IBD

Question 1

True or False

IBD is an independent risk factor for the development of C diff infection

Answer 1

True

Compared to the general population, IBD pts have a 3x increased risk of C diff infxn

Question 2

which meds are associated w/ microscopic colitis?

Answer 2

NSAID
PPI
SSRI
statins

tx w/ removing offending agent. also can give bismuth, loperamide, or budesonide

Question 3

for pts who have undergone total abdominal colectomy w/ IPAA for ulcerative colitis, and who later develop opuchitis, how do you treat? how do you prevent recurrent pouchitis?

Answer 3

tx: cipro and flagyl
ppx: VSL3 probiotic

Question 4

what skin complication can come from TNF inhibitor use?

Answer 4

TNF-induced psoriasis

risk factor - smoking.

tx: topical tx for psoriasis (usually allows continuing anti-TNF. stopping anti-TNF is required in 20% of pts)

if all this is ineffective, ustekinumab can tx both the Crohn’s and the psoriasis

Question 5

what factors are associated with increased clearance of anti-TNF agents?

Answer 5

presence of anti-drug Ab’s
greater systemic inflammation (CRP)
low serum albumin
drug clearance greater in UC as compared to CD
high BMI
males
concomitant therapy w/ immunosuppressive agents

Question 6

which type of medication is contraindicated in pts w/ IBD who also have heart failure?

Answer 6

anti-TNF agents are associated with heart failure

Question 7

what characterizes Peutz-Jeghers Syndrome?

Answer 7

two or more hamartomatous polyps in the small bowel or colon, mucocutaneous pigmentation of the mouth/lips and fingers.

Question 8

what malignancies are associated with Peutz-Jeghers Syndrome?

Answer 8

colorectal, stomach, small bowel, pancreatic, breast, ovarian, endometrial, cervical, testicular, and lung

Question 9

what is Cowden’s syndrome?

Answer 9

from mutation in the PTEN gene

hamartomas and ganglioneuromas in the GI tract

increased risk of cancers in the:
colon
breast
thyroid
endometrial
renal cell cancer
melanoma

nonmalignant features - glycogenic acanthosis in the esophagus, macrocephaly, skin lesions called trichilemmomas

Question 10

what is the gene defect in hereditary diffuse gastric cancer?

Answer 10

CDH1

Question 11

what is the tx recommended for carriers of CDH1 mutation?

Answer 11

for CDH1 mutation carriers (concerning for hereditary diffuse gastric cancer), risk-reducing total gastrectomy is recommended