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GI Final > IBD- Jenkins > Flashcards

IBD- Jenkins Flashcards

1
Q

***What is IBD? Is there a genetic component? What are the two types?

A
  • a complex GENETIC disorder that is influenced by environmental risk factors
  • genetic predisposition allows dysregulation of the GI immune system and host micro biome
  • lack of complete penetrance
  • Ulcerative colitis and Crohn’s disease
  • **Rapid rise in certain geographical regions is NOT genetic!
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2
Q

IBD is a disease of _______ nations. What areas have the highest incidence of IBD?*

A
  • IBD is a disease of industrialized nations
  • increased incidence in developed countries (Europe and America) and increasing incidence in China and India as they become industrialized
  • Increase risk in individuals when they move to a more developed country
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3
Q

What are some environmental risk factors for IBD? (6) What do other potential risk factors include (have not been proven)?

A
  • Current smoker/Ex-smoker
  • Oral contraceptives
  • Appendectomy
  • Diet
  • Breastfeeding
  • Antibiotics
  • NSAID’s

-Other risks: H. pylori, family size, birth order, pets, other microorganisms

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4
Q

***What layers of the GI tract are affected in Ulcerative Colitis? What regions?

A
  • diffuse MUCOSAL and SUBMUCOSAL ulceration and inflammation LIMITED TO THE COLON
  • present in symmetrical, circumferential and CONTINUOUS pattern in the large intestine
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5
Q

***What % of UC involve the rectum?

A

100%!! (starts distally and moves proximally)

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6
Q

***Is smoking helpful in the treatment of UC?

A

Yes! the nicotine may help treat UC

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7
Q

***Bloody diarrhea for > 30 days in a young person (20-30) is _____ until proven otherwise

A

UC!

severity correlates with extent of disease

< 30 days is considered infectious

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8
Q

What is the typical clinical presentation of UC?

A
  • bloody diarrhea on and off for > 30 days.

- negative stool for infectious causes (E. Coli, ova and parasites, C. diff)

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9
Q

***What are the most common associated conditions found with UC?

A

-Erythema nodosum (15%)
-Pyoderma gangrenosum (less common)
-rheumatologic (*peripheral arthritis, *ankylosing spondylitis, *sacroilitis, hypertrophic osteoarthropathy and pelvic/femoral osteomyelitis) –> often presents with back pain and bloody diarrhea
-uveitis
(Eyes, skin, joints, stones)

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10
Q

What are some other conditions associated with UC?

A
  • ocular
  • hepatobiliary
  • Urologic
  • Metabolic bone disorders
  • Thromboembolic disorders
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11
Q

***People with HLA B27 and IBD are MOST LIKELY to get what associated condition?

A

Arthritis (sacroilitis / ankylosing spondylitis)

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12
Q

What does erythema nodosum look like?

A
  • painful erythematous nodules in a symmetric distribution on the legs
  • common on the anterior tibial surface
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13
Q

What does pyoderma gangrenosum present as? What is the treatment for this?

A
  • Begins as a pustule, then spreads concentrically to rapidly undermine healthy skin.
  • Lesions then ulcerate, with violaceous edges surrounded by a margin of erythema.

-treat with IV antibiotics then treat IBD

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14
Q

What are the endoscopic manifestations of UC?

A
  • Ulceration (mucosal & submucosal)
  • Loss of typical vascular pattern (edema)
  • Erythema
  • Granularity
  • Friablity
  • frank mucopurulent exudate is present in severe cases
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15
Q

What are the different classifications of UC?

A

Mild:

  • BM < 4 per day
  • Small amounts of hematochezia
  • Mild anemia
  • Endoscopy: Erythema, fine granularity, decreased vascular pattern

Moderate:

  • BM 4-6 per day
  • Moderate amount hematochezia
  • Anemia
  • Endoscopy: increased Erythema, granularity, absent vascular markings, friability

Severe:

  • BM > 6 per day
  • Marked hematochezia
  • Fever >37.5 C
  • Pulse > 90
  • Endoscopy: spontaneous bleeding, ulcerations
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16
Q

***What are some of the complications of UC?

A
  • Toxic megacolon

- carcinoma (more in UC than Crohns; biopsy frequently to monitor)

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17
Q

***What is the treatment for UC?

A

Remission and then maintenance therapy

Active: 5-ASA (Sulfasalazine) oral or enema (can add glucocorticoid enema and PO or IV glucocorticoid if severe acute UC or Crohns, NOT for MAINTENANCE)

maintenance:
- 5-ASA oral or enema
- 6-MP or azothioprine (used to wean pts off steroids) (long-term)
- also give Inflizimab (after 5ASA and steroids)

18
Q

What is Mesalamine used to treat?

A
  • mild to moderate distal UC
  • proctitis
  • maintenance of remission
19
Q

What are topical glucocorticoids used to treat?

A

acute treatment of distal UC

NOT maintenance

20
Q

When is Cyclosporin A used to treat UC? What are some SE?

A
  • severe UC that is refractory to IV glucocorticoids

- SE: HTN, HA, tremor, paresthesias, elecrolyte abnormalities, gingival hyperplasia

21
Q

***Should antibiotics be used to treat UC?

A

NO!!!!

unless going to surgery

22
Q

How often should a pt with IBD have a colonoscopy?

A
  • annual or biennial in pts with >8-10 years of pan colitis of >12-15 years with left sided colitis
  • risk of cancer increases 1%/year after 8-10 years of disease
23
Q

***What is Crohn’s Disease? What makes it different from UC?

A
  • Crohn’s is a segmental TRANSMURAL (goes through muscle layer) IBD that can affect ANY part of the GI tract FROM MOUTH TO ANUS with SKIP LESIONS
  • UC is only in the mucosa and submucosa and only affects the colon
24
Q

***How do cigarettes affect Crohn’s? What about UC?

A
  • 2x increase risk for Crohn’s with smoking

- smoking can help in UC

25
Q

***What are some complications of Crohn’s?

A
  • Malabsorption with nutritional deficiencies (involve small intestine)
  • Calcium oxalate nephrolithiasis
  • *Abscess
  • ***Fistula formation
  • *sinus tracts
  • Carcinoma
26
Q

***Which IBD is carcinoma more common in?

A

UC

27
Q

***What is fibrostenotic CD? How does this develop and where is it most commonly found?

A
  • -Obstruction in CD due to thickening of the lumen walls d/t Crohn’s
  • signs of obstruction: abd pain, n/v, distention
28
Q

***Which IBD is toxic megacolon more associated with?

A

UC

29
Q

***What are the 3 presentations of Crohn’s disease? Which is the most common?

A
  1. Chronic diarrhea *MOST COMMON –> for > 30 days, normally intermittent for years (~2-3yrs)
  2. Appendix-like pain (RLQ b/c it involves the TERMINAL ILEUM)–> appendix will be normal but small bowel will be thickened
  3. Bowel obstruction in large or small bowel
30
Q

***How is Crohn’s diagnosed?

A
  • Radiographic imaging (barium studies) and
  • ENDOSCOPY WITH BIOPSY (most accurate)
  • Histology of intestinal biopsy (Transmural granulomas)
31
Q

What are the most common presenting sites of Crohn’s in both adults and peds?

A

ileocolitis and ileitis

32
Q

***What will Crohn’s look like on endoscopy?

A

Cobblestone appearance

33
Q

***What will the BE of a pt look like with Crohn’s in the terminal ileum?

A

“string sign”–> narrow lumen

34
Q

What is the earliest detectable lesion found on endoscopy in Crohn’s? What does this look like?

A

-Aphthous ulceration

  • Small , pinpoint lesions with exudate (white arrow) surrounded by an erythematous margin
  • -> can be seen in mouth too
35
Q

What serologic studies suggest Crohn’s? What about UC? What can high serum levels of markers indicate?

A
  • ASCA is frequently + in Crohn’s
  • ANCA is frequently + in UC
  • high serum levels of markers can indicate aggressive disease and predict likelihood of surgery
36
Q

***Which IBD is more likely to present with hematochezia?

A

UC*

37
Q

***Which IBD is more likely to present with systemic symptoms and pain?

A

Crohn’s disease

38
Q

What is the treatment for Crohn’s disease?

A

-Induction and then maintenance

Active:

  • sulfasalazine oral/enema
  • Budesonide (ileocecal disease)
  • Flagyl or Cipro
  • glucocorticoids (oral)
  • TNF directed treatment (Infliximab or Adalimumab)
  • Severe disease can include TPN diet and Certolizumab

Maintenance:

  • –Inflammatory:
  • Azathioprine or 6-MP
  • Methotrexate
  • Infliximab
  • Certolizumab
  • Budesonide: short term only
  • –Perianal or fistulizing disease
  • Azathioprine or 6-MP
  • Infliximab
  • Adalimumab
39
Q

***Is surgery curable for Crohn’s? UC?

A
  • not curable for Crohn’s (if removed, 50% will recur elsewhere in 5yrs– skip lesions; most pts will have at least 1 surgery–fistulas, complications)
  • is CURABLE for UC
40
Q

***Are there serology tests for UC and Crohn’s?

A

YES!

41
Q

***When is it appropriate to use antibiotics in the treatment of Crohn’s?

A

Fistulas and abscesses

42
Q

***If you have a 20yo pt w/ perianal fistulas, what should you think?

A

Crohn’s!

GI Final (18 decks)

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