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Clin Med III Exam I > IBD, Celiac, Lactose Intolerance > Flashcards

IBD, Celiac, Lactose Intolerance Flashcards

1
Q

Etiology of IBD

A

dysregulated mucosal immune response to host gut flora in genetically susceptible individuals

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2
Q

Two major types of IBD

A

Ulcerative colitis

Crohns disease

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3
Q

What parts of the GI tract does UC affect?

A

mucosa/submucosa of the colon and rectum (diffuse lesions)

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4
Q

What parts of the GI tract does Crohns disease affect?

A

the entire GI tract, transmurally (skip lesions)

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5
Q

Damage to what can contribute to IBD

A

epithelial mucin proteins and tight junctions

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6
Q

The breakdown of homeostatic balance between what two things can contribute to IBD (2 groups)

A

host mucosal immunity and enteric microflora

regulatory and effector T cells

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7
Q

Polymorphisms is what things are a factor in IBD

A

toll like receptors

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8
Q

IBD is common in what geographic location

A

western world and industrialized countries

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9
Q

Which type if IBD is most common

A

UC

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10
Q

Incidence of UC

A

bimodal distribution

15-30 years and 50-70 years

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11
Q

What things put you at a higher risk for developing UC?

A
  • being Jewish
  • hx of GI infections
  • weak association with OCP and NSAID use
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12
Q

What factors can lower your risk of getting UC or make the disease milder?

A

smoking

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13
Q

What are the most common presenting sx with UC?

A
  • rectal bleeding
  • bloody diarrhea
  • abdominal pain
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14
Q

What elements classify UC as mild to moderate?

A
  • <4 bloody BMs a day
  • urgency and tenesmus
  • LLQ cramping relieved by a BM
  • possible fever, anemia, hypoalbunemia
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15
Q

What classifies UC as severe?

A
  • > 6 bloody BM a day
  • severe anemia, hypovolemia, hypoalbunemia with nutritional deficit
  • abd pain
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16
Q

What is fulminant colitis?

A

subset of severe disease whichc is rapidly worsening sx’s with toxicity (pt present septic)

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17
Q

What is the clinical course of UC?

A

periods of remission and relapse

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18
Q

Common extraintestional manifestations of UC

A
  • apthous ulcers
  • iritis/uveitis/episcleritis
  • erythema nodosum
  • seronegative arthritis, ankylosing spondylitis, sacroilitis
  • primary sclerosing cholanitis
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19
Q

Which extraintestional manifestations improve after a colectomy

A
  • arthritis
  • ankylosing spondylitis
  • erythema nodosum
  • pyoderma gangrenosum
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20
Q

Which extraintestional manifestations do not improve after a colectomy

A

primary sclerosing cholangitis

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21
Q

What needs to be ruled out before a diagnosis of UC can be made

A

infectious and non infectious causes of diarrhea

  • infectious colitis
  • radiation proctitis
  • ischemic colitis
  • CMV colitis
  • STI proctitis
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22
Q

What labs are used to diagnose UC

A

ESR, CRP, H/H, albumin

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23
Q

What does a colonoscopy show in a patient with UC

A
  • diffuse disease proximal to the dentate line
  • friability of mucosa
  • erythema, erosions, ulcerations, spontaneous bleeding
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24
Q

Histologic features of UC

A
  • crypt abscess
  • infiltration of lamina propia with plasma cells, eosinophils, lymphocytes
  • lymphoid aggregates
  • mucin depletion
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25
Medical treatment for mild disease
aminosalicylates (5-ASA) mesalazine or sulfasalazine
26
Medical treatment with failure of 5-ASA
budesonide (preferred) | prednisone
27
Medical treatment of serve disease
hospitalization and IV methylprenisolone with IVF
28
Medical treatment of severe disease with steroid resistance
TNF- alpha blocker VGEF blocker
29
What is the last resort treatment for severe disease
cyclosporine
30
Maintenance therapy for UC
5-ASA (if responsive) steroids immunosuppresants OR continue with infliamab if induction therapy successful
31
Surgical therapy for UC
colectomy
32
When is a colectomy considered emergent? urgent? elective?
emergent: life threatening complications related to fulminant colitis or toxic megacolon that is unresponsive to medical treatment urgent: severe disease admitted to hospital and not responding to medical treatment elective: refractory disease, colorectal dysplasia or adenocarcinoma found on screening, long term disease (7-10 years)
33
When to pts begin to be screened for colorectal cancer w/ UC
8 years after diagnosis of disease
34
In patients with UC, when do you do a follow up colonoscopy if proctitis/proctosigmoiditis is found on initial screen? left-sided colitis/pancolitis? if patient hasPSC?
proctitis: follow specific age guidelines left-sided colitis: every 1-2 years UC w/ PSC: anually from time of diagnosis of PSC
35
In Crohns disease inflammation causes what in the GI tract
strictures, fistulas, ulcerations, abcesses
36
Extraintestinal manifestations of Crohns disease
- arthralgia - iritis/uveitis - pyoderma gangrenosum or erythema nodosum
37
Factors attributing to Crohns disease
- family history - smoking - sedentary lifestyle - exposure to air pollution - post infectious gastroenteritis
38
Presentation of Crohns disease
- RLQ intermittent abdominal pain - diarrhea (watery/nonbloody) - weithloss, anorexia - weakness
39
Complications of Crohns disease
- abcess - obstruction - fistula - perianal disease - carcinoma - malabsorption
40
Gold standard for diagnosis of Crohns
colonoscopy and mucosal biopsy
41
Labs for diagnosis of Crohns
CRP/ESR, fecal calprotectin, H/H, albumin, WBC
42
Treamtent of mild Crohns
colon and small bowel disease= mesalamine
43
Treatment of moderate to severe Crohns
Budesonide (short term) immunosuppresants TNF-alpha blockers (unable to taper from steroid) anti-integrins (last line, not responsive to anything else)
44
Treatment of fistula disease in Crohns
ABX (flagyl and metronidazole) immunosuppressants/ TNF-alpha surgery
45
Is surgery curative in Crohns diseae
NO
46
When us surgery indicated in Crohns disease
- abscess - intractable fistula - toxic megacolon - strictures with obstruction - perforation - cancer
47
When do you admit someone with Crohns to the hospital
- bowel obstruction - intra abdominla or perirectal abscess - sevre sx - serious infections in immunocompromised population
48
What screenings should be done for pts with Crohns
- TB - hepatits - CMV - HIV - C diff - colonscopy
49
What is celiac sprue disease
immunologic/inflammatory response to ingested gluten
50
What part of the GI tract does celiac sprue affect
mucosa of proximal small bowel
51
GI presentation of celiac
presenation - diarrhea - borborygmus - weightloss - weakness - abd pain
52
Extraintestional sx of celiac
- anemia - dermatitis herpetiformis - hormonal disorders - osteopenia and osteoperosis
53
Do older or younger people present with more GI sx at time of diagnosis
younger
54
Lab testing for celiac. What will it show?
CBC- anemia CMP- malnutrition, electrolyte abnormality Coags- PT prolonged (vit K def) Stool- fat malabsorption
55
Serologic testing for celiac
IgA TTG IgA level if less than 2 do IgA TTG and IgG
56
Gold standard for dx of celiac
endoscopy and mucosal biopsy of proximal and distal duodenum
57
What will an endoscopy show in a pt with celiac
- atrophy or scalloping of duodenal folds - absent villi or atrophic villi - hypertrophy of crypts
58
Treatment of celiac
REMOVE ALL GLUTEN | -steroid if accidental ingestion of gluten
59
What causes lactose intolerance
inability to digest lactose, not enough lactose
60
Lactose intolerance can develop secondarily to what other diseases
- celiac - crohns - giardia - viral gastrointeritis - malnutrition - short bowel syndrome
61
Clinical presentation of lactose intolerance
- abd bloating/cramping - flatulence - diarrhea - nausea - borborygmi
62
Labs for lactose intolerance
hydrogen breath test
63
Treatment for lactose intolerance
- remove lactose - lactase enzyme replacement - spread lactose intake throughout the day

Clin Med III Exam I (9 decks)

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