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Summer FDTN Exam 5 > IBD/Celiac > Flashcards

IBD/Celiac Flashcards

1
Q

What is IBD

A

multifactorial disorder comprised of crohns and CUC

Not well understood but thought to be caused by genetics, environmental (dietary trigger), or immunologic

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2
Q

Give basics about Crohn’s disease

A 
Idiopathic- more severe than UC! 
less prevalent than UC 
Peak onset 15-30 (but any age really) 
MC in jews 
Smoking increases your risk
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3
Q

Give basics about UC

A 
Idiopathic 
more prevalent than crohns 
Peak onset 15-30 (but really any age) 
More common in jews 
Smoking decreases your risk
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4
Q

What does crohn’s disease affect

A

the entire GI tract, mouth to anus

Transmural= affects entire thickness of mucosa! this means ulcers, abscesses, and fistulas!!

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5
Q

MC site of Crohn’s is

A

Distal ileum

only a small percent also have mouth or upper GI manifestations (aphthuos ulcers)

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6
Q

Crohn’s can cause a fistulas (tunnels) where

A

bowel to bowel- Enteroenteric
bowel to bladder- Enterovesicular
bowel to vagina- Enterovaginal
bowel to skin- Enterocutaneous

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7
Q

How does Crohn’s present

A

Gradual onset and intermittent Sx- patient alternates between exacerbations and relative remission
Mild= inflammation
Mod= inflammation and strictures
Severe= inflammation, strictures, and fistulae

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8
Q

Sx of Crohn’s are

A 
Abdominal pain 
Ileum: colicky RLQ pain
\+/- palpable RLQ mass/fullness 
*Chronic, intermittent diarrhea, often nocturnal*
Low grade fever, weight loss 
\+/- hematochezia/rectal bleeding
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9
Q

Rectal exam of someone with Crohn’s may present with

A

abscess, fistula, or skin tag

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10
Q

What does perianal disease in Crohn’s comprise

A

anal fissures
abscess
fistula

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11
Q

Extra-intestinal manifestations of crohn’s are

A

*Aphthous ulcers
*Large joint arthralgias
Erythema nodosum
*Episcleritis, uveitis, iritis
*Gallstones
Sclerosing cholangitis

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12
Q

What lab finding is indicative of sclerosing cholangitis

A

elevated alk phos

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13
Q

What Sx points you to iritis rather than another eye manifestation

A

Iritis is painful with pupil constriction

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14
Q

DDx for crohn’s can be

A 
Infection (C diff, giardia, salmonella, shigella, E. coli) 
UC
Colon cancer 
IBS
Diverticulitis 
Lactose intolerance 
Celiac disease 
Lymphoma 
Endometriosis 
Ischemia 
-it is very hard to diagnose this if it's the first exacerbation!
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15
Q

How do you diagnose Crohn’s

A

Colonoscopy* and you can establish the diagnosis with endoscopic findings
Helps rule out cancer and determine extent of disease

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16
Q

Popcorns for Crohn’s are

A 
Skip lesions* 
Cobblestoning, ulcerations 
Fistulas* 
*Spares the rectum*
*Granulomas on biopsy
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17
Q

Other tests to help diagnose Crohn’s are

A

CT A/P w/ contrast- shows inflammation, abscess, and fistulas
Small bowel follow through- String sign*
ESR/CRP will be elevated in active disease
IBD specific Abs (not the best)

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18
Q

Long term inflammation increases risk of

A

Colon cancer

Crohn’s need colonoscopy surveillance q1-2 years

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19
Q

Complications of Crohn’s are

A 
Fistula, abscess 
Obstruction 
Perforation 
*Nutrient deficiencies (iron, B12) 
Colon cancer 
Smoking and NSAIDs worsen Sx**
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20
Q

Generally what kind of treatment do you put a Crohn’s patient on

A

Step up plan; start conservative and build up

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21
Q

What are different Tx for Crohn’s

A 
Crohn's specific Salicylates (5-ASA) 
Antibiotics for fistula/abscess 
Corticosteroids for flares 
Immunosuppressants 
TNF blockers (Remicade) 
Surgery (not curative bc they can still develop lesions anywhere) 
Nutrition
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22
Q

Where does UC commonly present

A

The colon only, almost always involves the rectum
Starts distal, moves proximal
Affects Mucosal surface only= friability, erosions, bleeding. but not through the entire lining like crohn’s!

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23
Q

Give some UC terms

A

Proctitis: disease limited to rectum
Left sided colitis: extends proximally but stops before splenic flexure
Extensive: extends beyond splenic flexure
Pancolitis: extends into cecum

24
Q

How does UC present

A 
Rectal bleeding 
Diarrhea, usually bloody*  and nocturnal 
Crampy abdominal pain 
Tenesmus* (rectal urgency) 
Constipation w/ proctitis (rectum only)
25
Severe UC may cause
``` Anemia Fever >6 stools per day weight loss hospitalization PE: anemia, abd ttp, positive guaiac *if you see blood, you don't need to do a guaiac test! ```
26
Extra-intestinal manifestations of UC are
*Large joint arthralgias Erythema nodosum Episcleritis, iritis, uveitis Sclerosing cholangitis
27
Difference with IBS and IBD is
IBS diarrhea is not bloody. IBD it usually is, esp in UC
28
How do you diagnose UC
*Flex sigmoidoscopy or colonoscopy for definitive Dx | helps r/o cancer and determine extent of disease
29
Endoscopy with UC is associated with
risk of perforation and induction of toxic megacolon
30
Some popcorn for UC are
Inflammation starts distally and spreads proximally Continuous area of involvement, NO skip lesions Loss of haustral folds rarely see strictures
31
What are signs of inflammation in UC
Petechiae Exudates Friability
32
Other UC diagnostic tests are
CT A/P w/ contrast- will show inflammation ESR/CRP will be elevated in active disease IBD specific antibodies (not Sn/Sp)
33
Complications of UC are
**Toxic megacolon NSAIDs can worsen Colon cancer (colonoscopy q1-2 years) Hemorrhage
34
What is toxic megacolon
Colon dilation >6cm w/ signs of toxicity | Usually presents in early, severe disease
35
Generally, how do you treat UC
``` Step up therapy; start conservative and build up 1st line: Specific Salicylates (5-ASA) Corticosteroids for flares Immunomodulators TNF blockers (Remicade) Surgery ```
36
What are indications for surgery in UC
Perforation Severe hemorrhage (anemia requiring Tx) Dysplasia/cancer Refractory to medical management
37
If needed, what surgery is usually done
Proctocolectomy
38
What is first line therapy for UC
Salicylates specific to colon Sulfasalazine Mesalamine (asacol, lialda) (Rowsa enema, Canasa suppository) Colazol
39
ADE of colon salicylates are
Nephrotoxicity | GI upset
40
What corticosteroids can you use for flares in IBD
Budesonide (less ADE) Prednisone (may cause osteoporosis, insomnia, wt gain, adrenal insufficiency, psychosis) -must taper SLOWLY, dont use for maintenance, and avoid dependence
41
What antibiotics are for Crohn's ONLY (not UC)
Cipro and Flagyl | These are good for fistulas and abscesses
42
What immunomodulators are used for IBD
Mercaptopurine | Imuran
43
What TNF blockers are used for IBD
Remicade (infliximab)
44
Red flags in IBD are
``` Severe bleeding (severe anemia) Severe abdominal pain (peritoneal signs) Weight loss (cant tolerate PO) Signs of dehydration )high creatinine, tachy, hypotensive( ```
45
What are primary care considerations for IBD
Ensure compliance and appropriately monitor labs Smoking exacerbates Crohn's Sx so encourage them to stop (smoking improves UC Sx, but don't promote smoking) NSAIDs can worsen Sx Patients on steroids, immunomodulators, and biologics are at increased risk for infection Always check stool studies in patients with diarrhea
46
How are Crohn's and UC different
Crohn's: mouth to anus, transmural, MC at terminal ileum, fistulas, skip lesions, smoking worsens Sx UC: colon only, mucosal layer only, MC at rectum, toxic megacolon, smoking improves Sx
47
What is Celiac disease
Immune disorder triggered by environmental exposure Gluten is toxic to the small intestine; exposure causes mucosal inflammation, crypt hyperplasia, and villous atrophy (villa become flat)
48
Celiac is MC in
White northern Europeans | it runs in famiies
49
Celiac is associated with
``` FHx Autoimmune diseases T1DM Thyroid disease Down's syndrome ```
50
How does celiac disease present clinically
``` Diarrhea* w/ bulky, foul smelling floating stools (steatorrhea) *Bloating and flatulence Any GI Sx basically! Lactose intolerance *Iron deficiency anemia, Osteopenia, Dermatitis herpetiformis, vitamin B deficiencies (neuro d/o)* Elevated LFT weight loss FTT ```
51
How do you diagnose celiac disease
Must test pt WHILE gluten is in their diet Serology: IgA anti tissue transglutaminase antibody test -or- "Celiac panel" Gold: Small bowel biopsy with EGD (will see villous atrophy)
52
In order to complete an IgA test..
IgA levels must be normal to begin with in that patient. If IgA is baseline low, you wont know if they really have :low" levels
53
Someone presents with an itchy rash.. you think
Celiac disease!!!
54
DDx for celiac disease are
``` Crohn's IBS GERD Lactose intolerance or malabsorption Chronic constipation or diarrhea ```
55
How do you treat celiac disease
Avoid gluten! | Supplement as needed
56
What diseases are associated with malabsorption 2/2 celiac disease
*Iron deficiency anemia B deficiency Osteoporosis
57
Other celiac complications are
Increased risk of malignancy (non-hodgkins lymphoma, GI cancer) Treatment helps decrease complications associated with celiac disease

Summer FDTN Exam 5 (12 decks)

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