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X Clin Med III Exam I > IBD and Celiac > Flashcards

IBD and Celiac Flashcards

1
Q

What is IBD?

A

Chronic relapsing and remitting inflammatory conditions of the GI tract
Crohn Disease and Ulcerative colitis

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2
Q

Pathophysiology of IBD

A

Immunologic
Genetic
Environmental

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3
Q

Risk factors of IBD

A 
15-35 YO (bimodal at 50-80 yrs)
Men for UC and women for CD
Caucasian and jewish
1st degree relative with IBD
Smoking (increase in CD, decrease risk in UC)
Western diet
Imbalance in gut microbiome
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4
Q

Crohn Disease at a glance

A

GI tract from mouth to anus
Patchy/skip lesions
Transmural inflammation due to penetrating disease

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5
Q

Ulcerative colitis at a glance

A

Limited to colon (involves rectum)
Extend proximally with continuous, circumferential involvement
Mucosal layer inflammation

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6
Q

Different extents of CD

A

Apthous ulcers in mouth of gastroduodenal area
Ileum–ileitis most common
Terminal ileum and proximal ascending colon–ileocolitis
Colon–colitis
Perianal disease (abscess/fistula)

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7
Q

What is a fistula? Different types?

A 
Tunnel between 2 epithelial lined organs
Enterenteric-bowel to bowel
Enterovesical- bowel to bladder
Enterovaginal
Enterocutaenous- bowel to skin
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8
Q

Presentation of CD

A

*depends on extent and severity of involvement
Mild–inflammation
Moderate–inflammation and strictures
Severe– inflammation, strictures and fisturlas
Insidious onset and usually intermittent

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9
Q

Where is the pain with CD?

A

RLQ (due to terminal ileal involvement)

May have tender palpable mass there is abscess

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10
Q

Which IBD might present with B12 deficiency?

A

CD is there is terminal ileal involvement

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11
Q

How is the diarrhea with CD?

A

Intermittent and often nocturnal

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12
Q

Extra intestinal manifestations of CD

A 
Oral aphthous ulcers
Episleritis, iritis, uveitis
Erythema nodosum
Pyoderma gangrenosum (shins)
Arthralgias**
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13
Q

What is fecal calprotectin?

A

Non-invasive stool study to assess inflammation

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14
Q

Most commonly used diagnostics for CD

A 
Colonoscopy with TI intubation
Maybe EGD
(can use CT or UGI with SBFT or capsule endoscopy- not with strictures)
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15
Q

Findings on colonoscopy with CD

A

Skip lesions
Ulcerations and cobblestoning
Rectal sparing!
Granulomas and chronic inflammation on biopsy

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16
Q

What can CT or MR enterography detect for CD?

A

Small bowel imaging

Mucosal inflammation, strictures, abscess or fistulas

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17
Q

What is seen on UGI with SPFT in CD?

A

String sign

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18
Q

Complications of CD

A

Colon cancer
Small bowel obstruction and perf (strictures, fistulas etc)
Malabsorption so nutrient deficiencies

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19
Q

Colonoscopy recommendations

A

Every 1-2 yrs beginning 8 yrs after disease/sx onset

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20
Q

Extents of ulcerative colitis

A

Rectum–ulcerative proctitis
Rectosigmoid–ulcerative proctosigmoiditis
Extends to but not beyond splenic flexure– left sided/ distal UC
Extends beyond splenic flexure but not to cecum– extensive colitis
Disease that extends to cecum–pancolitis

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21
Q

Presentation of UC

A

Depend on extent and severity
Mild: <4 stools daily with no systemic toxicity
Moderate: > 4 stools daily, anemia and low fever
Severe: > 6 stools daily with systemic toxicity
Insidious onset and intermittent

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22
Q

Where is the pain with UC?

A

Periumbilical or LLQ pain

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23
Q

Why might there be constipation with UC?

A

Proctitis

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24
Q

Extra intestinal manifestations of EC

A 
Episleritis, iritis, uveitis
Erythema nodosum
Pyoderms gangrenosum
Sclerosing cholangitis (alk phos)
Arthralgias**
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25
Most commonly used diagnostic for UC
Flex sigmoidoscopy or colonoscopy (mostly)
26
Diagnostic findings on colonoscopy with UC
``` Begins distally and spreads proximally Continuous circumferential pattern No vascular markings Superficial: erythematous, exudate, friable Strictures are rare Crypt abscesses on biopsy ```
27
Complications of UC
Colon cancer Hemorrhage Toxic megacolon (colonic dilation > 6 cm with signs of toxicity)
28
How to approach IBD management?
Step up Top down Treat to target
29
Different medical therapies for IBD
``` Salicylates (5-ASA) Corticosteroids Immunomodulators Biologics Abx (CD) ```
30
When would you used step up vs step down in IBD?
Step up for low risk pts with mild disease | Step down for high risk pts with mod to severe disease
31
What is 5-ASA used for in IBD?
Anti-inflammatory effects | sulfasalazine-take folic acid or mesalamine
32
SE of 5-ASA
Diarrhea and kidney injury | nausea, pancreatitis
33
Use of corticosteroids in IBD
Flares (short term not maintenance, slow taper) | -prednisone, budesonide, hydrocortisone
34
SE of oral prednisone
Mood changes, insomnia and weight gain | Worsen DM, increased infections, osteoporosis, cataracts, psychosis, adrenal insufficiency
35
Considerations when prescribe prednisone for IBD
Consider DEXA scan when use for longer than 3 mos | Supplement Ca and Vit D
36
Why use immunomodulators in IBD?
Moderate to severe Steroid sparing agent when on chronic steroids Prevent immunogenicity -6MP, azathioprine, methotrexate (folate supplement)
37
SE of 6MP and azathioprine
Teratogenic (methotrexate) Bone marrow suppression, infection, pancreatitis, hepatotoxic, lymphoma, HPV related cervical dysplasia, non-melanoma skin cancer
38
Recommendations when prescribe immunomodulator for IBD
Monitor CBC and LFTS often Derm exams Cervical CA screen
39
Why use biologics/anti-TNFs to treat IBD?
Moderate to severe IBD | -Humira and other mabs
40
SE of biologics
Infections, activate TB or HBV, malignancies | Dont use with active infection, hx of CHF, MS or optic neuritis
41
Considerations before start anti-TNF for IBD
PPD or assess for TB Assess for HBV Monitor CBC, CMP and derm exams
42
Why use abx for IBD?
``` Acute CD (perianal disease-fistulas, abscesses) Cipro or flagyl ```
43
SE with abx used for IBD
Cipro- tendon rupture, photosensitivity, prolong QT and arrhythmia Flagyl- peripheral neuropathy, metallic tastes, disulfiram like
44
Red flag sxs with IBD that need emergent eval
``` Severe bleeding (anemia) Severe abd pain (peritoneal signs) Can't tolerate PO Dehydrated Sign of obstruction ```
45
Indications for surgery with IBD
Severe hemorrhage Perforation Dysplasia/cancer Medical refractory disease
46
Risk factors for aggressive IBD
(may be able to use top down therapy with them) High risk anatomic locations (perianal, extensive disease) Penetrating or fistulas Steroid resistance/dependence Severe disease activity (malabsorption) Young
47
What to think about in primary care with IBD?
Always check stool studies when the develop diarrheas and change baseline habits (looking for infection) NSAIDs can exacerbate this!!! ID pts at risk Maintenance exams
48
Pathophysiology of celiac disease
Immune mediated disease triggered by ingesting gluten in genetically susceptible ppl
49
What does gluten do to small intestine in celiac?
Villous atrophy and small bowel malabsorption (due to the inflammation and hyperplasia of crypt)
50
What else is associated with celiac?
Genetic (HLA DQ2 or 8) Autoimmune diseases (DM, thyroid) Down syndrome
51
Types of presentation of celiac
Classic (malabsorption): diarrhea, steatorrhea, flatulence/bloating, weight loss Atypical: abd pain, constipation, dyspepsia Silent: extra intestinal manifestations
52
Extra intestinal sxs of celiac
``` Nutrient def (IDA, vits) Osteoporosis Transaminase elevation Dermatitis herpetiformis* Neuropsych sxs FTT Reproductive disorders ```
53
What is dermatitis herpetiformis?
Chronic inflammatory disease that produces lesions that burn and itch intensely (erythematous, papular, pustular or vesicles)
54
3 things needed to diagnose celiac
Clinical suspicion Serologic testing Endoscopic findings
55
Diagnostic tests for celiac
Serology and biopsy of small intestine ON GLUTEN CONTAINING DIET Gold standard- EGD with duodenal biopsy
56
Serologic antibody tests for celiac
IgA tissue transglutaminase (primary) IgA endomysial Deamidated gliadin peptide
57
What is seen on the biopsy with celiac?
Intraepithelial lymphocytes Crypt hyperplasia Villous atrophy
58
Management of celiac
Gluten free diet!! (to minimize the complications) | Supplement when need (folate, iron, zinc, Ca, B12, D)
59
What should you educate the celiac pt about?
``` C-consult with skilled dietician E- educate about disease L- lifelong adherence to diet I- ID and treat nutritional deficiencies A- access to advocacy group/resource C- continuous long-term multidisciplinary follow up ```
60
Complications of celiac
Malabsorption (iron, B12, osteoporosis) | Slight increased risk of malignancy (non-hodgkin lymphoma, GI)

X Clin Med III Exam I (5 decks)

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