Inflammatory Bowel Disease

Question 1

What is the accepted pathological process of inflammatory bowel disease (IBD)?

Answer 1

The bowel becomes inflamed due to some environmental factor (meds, diet, infection)

The body fails to down regulate the immune system after the original environmental insult is eradicated

Question 2

What is a major risk factor in developing Crohn Disease (CD)?

Answer 2

Smoking: increases chance and number of surgeries, flares, and require more therapy

-nicotine actually causes remission in ulcerative colitis (UC) patients

Question 3

How is the GI tract affected in both CD and UC?

Answer 3

CD: invasion thru all 3 mucosa layers and into the submucosa

UC: just invasion of the mucosal layers

Question 4

Which of the two IBDs is associated with granuloma formation?

Answer 4

CD

Question 5

Which IBD usually forms in patchy patterns and which is continuous?

Answer 5

CD: patch
UC: continuous

Question 6

Which IBD is associated with fistula formation?

Answer 6

CD: the disease involves deeper layers of the GI tract wall and has a much higher chance of invading and perforating the entire GI wall

Most common type are perianal fistulas

Question 7

Which IBD is associated with bleeding?

Answer 7

UC

Question 8

Which IBD is associated with peripheral arthritis and osteoporosis?

Answer 8

CD- need a flare for arthritis to manifest

Question 9

Which IBD is associated with axial arthritis and ankylosing spondylitis (HLA-B27)? X-rays show a bamboo spine.

Answer 9

UC- doesn’t have to be flaring for arthritis to be present

Question 10

Both IBDs are associated with nephrolithiasis. Which is associated with (1) urate stones and which is associated with (2) oxate stones?

Answer 10

1. UC

2. CD

Question 11

What is the most common skin condition associated with both IBDs?

Answer 11

Erythema Nodosum - painful inflammation of the fat cells under the skin, usually on shins.

Question 12

Most common eye condition associated with both IBDs?

Answer 12

Uveitis - seen as opacity in the anterior chamber

Question 13

What must be ruled out in patients presenting with colitis?

Answer 13

Infection: check the stools with gram stain, wet mount and for ova

Question 14

What must be ruled out in patients presenting with proctitis?

Answer 14

STIs

Question 15

How can you differentiate histologically UC from infectious colitis?

Answer 15

You can’t. You have to do a stool study looking for infectious organisms

Question 16

What does a “burned out lead pipe appearance” refer to?

Answer 16

Radiological image of a colon in a patient with chronic UC.

Question 17

Treatment for mild active UC.

Answer 17

Aminosalicylate

Question 18

What 4 conditions merit surgical intervention for UC?

Answer 18

1. Hemorrhage
2. perforation
3. cancer
4. as a last resort if nothing else works on an acute condition

Question 19

Which anatomical location does CD manifest most often?

Answer 19

Terminal ileum, cecum, ascending colon

Question 20

Treatment for mild CD

Answer 20

Aminosalicylates
Antibiotics (CD is highly associated with lack of tolerance of normal microflora and controlling the flora can control flares)

Question 21

Which medication is used to induce CD remission but cannot maintain it?

Answer 21

Corticosteroids

Question 22

Which two medications are indicated in treating moderate UC and CD?

Answer 22

1. Azathioprine (AZA)
2. 6-mercaptopurine (6-MP)

6-MP is actually a metabolite of AZA

Question 23

Name the immune modulator that is implicated in CD.

Name the medication that prevents its activation.

Answer 23

TNF-alpha

Infliximab

Question 24

Name the combination therapy that is best for maintaining remission in CD.

Answer 24

Infliximab (biologic) + AZA (immune modulator)

Individually, infliximab is better than AZA but the combination is most effective

Question 25

Genetic mutation that signals a physician to jump straight to biological therapy (monoclonal antibodies) if a patient presents with CD.

Answer 25

NOD2 gene mutation

-indicates increased probability of developing ileum disease and fistulas

Question 26

In patients with UC, what is the surveillance guideline and method to monitor for cancers?

Answer 26

Patients with Left-sided UC or pan-UC (whole colon) for at least 8-10 yrs, segmental biopsy every 6 mo. to 2 yrs.

If patients have Primary sclerosing cholangitis (PSC) check immediately and every 6 months.