IBD & Treatment Flashcards by IFUNANYA CHRIS-UKAH

3 main extra-intestinal sx of IBD

erythema nodosum
arthritis– HA, pain, blurred vision
anterior uveitis or episcleritis

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which condition is smoking and prior appendectomy protective for?

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4 meds weakly associated with IBD

NSAIDs
abx
isotretinoin
OCPs

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has skip lesions, is transmural and shows granulomas on pathology

Crohns

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being transmural makes what two complications more likely to occur?

fistulas, strictures

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where are strictures most likely to occur?

small bowel– causes small bowel obstruction

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how are strictures treated?

medically if active; no surgery

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

ulcerative colitis

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which condition has fecal urgency and tenesmus as manifestations?

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which condition is more likely to have bloody diarrhea?

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

CD: RLQ
UC: LLQ pain

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

Ulcerative colitis

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

crohns dz

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3 PE findings for IBD

tachycardia
abdominal tenderness
distention

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

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

Prednisone- more effective
Budesonide– less SE

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which medication

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

5-ASA (aminosalicylates)

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when are steroids typically used in IBD?

symptom flare-ups while in transition
moderate to severe dz

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

5-ASA

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

azathioprine (immunomodulator)

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

azathioprine

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

methotrexate (immunomodulator)

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

methotrexate

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

Infliximab (Remicade)
Adalimumab (Humira)

anti-TNF meds

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?

Vedolizumab-- preferred; not as effective for small bowel crohns; limited in perianal dz Natalizumab | **lizumab= anti-integrin**

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

vedolizumab

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

natalizumab

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

Ustekinumab (stelara) Rizankizumab | both antiIL12/23

* mutual SE: infections * which med has SE-- TB, lymphoma? * which med has SE-- pneumonia, cellulits, abscess, delayed reaction?

- Adalimumab: TB, lymphoma - Infliximab: pneumonia, cellulits, abscess, delayed reaction

for which condition can surgery be curative?

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

2 most common surgeries for crohn's

intestinal resection stricturoplasty

3 indications for colectomy (UC)

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

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

fulminant colitis; more in UC

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

toxic megacolon

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

* bowel obstruction or perforation * abdominal abscess * medically refractory dz * colon cancer or dysplasia

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

infections

5 modifiable risk factors for developing infections

- medications - malnutrition - TPN - bowel surgery - **immunization status**

4 biggest vaccine prevenatable dz in hospitalized IBD patients

1. Herpes zoster-- most common 2. Hep B 3. influenza 4. pneumococcal pneumonia

4 pediatric live vaccines? live vaccines are contraindicated in IBD

- LAIV - varicella - MMR - travel vaccines

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

everyone-- both UC and CD

how does iBD affect bone health?

patients w/ it has increased risk of osteoporosis and osteopenia

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

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

6 parts of the clinical criteria for disease activity

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