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GI #2 > IBD & Treatment > Flashcards

IBD & Treatment Flashcards

1
Q

3 main extra-intestinal sx of IBD

A
  • erythema nodosum
  • arthritis– HA, pain, blurred vision
  • anterior uveitis or episcleritis
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2
Q

which condition is smoking and prior appendectomy protective for?

A

UC

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3
Q

4 meds weakly associated with IBD

A

NSAIDs
abx
isotretinoin
OCPs

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4
Q

has skip lesions, is transmural and shows granulomas on pathology

A

Crohns

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5
Q

being transmural makes what two complications more likely to occur?

A

fistulas, strictures

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6
Q

where are strictures most likely to occur?

A

small bowel– causes small bowel obstruction

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7
Q

how are strictures treated?

A

medically if active; no surgery

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8
Q

which condition involves mucosal layers, is continous and only involves the colon

A

ulcerative colitis

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9
Q

which condition has fecal urgency and tenesmus as manifestations?

A

UC

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10
Q

which condition is more likely to have bloody diarrhea?

A

UC

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11
Q

where is the pain most likely located in CD & UC?

A
  • CD: RLQ
  • UC: LLQ pain
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12
Q

which condition has stovepipe sign (loss of haustral markings) upon barium studies?

A

Ulcerative colitis

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13
Q

which condition has string sign (flow through inflamed/scarred area d/t strictures) upon barium studies?

A

crohns dz

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14
Q

3 PE findings for IBD

A

tachycardia
abdominal tenderness
distention

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15
Q

which condition has higher risk of colon cancer & can have pseudopolyps

A

UC

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16
Q

two steroids used in IBD treatment? which is more effective? which has less systemic SE?

A
  • Prednisone- more effective
  • Budesonide– less SE
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17
Q

which medication

  • used for induction & maintenance
  • many formulations
  • rarely has SE
  • not better than nothing for crohns
A

5-ASA (aminosalicylates)

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18
Q

when are steroids typically used in IBD?

A

symptom flare-ups while in transition
moderate to severe dz

19
Q

SE includes HA, Nausea, worsening of diarrhea, chronic interstitial nephritis, pancreatitis?

A

5-ASA

20
Q
  • oral purine analogue that inhibits immune response & converted to 6-MP
  • takes 3-4 months to take effect (30% efficacy)
  • has limited role in aggressive disease
A

azathioprine (immunomodulator)

21
Q

SE: Pancreatitis, leukopenia, elevated LFTs, skin cancer, lymphoma, infections

A

azathioprine

22
Q

SQ only anti-inflammatory med that decreases interleukin production; used only for Crohns
- used to induce remission & reduce use of steroids (PPP)
- contraindicated in pregnancy

A

methotrexate (immunomodulator)

23
Q

SE: N/V, leukopenia, hepatic fibrosis, pneumonitis, infections, less clear relationship w/ malignancy

A

methotrexate

24
Q

which two meds

  • most effective for moderate to severe dz
  • can be used with an immunomodulator
  • treats extra-intestinal manifestations
  • risk of infections and malignancies
A

Infliximab (Remicade)
Adalimumab (Humira)

anti-TNF meds

25
Q

which two meds are anti-integrins that target leukocyte trafficking & has lower risk of infection & malignancies compated to anti-TNFs or immunomodulators? which of the two is preferred?

A

Vedolizumab– preferred; not as effective for small bowel crohns; limited in perianal dz
Natalizumab

lizumab= anti-integrin

26
Q

SE: nasopharyngitis, URI, HA, nausea, arthralgia, hypersensitivity rxn, lupus-like syndrome

A

vedolizumab

27
Q

SE: HA, fatigue, upper&lower RI, nausea, arthralgia, depression, progressive multifocal leukoencephalopathy

A

natalizumab

28
Q
  • better efficacy than anti-integrin in Crohns; anti IL12/23 blocker
  • for when standard therapies are ineffective (PPP)
A

Ustekinumab (stelara)
Rizankizumab

both antiIL12/23

29
Q
  • mutual SE: infections
  • which med has SE– TB, lymphoma?
  • which med has SE– pneumonia, cellulits, abscess, delayed reaction?
A
  • Adalimumab: TB, lymphoma
  • Infliximab: pneumonia, cellulits, abscess, delayed reaction
30
Q

for which condition can surgery be curative?

A

Ulcerative colitis
- colectomy & IPAA or
- total colon and rectum removal & permanent ileostomy

31
Q

2 most common surgeries for crohn’s

A

intestinal resection
stricturoplasty

32
Q

3 indications for colectomy (UC)

A

medically refractory– fulminant colitis or elective
Cancer or dysplasia
toxic megacolon

33
Q

complication where there is bleeding in more than 10 stools per day

A

fulminant colitis; more in UC

34
Q

complication with pain, distention of the abdomen, fever, rapid heart rate, and dehydration

A

toxic megacolon

35
Q

if surgery isn’t curative, why do it in people with crohn’s? (4 reasons)

A
  • bowel obstruction or perforation
  • abdominal abscess
  • medically refractory dz
  • colon cancer or dysplasia
36
Q

what is the most common significant adverse event in ppl w/ IBD

A

infections

37
Q

5 modifiable risk factors for developing infections

A
  • medications
  • malnutrition
  • TPN
  • bowel surgery
  • immunization status
38
Q

4 biggest vaccine prevenatable dz in hospitalized IBD patients

A
  1. Herpes zoster– most common
  2. Hep B
  3. influenza
  4. pneumococcal pneumonia
39
Q

4 pediatric live vaccines? live vaccines are contraindicated in IBD

A
  • LAIV
  • varicella
  • MMR
  • travel vaccines
40
Q

if smoking could be protective in UC, who gets counseled to quit?

A

everyone– both UC and CD

41
Q

how does iBD affect bone health?

A

patients w/ it has increased risk of osteoporosis and osteopenia

42
Q

when should you evaluate patients on steroids for their bone health?

A

if taking over 10mg for 60 days; bone density evaluation & vitamin D

43
Q

6 parts of the clinical criteria for disease activity

A
  • # of bowel movements/day
  • blood in stool & how often
  • urgency
  • abdominal pain
  • wt loss
  • fevers

GI #2 (9 decks)

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