymphocytes
lymphoid aggregates
mucin depletion
24
Q

Tx Mild UC

A
  • 5-ASA drugs (aminosalicylates)- release only in colon
    (Mesalazine PR suppository or budesonide rectal foam if rectal proctitis)
  • Distal colon inflammation- rectal/oral 5-ASA (PO sulfasalazine and PR mesalazine)
  • long term maintenance with 5-ASA
25
Q

Tx Mild/Moderate UC

A
  • Fail of 5-ASA
  • PO Budesonide
  • Prednisone
  • Taper over 60 days
26
Q

Tx Severe UC

A
  • hospitalization and IV steroids with IVF (methylprednisone 60mg/d)
  • Anti-biologics if fail steroid tx (TNF alpha- infliximab, adalimumab, golimumab) or (VGEF blocker if fail TNF- vedolizumab)
  • cyclosporine is last resort
27
Q

Maintenence TX UC

A
  • once in remission
  • 5-ASA
  • Budesonide
  • Immunosuppressant- golimumab or 6-MP
  • Induct with infliximab, then continue use
  • probiotics
28
Q

Only curative tx for UC

A

colectomy

29
Q

Surgery TX UC

A

Emergency- toxic megacolon
Urgent- severe dz and not responding to tx in hospital
Elective
- refractory: intolerant to long term maintenance tx
- colorectal dysplasia or adenocarcinoma found
- dz more than 7-10yrs

30
Q

UC patients at increased risk of?

A

colorectal cancer

31
Q

Screening UC

A
  • colonoscopy begins 8yrs after dz onset
  • if L. sided colitis/pancolitis: every 1-2 yrs
  • UC with PSC: every yr from PSC dx
32
Q

Def Crohn Dz

A

insidious variable presentation of lifelong idiopathic inflammatory dz that affects anywhere in GI system

33
Q

What type of inflammation in crohn dz and what does it cause?

A

transmural inflammation in skip distribution that causes strictures, fistulas, ulcerations, abscess

34
Q

MC area affected in Crohn dz

A

small bowel and colon (terminal ileum and ascending colon)

35
Q

Strongest risk factor for CD

A

family hx

36
Q

Environmental factors for CD

A

tobacco
sedentary lifestyle
exposure to air pollution
consumption of western diet

37
Q

When does CD commonly begin?

A

after infectious gastroenteritis

38
Q

Clinical CD

A
  • RLQ, periumbilical pain
  • watery diarrhea
  • incontinence
  • low grade fever
  • weight loss/anorexia/ malnutrition
  • weak, fatigue, malaise
  • bone loss
  • SBO presentation
  • rectal abscess or anal fistula
  • arthralgia
  • iritis
  • erythema nodosum
39
Q

6 complication of CD

A 
abscess
obstruction
fistula
perianal dz
colon cancer
dysplasia/malignancy--> malabsorption
40
Q

Treat fistulas in patient with CD

A

TPN/ oral elemental diet
Antibiologics for 10 weeks
Surgery is medication fails

41
Q

Treat perianal dz in patient with CD

A

ABX (flagyl or cipro)
Mesalamine suppository or tacrolimus ointment if refractory fissure
Antibiologics

42
Q

Classification of CD

A 
L= extent
1- terminal ileum
2- colon
3- ileum and colon
4- upper GI
L3+L4= upper GI and distal
B= phenotype
1- no stricture and non-penetrating
2- stricture
3- penetrating
3p- perianal penetrating
43
Q

Colonoscopy results for CD

A

aphthoid, stellate, linear ulcers
strictures
segmental involvement with skip lesions

44
Q

General TX CD

A
  • stop smoking

- diarrhea: loperamide, BAS (terminal ileal disease), low fat diet if short gut

45
Q

Tx mild CD

A

Mesalamine (colon and small bowel)

46
Q

Tx moderate to severe

A
  • Steroid short term to control sx, use until remission and then a slow 60day taper
  • immunosuppressants (azathioprine or methotrexate)
47
Q

When to use TNF alpha in CD

A
  • steroid dependent and no taper
  • fistula tx no responding to ABX
    refractory cases
  • can do an induction and maintenance
  • infliximab, adalimumab, certolizumab pegol
48
Q

When to use anti-integrins in CD

A
  • no response to TNF

- vedolizumab (gut leukocyte trafficking)

49
Q

Screen CD

A
  • Regular screen TB, hepatitis, CMV, HIV, and C. diff
  • more than 1/3 colon affected (L3) colonoscopy 8 yrs after onset and repeat every 1-2yrs and 1-3 once normal
  • PSC= annual screening
50
Q

PSC and CD have a risk of? Screen with?

A

cholangiocarcinoma (cancer of bile ducts)

screen with MRCP

Clin Med 2 (25 decks)

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