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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
Q

Severe UC may cause

A 
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
Q

Extra-intestinal manifestations of UC are

A

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

27
Q

Difference with IBS and IBD is

A

IBS diarrhea is not bloody. IBD it usually is, esp in UC

28
Q

How do you diagnose UC

A

*Flex sigmoidoscopy or colonoscopy for definitive Dx

helps r/o cancer and determine extent of disease

29
Q

Endoscopy with UC is associated with

A

risk of perforation and induction of toxic megacolon

30
Q

Some popcorn for UC are

A

Inflammation starts distally and spreads proximally
Continuous area of involvement, NO skip lesions
Loss of haustral folds
rarely see strictures

31
Q

What are signs of inflammation in UC

A

Petechiae
Exudates
Friability

32
Q

Other UC diagnostic tests are

A

CT A/P w/ contrast- will show inflammation
ESR/CRP will be elevated in active disease
IBD specific antibodies (not Sn/Sp)

33
Q

Complications of UC are

A

**Toxic megacolon
NSAIDs can worsen
Colon cancer (colonoscopy q1-2 years)
Hemorrhage

34
Q

What is toxic megacolon

A

Colon dilation >6cm w/ signs of toxicity

Usually presents in early, severe disease

35
Q

Generally, how do you treat UC

A 
Step up therapy; start conservative and build up 
1st line: Specific Salicylates (5-ASA) 
Corticosteroids for flares 
Immunomodulators 
TNF blockers (Remicade) 
Surgery
36
Q

What are indications for surgery in UC

A

Perforation
Severe hemorrhage (anemia requiring Tx)
Dysplasia/cancer
Refractory to medical management

37
Q

If needed, what surgery is usually done

A

Proctocolectomy

38
Q

What is first line therapy for UC

A

Salicylates specific to colon
Sulfasalazine
Mesalamine (asacol, lialda) (Rowsa enema, Canasa suppository)
Colazol

39
Q

ADE of colon salicylates are

A

Nephrotoxicity

GI upset

40
Q

What corticosteroids can you use for flares in IBD

A

Budesonide (less ADE)
Prednisone (may cause osteoporosis, insomnia, wt gain, adrenal insufficiency, psychosis)
-must taper SLOWLY, dont use for maintenance, and avoid dependence

41
Q

What antibiotics are for Crohn’s ONLY (not UC)

A

Cipro and Flagyl

These are good for fistulas and abscesses

42
Q

What immunomodulators are used for IBD

A

Mercaptopurine

Imuran

43
Q

What TNF blockers are used for IBD

A

Remicade (infliximab)

44
Q

Red flags in IBD are

A 
Severe bleeding (severe anemia) 
Severe abdominal pain (peritoneal signs) 
Weight loss (cant tolerate PO) 
Signs of dehydration )high creatinine, tachy, hypotensive(
45
Q

What are primary care considerations for IBD

A

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
Q

How are Crohn’s and UC different

A

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
Q

What is Celiac disease

A

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
Q

Celiac is MC in

A

White northern Europeans

it runs in famiies

49
Q

Celiac is associated with

A 
FHx 
Autoimmune diseases 
T1DM 
Thyroid disease 
Down's syndrome
50
Q

How does celiac disease present clinically

A 
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
Q

How do you diagnose celiac disease

A

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
Q

In order to complete an IgA test..

A

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
Q

Someone presents with an itchy rash.. you think

A

Celiac disease!!!

54
Q

DDx for celiac disease are

A 
Crohn's 
IBS
GERD
Lactose intolerance or malabsorption 
Chronic constipation or diarrhea
55
Q

How do you treat celiac disease

A

Avoid gluten!

Supplement as needed

56
Q

What diseases are associated with malabsorption 2/2 celiac disease

A

*Iron deficiency anemia
B deficiency
Osteoporosis

57
Q

Other celiac complications are

A

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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