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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
where is crohns disease usually found?
- 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
what are common complications of crohns
- abscesses - fistulae - sinus tracts - strictures - adhesions
27
risk factors for crohns
- genetics - tobacco use - sedentary lifestyle - exposure to air pollution - western diet - infectious gastroenteritis
28
si/sx of crohns
- intermittent abdominal pain - RLQ pain usually - diarrhea- watery, nonbloody - incontinence - more constitutional sx - weight loss, anorexia, malnutrition - bone loss - SBO
29
surgical intervention for crohns
- 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
treatment for abscesses in crohns
- CT to dx - broad spectrum abx - percutaneous drainage
31
treatment for obstruction in crohns
- IVF, IV steroids - NGT decompression - refractory -> partial resection or stricturoplasty
32
treatment for fistulas in crohns
- 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
treatment for perianal disease in crohns
- cipro or flagyl - mesalazine PR or tacrolimus ointment for fissures - antibiologics - recurrence common
34
what is included in the montreal classification for crohns
- extent (L) | - phenotype (B)
35
L1 crohns
- confined to terminal ileum
36
L2 crohns
- confined to colon
37
L3 crohns
- ileum + colon
38
L4 crohns
- involves upper GIT
39
L3 + L4 crohns
- upper GIT plus distal GIT
40
B1 crohns
- without strictures, non-penetrating
41
B2 crohns
- stricturing
42
B3 crohns
- penetrating
43
B4 crohns
- perianally penetrating
44
crohns dx
- must r/o infectious and noninfectious causes first - colonoscopy + bx - inflammatory markers are good for monitoring disease progression
45
what is fecal calprotectin
- specific colonic inflammatory marker | - used in monitoring crohns
46
crohns treatment for diarrhea
- loperamide - if terminal ileal disease or resection give bile acid sequesterants - if short cut have pt on low fat diet
47
treatment for mild crohns disease
- mesalazine
48
treatment for mod-severe crohns
- 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
surgical indications for crohns
- abscess failing medical mgmt - intractable fistula - toxic megacolon - fibrotic strictures with obstruction - recalcitrant sx despite high dose steroids - perforation - intractable hemorrhage - cancer
50
colonoscopy screenings for crohns
- 8 years after onset - q 1-2 years - crohns + PSC annually
51
what infections should you monitor for in pts on immunosuppressants
- TB - hepatitis - CMV - HIV - C diff
52
where does celiac affect the gut
- proximal small bowel- duodenum | - vili become atrophied/ damaged/ absent -> malabsorption issues
53
si/sx of celiac
- diarrhea, flatulence, borborygmus - weight loss - weakness and fatigue - sever abd pain - older onset usually have atypical sx
54
extraintestinal sx of celiac
- fatigue, depression, iron deficiency anemia - osteopenia/porosis - neurologic sx - dermatitis herpetiformis*- extensor surfaces of extremities, trunk, buttocks, scalp, neck - amenorrhea, delayed puberty, infertility
55
PE findings for celiac
- 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
what blood tests are used for dx of celiac
- 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
gold standard for celiac dx
- endoscopy and biopsy at proximal and distal duodenum
58
treatment for celiac
- GF diet** - dietary consult - supplement initially for vit def - steroids X2+ weeks for flare
59
what is often associated with celiac
- lactose intolerance
60
lactose intolerance
- inability to digest lactose - low levels of lactase - born wit high levels of lactase and declines with aging
61
si/sx of lactose intolerance
- abd bloating/ cramping - flatulence, diarrhea - nausea - borborygmi
62
what lab test can be used to dx lactose intolerance
- hydrogen breath test | - lactose is fermented in absence of lactase -> acid production (H-)

Clin Med III (26 decks)

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