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IBD/IBS Flashcards

1
Q

alarm symptoms for iBS

A

GIB
Anorexia weight loss, fever, night sweats, family history, IBD
persistent diarrhea or dehydration severe constipation or
onset >45 yrs

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2
Q

area effected in UC

A

limited to colon and begins in rectum

contiguous spread proximally to colon

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3
Q

location of abdominal pain in UC

A

LLQ MC

Colicky

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4
Q

rectal involvement in crohn’s

A

random

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5
Q

inflammation in UC

A

uniform or confluent on

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6
Q

distribution is confluent in this form of IBD

A

UC

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7
Q

colonoscopy of UC

A

uniform inflammation
+/- ILCERATION IN RECTUM OR COLOM

PSEUDOPOLYPS

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8
Q

hallmarck of UC

A

bloody diarrhea

hematochezia is MC

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9
Q

Rectum is always involved in this form of IBD

A

UC

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10
Q

colonoscopy of crohn’s

A

skip lesions = normal area interspersed between inflamed areas

cobblestone appearance

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11
Q

IBD definition

A

chronic or reoccurring inflammation of the GI tract due to dysregulated immune response

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12
Q

which iBD is more common

A

UC

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13
Q

Gender distribution in UC

A

Males more than females

opposite in crohn’s

usually diagnosed between 15-35

bimodal distribution with 60-70 yrs too

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14
Q

strictures are most commonly seen with

A

Crohn’s dz

seen as string sign on barium study

rare in UC

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15
Q

inflammation in UC involves

A

mucosal and submucosal layers

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16
Q

other than the hallmark of bloody diarrhea what other symptoms would you expect to see

A
  1. Mucus
  2. Frequency
  3. Urgency
    a. Urgency is pretty consistent during a flare and need to run
  4. Tenesmus í crampy rectal sensation people have when they need to go to the bathroom
  5. Nocturnal bowel movements í sometimes wake up 4-5 times in the middle of the night
  6. Inflammation in the rectum causes most of the symptoms b/c that’s where you hold stool
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17
Q

areas that can be involved in crohn’s

A

i. Mouth ulcers
ii. Esophageal ulcerations
iii. Colon
iv. Perianal dz

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18
Q

smoking is a RF for

A

CD

protective in UC

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19
Q

RF for IBD

A

NSAID
OCP, Accutane
appendicitis in CD protective in UC
diet high in animal protein

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20
Q

CM of colonic Crohn’s

A
  1. Diarrhea
  2. Blood in stool
  3. Abdominal pain
  4. Weight loss, weakness and anorexia
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21
Q

CM of small bowel Crohn’s

A

FEVER

Malabsorption/malnutrition
Stricturing - nausea, vomiting, bloating, food aversion

Will start to avoid food - especially raw vegetable (salad, broccoli, etc)

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22
Q

CM of perianal Crohn’s

A

a. Up to one-third of patients have perianal disease before developing other symptoms of crohn’s disease

Manifestations of perianal disease include fissures, low and high fistulas, perianal abscess, anorectal strictures, hemorrhoids and anal ulcers

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23
Q

if both parents have IBD your chance of having IBD is

A

36%

24
Q

Primarily tx used for treatment of mild UC for induction

A

5-Aminosalicylates (5-ASA)

25
Q

what is 5-Aminosalicylates (5-ASA)

A
  1. Major drug in class is mesalamine
  2. Anti-inflammatory compounds
  3. Decrease inflammation in wall of intestine
  4. Can be given orally or rectally
  5. Generally very safe
26
Q

onset of Immunomodulators

A

nset of Immunomodulators

27
Q

adverse events with immunomodulators

A

a. Infectious complications (7%): serious 2%
b. Myelosuppression 5%
i. TPMT predicts early but not late leukopenia
c. Transaminase elevation 10% (dose-dependent)
i. Cholestatic hepatitis <1%
d. Pancreatitis 3%
e. Fever/myalgia 2%
f. Nausea/dyspepsia up to 20%
g. Lymphoma (1/2000)
h. Increase in non-melanoma skin cancers
i. Up to 20% discontinue 6-MP/AZA due to AEs

28
Q

what are biologics and when would you use them

A

last resort
anti -TNF

target TNF and it neutralizes it so it can’t propagate inflammation

29
Q

name some biologics used for iBD

A

Remicade, Humira, Cimzia, Simponi

30
Q

some of the problems iwht biologics

A

a. 40% of primary responders lose response to the drug over time
c. Extremely expensive (>$15,000/year)
d. Requires either self-injection or infusion
bind and neutralize the TNF molecule, you can increase you risk to infection b/c our inflammatory response is not there

31
Q

some results of neutralizing TNF via biologics

A

a. Tuberculosis reactivation
b. Hepatitis B reactivation
c. Reactivation of opportunistic infections
d. Autoimmunity
e. Malignancy / lymphoma
f. Neurologic events/ demyelination syndromes
g. Cardiovascular events
h. Deaths

32
Q

mainstay of treatment for acute flairs

A
  1. Prednisone continues to be the mainstay of treatment for patients with acute flares of IBD
    a. Not indicated for chronic maintenance
33
Q
  1. Patients who are steroid-dependent should
A

be started on immunomodulators early on to prevent morbidity of chronic steroid exposure

34
Q

short term effects of prednisone

A

i. Weight gain
ii. Fluid retention
iii. Sleep disturbance
iv. Mood swings
v. Acne

35
Q

long term effects of prednisone

A

i. Infection
ii. Bone loss / osteoporosis
iii. Cataracts / Glaucoma
iv. Skin fragility
v. Hypertension
vi. Diabetes

36
Q

Absorbed in the GI tract so less effective than other steroids but with fewer side effects

A
  1. Budesonide

Glucocorticoid with high affinity but low systemic activity due to extensive first-pass metabolism in the liver

37
Q

alternative treatments for IBD

A
  1. Diet –> Mediterranean diet (high in fruits, veggies, fish and foul)
  2. Supplements - Turmeric
  3. Marijuana
  4. Fecal Transplant
  5. Helminth therapy
38
Q

unresponsive to 5-asa with prominent fever and weight loss

abd pain and tenderness

what stage of IBD is this

A

MODERATE TO SEVERE

39
Q

ambulatory without toxicity and no abd tenderness-what stage of IBD is this

A

mild to moderate

40
Q

asymptomatic without inflamtory sequelae

responsive to medication

-what stage is this

A

remission

41
Q

if your ot has persistent symptoms on corticosteroids or has high fever and rebound tenderness, cachexia or abscess- what stage of IBD is this

A

severe to fulminant

42
Q

theories of IBS

A

motility- motor issue
visceral- increased sensitivity or perception of distention
inflammation-increased lymphocytes

43
Q

differential for iBS

A 
parasites
celiac
IBD
bacterial alterations
abuse of motility agents
medication
dietary
44
Q

ROME criteria for IBS

A

recurrent abdominal pain 1d/week for threemoneths

associated with 2

defictation
changes in stool frequency
stool appearance

45
Q

cancer is common in what form of IBD

A

UC

rare in CD

46
Q

onset of UC

A

progressive and gradual

47
Q

mild UC is classified as

A
48
Q

moderate UC

A

> 4 bloody stools per day with mild anemia mild systemic signs and abdominal pain

and NO weight loss

49
Q

sever UC is defined as

A

> 6 bloody stools per a day with severe cramps and systemic toxicity

50
Q

complications for UC include

A

severe bleeds
fulminant colitits and toxic megacolon
perf (from megacolon)

51
Q

what are some complications from UC that are outside GI

A

arthritis, uveititis, erythema nodosum, increased coagulation

52
Q

what labs would you want to order for suspected UC

A 
CBC (anemia)
ESR
albumin 
electrolyte abnormalities (w/diarrhea)
endoscopy with inflammation confirms disease in pts with weeks of diarrhea
53
Q

hallmarks of crohn’s

A

weight loss

fatigue and fever

54
Q

MC reported sx with Crohn’s

A

episodes of D over long time

55
Q

other sxs of Crohn’s

A 
crampy 
extra-intestinal inflammation (joints, eyes, skin)
obstruction common
D fluctuates over time 
gross blood less frequent
56
Q

ddx for IBD

A 
lactose intolerance
appednicitis
diverticulitis
ischemic colitis
lymphoma
endometriosis
obstruction d/t other causes (cancer)

GI (13 decks)

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