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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

24
Q

Primarily tx used for treatment of mild UC for induction

A

5-Aminosalicylates (5-ASA)

25
what is 5-Aminosalicylates (5-ASA)
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
onset of Immunomodulators
nset of Immunomodulators
27
adverse events with immunomodulators
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
what are biologics and when would you use them
last resort anti -TNF target TNF and it neutralizes it so it can't propagate inflammation
29
name some biologics used for iBD
Remicade, Humira, Cimzia, Simponi
30
some of the problems iwht biologics
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
some results of neutralizing TNF via biologics
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
mainstay of treatment for acute flairs
1. Prednisone continues to be the mainstay of treatment for patients with acute flares of IBD a. Not indicated for chronic maintenance
33
3. Patients who are steroid-dependent should
be started on immunomodulators early on to prevent morbidity of chronic steroid exposure
34
short term effects of prednisone
i. Weight gain ii. Fluid retention iii. Sleep disturbance iv. Mood swings v. Acne
35
long term effects of prednisone
i. Infection ii. Bone loss / osteoporosis iii. Cataracts / Glaucoma iv. Skin fragility v. Hypertension vi. Diabetes
36
Absorbed in the GI tract so less effective than other steroids but with fewer side effects
5. Budesonide Glucocorticoid with high affinity but low systemic activity due to extensive first-pass metabolism in the liver
37
alternative treatments for IBD
1. Diet --> Mediterranean diet (high in fruits, veggies, fish and foul) 2. Supplements - Turmeric 3. Marijuana 4. Fecal Transplant 5. Helminth therapy
38
unresponsive to 5-asa with prominent fever and weight loss abd pain and tenderness what stage of IBD is this
MODERATE TO SEVERE
39
ambulatory without toxicity and no abd tenderness-what stage of IBD is this
mild to moderate
40
asymptomatic without inflamtory sequelae responsive to medication -what stage is this
remission
41
if your ot has persistent symptoms on corticosteroids or has high fever and rebound tenderness, cachexia or abscess- what stage of IBD is this
severe to fulminant
42
theories of IBS
motility- motor issue visceral- increased sensitivity or perception of distention inflammation-increased lymphocytes
43
differential for iBS
``` parasites celiac IBD bacterial alterations abuse of motility agents medication dietary ```
44
ROME criteria for IBS
recurrent abdominal pain 1d/week for threemoneths associated with 2 defictation changes in stool frequency stool appearance
45
cancer is common in what form of IBD
UC rare in CD
46
onset of UC
progressive and gradual
47
mild UC is classified as
48
moderate UC
>4 bloody stools per day with mild anemia mild systemic signs and abdominal pain and NO weight loss
49
sever UC is defined as
>6 bloody stools per a day with severe cramps and systemic toxicity
50
complications for UC include
severe bleeds fulminant colitits and toxic megacolon perf (from megacolon)
51
what are some complications from UC that are outside GI
arthritis, uveititis, erythema nodosum, increased coagulation
52
what labs would you want to order for suspected UC
``` CBC (anemia) ESR albumin electrolyte abnormalities (w/diarrhea) endoscopy with inflammation confirms disease in pts with weeks of diarrhea ```
53
hallmarks of crohn's
weight loss | fatigue and fever
54
MC reported sx with Crohn's
episodes of D over long time
55
other sxs of Crohn's
``` crampy extra-intestinal inflammation (joints, eyes, skin) obstruction common D fluctuates over time gross blood less frequent ```
56
ddx for IBD
``` lactose intolerance appednicitis diverticulitis ischemic colitis lymphoma endometriosis obstruction d/t other causes (cancer) ```

GI (13 decks)

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