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PHCP 2 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

two forms of idiopathic inflammatory bowel disease (IBD)

A

Ulcerative colitis (UC) & Crohn’s disease

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2
Q

mucosal inflammatory condition confined to the rectum and colon

A

Ulcerative colitis (UC)

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3
Q

transmural inflammation of gastrointestinal (GI) mucosa that may occur in any part of the GI tract

A

Crohn’s disease

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4
Q

Autoimmune IBD

A

Ulcerative colitis (UC)

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5
Q

Extensive immune reaction

A

Crohn’s disease

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6
Q

shift toward the presence of more proinflammatory bacteria in the GI tract

A

dysbiosis

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7
Q

Th1 cytokine activity is excessive in

A

CD

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8
Q

Th2 cytokine activity is excessive with

A

UC

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9
Q

___ cytokine activity is excessive in CD

A

Th1

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10
Q

____ cytokine activity is excessive with UC

A

Th2

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11
Q

pivotal proinflammatory cytokine that is increased in the mucosa and intestinal lumen of patients with CD and UC

A

Tumor necrosis factor-α (TNF-α)

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12
Q

found in a high percentage of patients with UC and less frequently with CD

A

Antineutrophil cytoplasmic antibodies

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13
Q

appears to be protective for ulcerative colitis but associated with increased frequency of Crohn disease

A

Smoking

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14
Q

Local complications (involving the colon) occur in the majority of patients with

A

UC

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15
Q

A major complication of UC is

A

toxic megacolon

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16
Q

severe condition that occurs in up to 7.9% of UC patients admitted to hospitals

A

toxic megacolon

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17
Q

The risk of _______________ is much greater in patients with UC as compared with the general population.

A

colonic carcinoma

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18
Q

commonly occurs in patients with IBD and is typically asymptomatic and migratory

A

Arthritis

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19
Q

Ocular complications occur in some patients

A

iritis, episcleritis, and conjunctivitis

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20
Q

Inflammation of the bile duct

A

cholangitis

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21
Q

Bile duct cancer

A

cholangiocarcinoma

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22
Q

Large painful sores/ulcers in skin

A

pyoderma gangrenosum

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23
Q

Abrupt onset of papules and nodules that coalesce to form plaques

A

Sweet syndrome

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24
Q

Affected region: Rectum

A

Proctitis

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25
Q

Affected region: rectum, sigmoid colon, descending colon

A

Left-sided colitis

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26
Q

Affected region: rectum, sigmoid colon, descending colon, transverse colon, ascending colon

A

Extensive pancolitis

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27
Q

Affected region: rectum, sigmoid colon

A

Proctosigmoiditis

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28
Q

Characterized by Cobblestone appearance due to ulceration and elevation of the remainder of the mucosa

A

Crohn’s disease

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29
Q

most common site of the disorder (CD)

A

terminal ileum

30
Q

Nutritional deficiencies are common with Crohn disease

A

weight loss, iron deficiency anemia, vitamin B12 deficiency, folate deficiency, hypoalbuminemia, hypokalemia, and osteomalacia

31
Q

_________ formation is common and occurs much more frequently than with UC

A

Fistula

32
Q

generally reserved for patients with severe malnutrition or those who fail enteral therapy or have a contraindication to receiving enteral therapy

A

Parenteral nutrition

33
Q

may be necessary when the UC patient has disease uncontrolled by maximum medical therapy

A

Colectomy

34
Q

Mild to Moderate UC

A

● Oral/ Topical Mesalamine
● 4-6 grams of sulfasalazine

35
Q

Moderate to Severe UC

A

Oral prednisone

36
Q

Oral prednisone dose

A

40-60mg/ day

37
Q

replaces those who are unresponsive to the max dose of oral mesalamine

A

Oral prednisone (40-60mg/ day)

38
Q

for patients unresponsive to ASAs, corticosteroids, or other immunosuppressive agents

A

TNF-alpha inhibitors

39
Q

Sever intractable UC

A

IV Hydrocortisone 300mg in three divided doses or methylprednisolone 60mg OD

40
Q

First line therapies for UC

A

IV Hydrocortisone 300mg in three divided doses or methylprednisolone 60mg OD

41
Q

IV hydrocortisone dose

A

300mg

42
Q

methylprednisolone dose

A

60mg od

43
Q

Patients who are unresponsive to parenteral corticosteroids after 3 to 7 days can receive

A

cyclosporine or infliximab

44
Q

optimal dose to prevent relapse is ____

A

2 to 2.4 g/day of mesalamine

45
Q

optimal dose to prevent relapse is

A

2 to 2.4 g/day of mesalamine

46
Q

do not have a role in the maintenance of remission with UC because they are ineffective

A

Steroids

47
Q

considered first-line therapies and are frequently used for the treatment of moderate to severe Crohn disease

A

prednisone 40 to 60 mg/day or Oral corticosteroids

48
Q

viable first-line option for patients with mild to moderate ileal or right-sided (ascending colonic) disease

A

Budesonide (Entocort)

49
Q

Budesonide (Entocort) at a dose of

A

9 mg daily

50
Q

given orally as 10 to 20 mg/kg/day in divided doses

A

Metronidazole

51
Q

useful in some patients with CD, particularly for patients with colonic or ileocolonic involvement

A

Metronidazole

52
Q

useful in some patients who are unresponsive to sulfasalazine

A

Metronidazole

53
Q

Metronidazole dose

A

10 to 20 mg/kg/day

54
Q

effective in maintaining steroid-induced remission

A

Azathioprine and mercaptopurine

55
Q

limited to use for patients not achieving adequate response to standard medical therapy or in the setting of steroid dependency

A

Azathioprine and mercaptopurine

56
Q

demonstrated some efficacy for induction of remission in Crohn disease, and for corticosteroid sparing effects

A

Methotrexate

57
Q

Methotrexate dose

A

15–25 mg

58
Q

MTX risks

A

bone marrow suppression, hepatotoxicity, and pulmonary toxicity

(BPH)

59
Q

most effective and thus the preferred agents in the management of moderate to severe CD

A

TNF-α inhibitors

60
Q

The use of TNF-α inhibitors in combination with __________ has quickly become the preferred approach to the treatment of moderate to severe CD.

A

thiopurines

61
Q

options for patients who do not respond to steroids or TNF-α inhibitors

A

integrin antagonists

62
Q

preferred approach to treatment of moderate to severe CD

A

TNF-α inhibitors in combination with thiopurines

63
Q

considered for maintenance therapy for up to 1 year

A

Budesonide

64
Q

Used for patients who have become corticosteroid dependent

A

Budesonide

65
Q

effective in maintaining remission in CD

A

Azathioprine and mercaptopurine

66
Q

weak evidence to suggest that, ________ is effective in maintaining remission in Crohn disease

A

methotrexate

67
Q

should be administered IV to reduce acute inflammation

A

Steroids in high dosages

68
Q

may exacerbate the underlying IBD and predispose patients to GI bleeding

A

NSAID use

69
Q

Anemia secondary to blood loss from the GI tract can be treated with

A

oral ferrous sulfate

70
Q

Vitamin B12 or ______ may also be required.

A

folic acid

PHCP 2 (5 decks)

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