IBD

Question 1

Crohns disease

Answer 1

patchy inflammation, mouth to anus involvement, full-thickness inflammation, variable involvement, cobble stone appearance, fistula, strictures and surgery, extraintestinal manifestations

Question 2

chrohns disease clinical presentation

Answer 2

VARIABLE!
abdominal pain, diarrhea, constipation, wt loss, anorexia, vomiting, fevers, rectal bleeding, stunted growth in kids

Symptoms dictated by location of disease

Small bowel vs large bowel symptoms (but also both)

Perianal disease

Question 3

different types of lesions in crohns

Answer 3

apthous ulcers- canker sores in colon
skip lesions- patchy erythema

linear ulcerations- cobblestones

Question 4

ulcerative colitis

Answer 4

continuous inflammation
colon only, superficial inflammation, variable involvement, risk of cancer, extraintestinal manifestations

Starts in the rectum

Presentation is less variable- bloody stools, urgency for bowel movement, diarrhea, abdominal pain typically less than crohns, loss of appetite and weight, fever, fatigue, kids have growth and developmental failure

Question 5

endoscopic findings of ulcerative colitis

Answer 5

Erythema, loss of normal vascular pattern, granularity of the mucosa, friability edema, pseudopolyps, erosions, ulcers, spontaneous bleeding, cecal patch, back wash illetitis

Question 6

Fulinant colitis and toxic megacolon

Answer 6

Severe Ulcerative colitis with Fever, elevated WBC and unstable vitals

High risk of perforation with Endoscopy and spontaneously
Toxic megacolon when transverse colon >5.5 cm, surgical emergency

Question 7

Risk of colerectal cancer in Ulcerative colitis

Answer 7

Risk for cancer in UC proportional to extent and duration of disease

Smoking, chronic inflammation on surveillance, family history of CRC, development of dysplasia (precancerous tissue), PSC

Question 8

Big differences between crohns and ulcerative colitis

Answer 8

Rectal sparing- UC always affects the rectum
Normal vasculature next to affected tissue–patchy= Crohns
ISolated involvement of the terminal ileum = Crohns (for backwash iletisi needs to be pan colitis

Fistulats or strictures= Crohns
Granulomas on biopsy= crhns
Transmural inlfammation = crohns
Cecal patch

Question 9

Extraintestinal manifestations of inflammatory bowel disease

Answer 9

Arthropathy- 15-20%
Erythema nodosum- 15%
Pyoderma gangrenosum
Ocular complications: 5-15%
Sacroilitis:9-11
Ankylosing spondylitits
Nephrolithiasis, calcium oxalate stone (Crohns only)
Primary sclerosing cholangitis

Question 10

pathogenesis of crohns disease

Answer 10

genetic: NOD2 mutations
Mucosal immune response- Th17 cells
Epithelial defects- defects in epithelial tight junctions
Microbiota

Question 11

colonizing bacteria are the most predominant non genetic factor in IBD

Answer 11

IBD is charachterized by an amplified response to the intestinal microbiota, differences in microbiota composition and diversity may contribute to iBD

Question 12

Treating IBD

Answer 12

start by inducing remission then maintain remission
REmission= feeling nearly normal again
Induce- start feeling better
Maintain- keep feeling better
We control we dont cure, takes more to induce remission than it does to maintain remission

Question 13

Medication used for ibd

Answer 13

Mesalamines (induce and maintain) (many names, work well for mild to moderate ulcerative colitis, less efective to crohns

Immunomodulators (maintain only)- azathioprine, 6MP, MTxate, oral therapy requires lab monitoring, anti TNFs (infliximab, certozolumab, adalimumab). Anti adhesions (Natalizumab, vedolizumab)

Corticosteroids (Induction only)