IBD & Celiac disease

Question 1

What are the possible causes of IBD?

Answer 1

Multifactoral:
Genetic
Environmental
Immunologic

Question 2

What is the effect of smoking on crohn’s vs UC?

Answer 2

Increases risk of Crohns

Decreases risk of UC

Question 3

Which is more common? UC or Crohn’s?

Answer 3

UC

Question 4

What are characteristics of Crohn’s?

Answer 4

Can affect entire GI tract: Mouth –> anus

Transmural (affects entire thickness of mucosa)

Can cause fistula

Question 5

Crohn’s: What is the MC site of involvement?

Answer 5

Distal ileum

Question 6

How does Crohn’s present?

Answer 6

Gradual onset

Colicky RLQ pain

Chronic, intermittent diarrhea
(often nocturnal)

Question 7

What extra-intestinal manifestations are seen in both Crohn’s & UC?

Answer 7

Arthralgias, arthritis (MC!)
Erythema nodosum
Episcleritis, iritis, uveitis
Sclerosing cholangitis

Question 8

What is the procedure of choice for crohn’s?

Answer 8

Colonoscopy: Skip lesions

Question 9

What will biopsy show in crohn’s?

Answer 9

Granulomas

Question 10

What other tests can you use to dx crohn’s?

Answer 10

CT of abd/pelvis w/ contrast

Small bowel follow-through: String sign

ESR, CRP: elevated in active disease

IBD specific antibodies

Question 11

What are complications of crohn’s?

Answer 11

Fistula, abscess
Obstruction
Perforation
Nutrient deficiencies (Fe, B12)**

Question 12

What class of medication can worsen sx of both Crohn’s & UC?

Answer 12

NSAIDs!

Question 13

Both Crohn’s & UC increase the risk of what?

Answer 13

Colon CA

Perform colonoscopy every 1-2yrs

Question 14

How do you treat Crohn’s disease?

Answer 14

Salicylates 
Abx (fistulas/abscess)*cipro+flagyl
Corticosteroids (flares)
Immunosuppressants 
TNF blockers 
Surgery 
Nutrition*

Question 15

UC affects what organ in the body?

Answer 15

Mucosal surface of colon only

Question 16

What term is used to describe a disease that extends into the cecum?

Answer 16

Pancolitis

Question 17

What term is used to describe a disease that extends to (but not beyond) splenic flexure?

Answer 17

Left-sided colitis

Question 18

How does UC present?

Answer 18

Diarrhea (often bloody)

Tenesmus

Question 19

What extra-intestinal manifestations are only seen in crohn’s?

Answer 19

Aphthous ulcers

Gallstones

Question 20

How do you make the definitive dx of UC?

Answer 20

Flex Sig or colonoscopy

Question 21

What other tests are used to dx UC?

Answer 21

CT abd/pelvis w/ contrast

ESR, CRP

IBD specific antibodies

Question 22

What are complications of UC?

Answer 22

Hemorrhage

Toxic megacolon

Question 23

How do you treat UC?

Answer 23

Step up therapy

1. Salicylates 1st line**
2. Corticosteroids (flares)**
3. Immunomodulators (6-MP/Azathioprine)
4. TNF blockers (Remicade)
5. Surgery

Question 24

What are indications that surgery is needed for UC?

Answer 24

Perforation
Severe hemorrhage
Dysplasia/CA
Refractory to med tx

Question 25

What are the ADEs of cipro?

Answer 25

Tendinitis Photosensitivity QT prolongation

Question 26

What are ADEs of flagyl?

Answer 26

Peripheral neuropathy Metallic taste Disulfuram rxn

Question 27

What are red flags in IBD?

Answer 27

``` Severe bleeding Severe abd pain Wt loss Dehydration Obstruction Failure to respond to med tx ```

Question 28

What causes celiac disease?

Answer 28

Immune d/o triggered by environmental exposure

Question 29

Exposure to gluten can cause ______, _______, & _____ in the small intestine

Answer 29

inflammation, crypt hyperplasia, & villous atrophy

Question 30

Celiac disease is associated w/ what conditions?

Answer 30

Autoimmune disease DM I Thyroid disease Down's

Question 31

How does celiac disease present?

Answer 31

Diarrhea w/ foul smelling stools Bloating & flatulence Fe deficiency anemia Vit B deficiency --> neuro d/o Osteopenia Dermatitis herpetiformis

Question 32

How do you dx celiac disease? What is gold standard?

Answer 32

Serologic: IgA, celiac panel Small bowel biopsy via EGD = GOLD

Question 33

Is there an increased risk of malignancy in celiac disease?

Answer 33

Slightly! Non-hodgkins GI malignancy

Question 34

What does "AEIOU" stand for in celiac disease per Coplan?

Answer 34

``` Anemia Elevated LFTs Iron deficiency Osteopenia Uncomfortable digestion ```