Inflammatory Bowel Disease Flashcards
What is the accepted pathological process of inflammatory bowel disease (IBD)?
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
What is a major risk factor in developing Crohn Disease (CD)?
Smoking: increases chance and number of surgeries, flares, and require more therapy
-nicotine actually causes remission in ulcerative colitis (UC) patients
How is the GI tract affected in both CD and UC?
CD: invasion thru all 3 mucosa layers and into the submucosa
UC: just invasion of the mucosal layers
Which of the two IBDs is associated with granuloma formation?
CD
Which IBD usually forms in patchy patterns and which is continuous?
CD: patch
UC: continuous
Which IBD is associated with fistula formation?
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
Which IBD is associated with bleeding?
UC
Which IBD is associated with peripheral arthritis and osteoporosis?
CD- need a flare for arthritis to manifest
Which IBD is associated with axial arthritis and ankylosing spondylitis (HLA-B27)? X-rays show a bamboo spine.
UC- doesn’t have to be flaring for arthritis to be present
Both IBDs are associated with nephrolithiasis. Which is associated with (1) urate stones and which is associated with (2) oxate stones?
- UC
2. CD
What is the most common skin condition associated with both IBDs?
Erythema Nodosum - painful inflammation of the fat cells under the skin, usually on shins.
Most common eye condition associated with both IBDs?
Uveitis - seen as opacity in the anterior chamber
What must be ruled out in patients presenting with colitis?
Infection: check the stools with gram stain, wet mount and for ova
What must be ruled out in patients presenting with proctitis?
STIs
How can you differentiate histologically UC from infectious colitis?
You can’t. You have to do a stool study looking for infectious organisms
What does a “burned out lead pipe appearance” refer to?
Radiological image of a colon in a patient with chronic UC.
Treatment for mild active UC.
Aminosalicylate
What 4 conditions merit surgical intervention for UC?
- Hemorrhage
- perforation
- cancer
- as a last resort if nothing else works on an acute condition
Which anatomical location does CD manifest most often?
Terminal ileum, cecum, ascending colon
Treatment for mild CD
Aminosalicylates
Antibiotics (CD is highly associated with lack of tolerance of normal microflora and controlling the flora can control flares)
Which medication is used to induce CD remission but cannot maintain it?
Corticosteroids
Which two medications are indicated in treating moderate UC and CD?
- Azathioprine (AZA)
- 6-mercaptopurine (6-MP)
6-MP is actually a metabolite of AZA
Name the immune modulator that is implicated in CD.
Name the medication that prevents its activation.
TNF-alpha
Infliximab
Name the combination therapy that is best for maintaining remission in CD.
Infliximab (biologic) + AZA (immune modulator)
Individually, infliximab is better than AZA but the combination is most effective
Genetic mutation that signals a physician to jump straight to biological therapy (monoclonal antibodies) if a patient presents with CD.
NOD2 gene mutation
-indicates increased probability of developing ileum disease and fistulas
In patients with UC, what is the surveillance guideline and method to monitor for cancers?
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.
