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Clin Med III > IBD, celiac, lactose intolerance > Flashcards

IBD, celiac, lactose intolerance Flashcards

1
Q

what diseases make up IBD

A
  • ulcerative colitis- more common

- crohns disease

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2
Q

where is UC usually found

A
  • diffuse inflammation
  • colon and rectum
  • likely to see extraintestinal manifestations
  • periods of relapse and remission
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3
Q

risk factors for UC

A
  • genetics
  • hx of GI infections
  • week assoc with NSAIDs and OCP
  • no data to support psychologic stress as trigger
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4
Q

si/sx of UC

A
  • rectal bleeding*
  • bloody, mucousy diarrhea*
  • LLQ/ suprapubic pain*
  • tenesmus
  • few constitutional sx
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5
Q

extraintestinal sx of UC

A
  • aphthous oral ulcers
  • iritis, uveitis, episcleritis
  • seroneg arthritis, ankylosing spondylitis, sacroilitis
  • erythema nodosum*, pyoderma gangrenosum
  • autoimmune hemolytic anemia
  • primary sclerosing cholangitis
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6
Q

what treatment is considered curative for UC

A
  • colectomy

- usually extraintestinal manifestations will also clear

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7
Q

mild-mod UC

A
  • gradual onset diarrhea < 4x/day
  • intermittent bloody mucoid stool
  • urgency, tenesmus, accidents
  • no significant abd pain
  • LLQ cramping
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8
Q

severe UC

A
  • bloody diarrhea > 6x/day
  • severe anemia, hypovolemia, hypoalbuminemia, nutritional deficits
  • LLQ pain/ tenderness
  • fulminant -> toxicity and sepsis
  • tachycardia, fever
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9
Q

how is IBD classified

A
  • montreal classification
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10
Q

what is included in the montreal classification for UC

A
  • extent (e)

- severity (s)

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11
Q

E1 UC

A
  • proctitis
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12
Q

E2 UC

A
  • left sided
  • distal
  • inflammation limited to splenic flexure
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13
Q

E3 UC

A
  • pancolitis

- extends into proximal splenic flexure

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14
Q

S0 UC

A
  • remission, no sx
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15
Q

S1 UC

A
  • mild
  • 4 or less stools per day
  • absence of systemic sx
  • normal inflammatory markers
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16
Q

S2 UC

A
  • moderate
  • 4 stools per day
  • minimal systemic sx
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17
Q

S3 UC

A
  • severe
  • 6+ bloody stools per day
  • pulse > 90
  • temp > 37.5
  • ESR > 30
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18
Q

dx of UC

A
  • always r/o infection and non-infectious causes first with stool sample
  • H&P
  • inflammatory markers are good indicator of disease severity
  • colonoscopy with bx
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19
Q

colonoscopy findings for UC

A
  • diffuse disease from dentate line proximally
  • edema, friability of mucosa
  • erythema, erosions, ulcerations
  • spontaneous bleeding
  • do NOT perform on fulminant disease- risk of perf
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20
Q

medical management for mild UC

A
  • aminosalicylates (5-ASA)
  • mesalazine PR suppository or budesonide rectal foam for proctitis
  • rectal and PO sulfasalazine, PR mesalazine
  • used for long term maintenance after remission
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21
Q

medical management for mild-mod UC

A
  • used after failing 5-ASA
  • budesonide PO- targets colon with minimal systemic ADRs
  • prednisone
  • taper over 60 days
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22
Q

medical management for severe UC

A
  • induction thearpy
  • admission + IV methylprenisolone
  • if steroid resistant give antibiologics
  • TNF inhibitors: infliximab, adalimumab, golimuab
  • VEGF inhibitors: vedolizumab
  • cyclosporine last line
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23
Q

maintenance therapy for UC

A
  • 5-ASA
  • budesonide
  • immunosuppressants- azathioprine or 6-MP
  • if infiximab or azathioprine induction the continue with maintenance dose
  • probiotics
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24
Q

colonoscopy screening for UC

A
  • 8 years after disease onset
  • if proctitis/ proctosigmoiditis guidelines vary
  • left sided colitis/ pancolitis q1-2 years
  • UC + PSC- annually from time of dx
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25
Q

where is crohns disease usually found?

A
  • transmural
  • anywhere in GIT
  • skip lesions
  • assos with exacerbations and remissions
  • 1/3 of pts- terminal ileum onlin
  • half of pts- small bowel + colon
  • 1/5 of pts- colon only
  • 1/3 of pts- perianal disease
  • extraintestinal manifestations not as commo
26
Q

what are common complications of crohns

A
  • abscesses
  • fistulae
  • sinus tracts
  • strictures
  • adhesions
27
Q

risk factors for crohns

A
  • genetics
  • tobacco use
  • sedentary lifestyle
  • exposure to air pollution
  • western diet
  • infectious gastroenteritis
28
Q

si/sx of crohns

A
  • intermittent abdominal pain
  • RLQ pain usually
  • diarrhea- watery, nonbloody
  • incontinence
  • more constitutional sx
  • weight loss, anorexia, malnutrition
  • bone loss
  • SBO
29
Q

surgical intervention for crohns

A
  • generally want to avoid for as long as possible
  • bowel resection does not decrease likelihood that pt has relapses
  • want to preserve as much bowel as possible
30
Q

treatment for abscesses in crohns

A
  • CT to dx
  • broad spectrum abx
  • percutaneous drainage
31
Q

treatment for obstruction in crohns

A
  • IVF, IV steroids
  • NGT decompression
  • refractory -> partial resection or stricturoplasty
32
Q

treatment for fistulas in crohns

A
  • abdominal and rectovaginal fistulas common
  • TPN/ oral elemental diet may temporarily close fistula
  • antibiologics X 10 weeks- best mgmt but half recurr
  • surgical resection if all others fail
33
Q

treatment for perianal disease in crohns

A
  • cipro or flagyl
  • mesalazine PR or tacrolimus ointment for fissures
  • antibiologics
  • recurrence common
34
Q

what is included in the montreal classification for crohns

A
  • extent (L)

- phenotype (B)

35
Q

L1 crohns

A
  • confined to terminal ileum
36
Q

L2 crohns

A
  • confined to colon
37
Q

L3 crohns

A
  • ileum + colon
38
Q

L4 crohns

A
  • involves upper GIT
39
Q

L3 + L4 crohns

A
  • upper GIT plus distal GIT
40
Q

B1 crohns

A
  • without strictures, non-penetrating
41
Q

B2 crohns

A
  • stricturing
42
Q

B3 crohns

A
  • penetrating
43
Q

B4 crohns

A
  • perianally penetrating
44
Q

crohns dx

A
  • must r/o infectious and noninfectious causes first
  • colonoscopy + bx
  • inflammatory markers are good for monitoring disease progression
45
Q

what is fecal calprotectin

A
  • specific colonic inflammatory marker

- used in monitoring crohns

46
Q

crohns treatment for diarrhea

A
  • loperamide
  • if terminal ileal disease or resection give bile acid sequesterants
  • if short cut have pt on low fat diet
47
Q

treatment for mild crohns disease

A
  • mesalazine
48
Q

treatment for mod-severe crohns

A
  • steroid therapy until remission then taper X 60 days
  • immunosuppressants- azathioprine or methotrexate
  • TNF- alpha blockers common with good success
  • VEGF inhibitors if lose response to TNF
  • surgery NOT curative
49
Q

surgical indications for crohns

A
  • abscess failing medical mgmt
  • intractable fistula
  • toxic megacolon
  • fibrotic strictures with obstruction
  • recalcitrant sx despite high dose steroids
  • perforation
  • intractable hemorrhage
  • cancer
50
Q

colonoscopy screenings for crohns

A
  • 8 years after onset
  • q 1-2 years
  • crohns + PSC annually
51
Q

what infections should you monitor for in pts on immunosuppressants

A
  • TB
  • hepatitis
  • CMV
  • HIV
  • C diff
52
Q

where does celiac affect the gut

A
  • proximal small bowel- duodenum

- vili become atrophied/ damaged/ absent -> malabsorption issues

53
Q

si/sx of celiac

A
  • diarrhea, flatulence, borborygmus
  • weight loss
  • weakness and fatigue
  • sever abd pain
  • older onset usually have atypical sx
54
Q

extraintestinal sx of celiac

A
  • fatigue, depression, iron deficiency anemia
  • osteopenia/porosis
  • neurologic sx
  • dermatitis herpetiformis*- extensor surfaces of extremities, trunk, buttocks, scalp, neck
  • amenorrhea, delayed puberty, infertility
55
Q

PE findings for celiac

A
  • protuberant and tympanitic abdomen
  • weight loss
  • orthostatic hypotension- dehydration
  • peripheral edema- malabsorption
  • ecchymosis- vit K
  • hyperkeratosis- vit A
  • cheilosis and glossitis- Fe
  • peripheral neuropathy or ataxia- B12, E
  • chvostek or trousseau sign, tetany- Ca
56
Q

what blood tests are used for dx of celiac

A
  • IgA TTG- best
  • IgA levels- some may be deficient
  • IgA TTG combined testing for IgG deaminated gliadin peptides
  • all Ab should return to normal after GF diet- monitor compliance
57
Q

gold standard for celiac dx

A
  • endoscopy and biopsy at proximal and distal duodenum
58
Q

treatment for celiac

A
  • GF diet**
  • dietary consult
  • supplement initially for vit def
  • steroids X2+ weeks for flare
59
Q

what is often associated with celiac

A
  • lactose intolerance
60
Q

lactose intolerance

A
  • inability to digest lactose
  • low levels of lactase
  • born wit high levels of lactase and declines with aging
61
Q

si/sx of lactose intolerance

A
  • abd bloating/ cramping
  • flatulence, diarrhea
  • nausea
  • borborygmi
62
Q

what lab test can be used to dx lactose intolerance

A
  • hydrogen breath test

- lactose is fermented in absence of lactase -> acid production (H-)

Clin Med III (26 decks)

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