IBD popcorn

Question 1

Smoking ↑ risk

Answer 1

Crohn’s Disease

Question 2

Smoking ↓ risk

Answer 2

Ulcerative Colitis

Question 3

Condition?

• Mouth –> Anus
• Transmural
• Causes fistulas
• MC site : Distal Ileum
• 1/3 w/ perianal dz (fistula/fissure/abscess)
• Aphthous ulcer

Answer 3

Crohn’s

Question 4

Condition?

• Chronic, int, NOCTURNAL NON-bloody diarrhea
• “Colicky” RLQ pain / mass

Answer 4

Crohn’s

Question 5

Condition?

• Skip lesions
• Rectal sparing!!
• “string sign” on small bowel follow thru

1st line Tx?

Answer 5

Crohn’s

1st line Tx:

• Step up (5-ASA- Salicylates) = Mesalamine or Sulfalazine
• Immunomodulator= Azathioprine
• Bio/TNF blockers = Infliximab, Adalimumab

Question 6

Tx for Flares of Crohn’s?

Answer 6

Corticosteroids

• Budesonide (less systemic effects)
• Prednisone (oral = systemic effects)
• SLOW taper!! Avoid dependence

Antibiotics

• Cipro + Metro
• Cipro: tendinitis, photosens, QT prolong
• Metro: Disulfuram rxn (avoid ETOH), metallic taste

Question 7

Condition?

• Colon only
• Rectum almost always
• Mucosal surface of colon
• Proctitis (rectum) is MC site!

Answer 7

UC

Question 8

Condition?

• Rectal bleeding
• BLOODY/MUCOUS NOCTURNAL diarrhea
• “crampy” abd pain
• Tenesmus (rectal urgency)
• Anemia if dz is severe

Answer 8

UC

Question 9

Condition?

• ↑ ESR & CRP if dz active
• Colonoscopy (choice dx study)
• Complications:
  
  • Pyoderma Gangrenosum
  • Nutrient deficiency (Fe, B12)

Answer 9

Crohn’s

Question 10

Condition?

• On flex sig / colonoscopy
  
  • inflammation distal –> proximal
  • Continous involvement
  • Loss of haustral folds
  • Petechia, exudate, friability

Answer 10

UC

Question 11

Complications of which dz?

• Hemorrhage
• TOXIC MEGACOLON (very serious)
  
  • colonic dilation >6cm

Answer 11

UC

Question 12

Tx for UC?

Answer 12

Step up therapy

• 1st line: 5-ASA-Salicylate (Mesalamine/Sulfalazine)
• Immunomodulators (6MP, Azathioprine)
• TNF blocker (Remicade)

Question 13

Tx for flares of UC?

Answer 13

Corticosteroids

• Budesonide: less systemic SE. Used for ileal or Right sided colonic dz
• Prednisone: oral. Systemic SE (osteoporosis, insomnia, weight gain, psychosis)
• (SLOW taper!!) & avoid dependence

Question 14

What is the surgery for UC?

What are 3 indications for this surgery?

Answer 14

Complete Proctolectomy

• Perforation / Severe hemorrhage
• Dysplasia / Cancer
• Refractory dz to medical management

Question 15

What are the 6 RED FLAGS of IBD (Crohn’s & UC)

Answer 15

1. Anemia from severe bleeding
2. Peritoneal signs (Severe abd pain)
3. Weight loss d/t not tolerating POs
4. Dehydration (↑ creatinine, tachycardia, hypotension)
5. Obstruction
6. Failure of therapy

PAWD-OF

Question 16

Condition?

• Gluten toxic to small intestine
• Exposure –> mucosal inflammation, crypt hyperplasia, villous atrophy
• White Northern Europeans

Answer 16

Celiac

Question 17

Complications of Celiac?

Answer 17

• Fe deficiency anemia
• B vitamin deficiency
• Osteoporosis
• Slight incr. risk of malignancy (Non-hodgkin’s lymphoma or GI)

Question 18

Celiac associated with what 4 things?

Previously dz of infants, now what age group?

Answer 18

• Autoimmune
• DM 1
• Thyroid dz
• Trisomy 21/Down’s
• 10 - 40 yrs

Question 19

Condition?

• Diarrhea, bloating, flatulance
• Dermatitis herpetiformis
• Lactose intolerant
• Neuro disorders from B vit deficiency
• FTT (children)

Tx?

Answer 19

Celiac

Tx: avoid gluten, supplement PRN

Question 20

GOLD STANDARD dx for Celiac?

Answer 20

Small bowel biopsy (via EGD) –> will show villous atrophy

MUST be done while pt eating gluten

Question 21

Serologic Blood Testing for Celiac

• What level must be NORMAL for test to be valid?
• 3 other diagnostic findings?

Answer 21

IgA must be normal

• Fe deficiency anemia
• Osteopenia
• Elevated LFTs

Question 23

What is seen on PE of Celiac dz?

Answer 23

Dermatitis Herpetiformis

Close-up of dermatitis herpetiformis lesions. Dermatitis herpetiformis is a chronic inflammatory disease that produces lesions that burn and itch intensely. The lesions are erythematous and may be slightly papular, form small pustules, or there may be vesicles.