Inflammatory Bowel Disease

Question 1

Which is deeper: UC or Crohns?

Answer 1

Crohns

UC is limited to the mucosal layer

Question 2

Does smoking help UC or Crohns?

Answer 2

UC

partially helps relieve symptoms

Question 3

UC or Crohns?

Bloody Diarrhea (>4 wks)

Answer 3

UC

Crohns is usually not bloody

Question 4

Test of choice for UC?
Mild/Mod -> ______
Severe Inpt -> ______

Answer 4

Mild/Mod -> Colonoscopy
Sever inpt -> Sigmoidoscopy (avoid colonoscopy for risk of perforation)

Question 5

Trmnt for Mild/Mod UC?

Answer 5

4 wk Trmnt
Topical Mesalamine or Sulfasalazine (5-ASA)
Topical Glucocorticoids if cannot tolerate 5-ASA

Use TOPICAL unless cannot tolerate -> ORAL

Question 6

Trmnt for Mod/Severe UC?

Answer 6

Infliximab (Remicade) -> TNF blocking agent
Azathioprine (Imuran) -> inhibits B & T Cell proliferation
Prednisone

Question 7

FU Monitoring for UC

Answer 7

CBC, LFTs, CRP, fecal calprotectin, CRP -> Q3-4mo
CMP -> annually
Repeat Endoscopy in ~ 6 mo

Question 8

Gold standard trmnt for chronic UC?

Answer 8

TOTAL PROCTOCOLECTOMY

Question 9

Emergent Sx Indications for UC?

Answer 9

Hemorrhage
Toxic Megacolon
Fulminant colitis that fails to get better within 24-48hrs of trmnt

Question 10

For UC, you have to run a bunch of tests before prescribing which type of special medications?

Answer 10

Test for immunosuppressing ET prior to giving biologics which would further immunosuppress them
Ex. Infliximab (Remicade)

Question 11

UC or Crohns?

ALWAYS affects the RECTUM and may spread upwards

Answer 11

UC

Question 12

While Crohns may affect ANY part of the bowels, which regions are MC affected?

Answer 12

Ileum
Proximal colon

Question 13

UC vs Crohns?

Which is transmural/FULL thickness?

Answer 13

Crohns

Question 14

UC vs Crohns?

Which ismore likely to have Abcesses and Perianal Dz

Answer 14

Crohns

Question 15

Study of choice for Crohns?

Answer 15

MRI Enterography

Hard to reach the small bowel with direct endoscopy

Question 16

Trmnt for Mild Crohns?

Answer 16

Budesonide (4-8wks)
Prendisone
Sulfasalazine (5-ASA)

Question 17

Trmnt for Crohns relapse

Answer 17

Glucocorticoids + a thiopurine (azathioprine)
Additive therapy, glucocorticoids while a thiopurine is becoming effective over ~4 weeks, then taper glucocorticoid

Question 18

Combo therapy for crohns

Answer 18

tumor necrosis factor-alpha (TNF) inhibitor (infliximab) +​ Immunomodulator (azathioprine)​