Inflammatory Bowel Disease Flashcards
two forms of idiopathic inflammatory bowel disease (IBD)
Ulcerative colitis (UC) & Crohn’s disease
mucosal inflammatory condition confined to the rectum and colon
Ulcerative colitis (UC)
transmural inflammation of gastrointestinal (GI) mucosa that may occur in any part of the GI tract
Crohn’s disease
Autoimmune IBD
Ulcerative colitis (UC)
Extensive immune reaction
Crohn’s disease
shift toward the presence of more proinflammatory bacteria in the GI tract
dysbiosis
Th1 cytokine activity is excessive in
CD
Th2 cytokine activity is excessive with
UC
___ cytokine activity is excessive in CD
Th1
____ cytokine activity is excessive with UC
Th2
pivotal proinflammatory cytokine that is increased in the mucosa and intestinal lumen of patients with CD and UC
Tumor necrosis factor-α (TNF-α)
found in a high percentage of patients with UC and less frequently with CD
Antineutrophil cytoplasmic antibodies
appears to be protective for ulcerative colitis but associated with increased frequency of Crohn disease
Smoking
Local complications (involving the colon) occur in the majority of patients with
UC
A major complication of UC is
toxic megacolon
severe condition that occurs in up to 7.9% of UC patients admitted to hospitals
toxic megacolon
The risk of _______________ is much greater in patients with UC as compared with the general population.
colonic carcinoma
commonly occurs in patients with IBD and is typically asymptomatic and migratory
Arthritis
Ocular complications occur in some patients
iritis, episcleritis, and conjunctivitis
Inflammation of the bile duct
cholangitis
Bile duct cancer
cholangiocarcinoma
Large painful sores/ulcers in skin
pyoderma gangrenosum
Abrupt onset of papules and nodules that coalesce to form plaques
Sweet syndrome
Affected region: Rectum
Proctitis
Affected region: rectum, sigmoid colon, descending colon
Left-sided colitis
Affected region: rectum, sigmoid colon, descending colon, transverse colon, ascending colon
Extensive pancolitis
Affected region: rectum, sigmoid colon
Proctosigmoiditis
Characterized by Cobblestone appearance due to ulceration and elevation of the remainder of the mucosa
Crohn’s disease
most common site of the disorder (CD)
terminal ileum
Nutritional deficiencies are common with Crohn disease
weight loss, iron deficiency anemia, vitamin B12 deficiency, folate deficiency, hypoalbuminemia, hypokalemia, and osteomalacia
_________ formation is common and occurs much more frequently than with UC
Fistula
generally reserved for patients with severe malnutrition or those who fail enteral therapy or have a contraindication to receiving enteral therapy
Parenteral nutrition
may be necessary when the UC patient has disease uncontrolled by maximum medical therapy
Colectomy
Mild to Moderate UC
● Oral/ Topical Mesalamine
● 4-6 grams of sulfasalazine
Moderate to Severe UC
Oral prednisone
Oral prednisone dose
40-60mg/ day
replaces those who are unresponsive to the max dose of oral mesalamine
Oral prednisone (40-60mg/ day)
for patients unresponsive to ASAs, corticosteroids, or other immunosuppressive agents
TNF-alpha inhibitors
Sever intractable UC
IV Hydrocortisone 300mg in three divided doses or methylprednisolone 60mg OD
First line therapies for UC
IV Hydrocortisone 300mg in three divided doses or methylprednisolone 60mg OD
IV hydrocortisone dose
300mg
methylprednisolone dose
60mg od
Patients who are unresponsive to parenteral corticosteroids after 3 to 7 days can receive
cyclosporine or infliximab
optimal dose to prevent relapse is ____
2 to 2.4 g/day of mesalamine
optimal dose to prevent relapse is
2 to 2.4 g/day of mesalamine
do not have a role in the maintenance of remission with UC because they are ineffective
Steroids
considered first-line therapies and are frequently used for the treatment of moderate to severe Crohn disease
prednisone 40 to 60 mg/day or Oral corticosteroids
viable first-line option for patients with mild to moderate ileal or right-sided (ascending colonic) disease
Budesonide (Entocort)
Budesonide (Entocort) at a dose of
9 mg daily
given orally as 10 to 20 mg/kg/day in divided doses
Metronidazole
useful in some patients with CD, particularly for patients with colonic or ileocolonic involvement
Metronidazole
useful in some patients who are unresponsive to sulfasalazine
Metronidazole
Metronidazole dose
10 to 20 mg/kg/day
effective in maintaining steroid-induced remission
Azathioprine and mercaptopurine
limited to use for patients not achieving adequate response to standard medical therapy or in the setting of steroid dependency
Azathioprine and mercaptopurine
demonstrated some efficacy for induction of remission in Crohn disease, and for corticosteroid sparing effects
Methotrexate
Methotrexate dose
15–25 mg
MTX risks
bone marrow suppression, hepatotoxicity, and pulmonary toxicity
(BPH)
most effective and thus the preferred agents in the management of moderate to severe CD
TNF-α inhibitors
The use of TNF-α inhibitors in combination with __________ has quickly become the preferred approach to the treatment of moderate to severe CD.
thiopurines
options for patients who do not respond to steroids or TNF-α inhibitors
integrin antagonists
preferred approach to treatment of moderate to severe CD
TNF-α inhibitors in combination with thiopurines
considered for maintenance therapy for up to 1 year
Budesonide
Used for patients who have become corticosteroid dependent
Budesonide
effective in maintaining remission in CD
Azathioprine and mercaptopurine
weak evidence to suggest that, ________ is effective in maintaining remission in Crohn disease
methotrexate
should be administered IV to reduce acute inflammation
Steroids in high dosages
may exacerbate the underlying IBD and predispose patients to GI bleeding
NSAID use
Anemia secondary to blood loss from the GI tract can be treated with
oral ferrous sulfate
Vitamin B12 or ______ may also be required.
folic acid
