Inflammatory Bowel Disease Flashcards
1
Q
An autoimmune disease
A
Inflammatory Bowel Disease
2
Q
Characterized by chronic inflammation of the gastrointestinal tract
A
Inflammatory Bowel Disease
3
Q
What happens if there is a prolonged inflammation?
A
It can cause damage
4
Q
What are the two disorders of inflammatory bowel disease?
A
- Ulcerative Colitis
- Chron’s Disease
5
Q
A chronic and idiopathic characterized by inflammation and ulceration of the rectum and colon
A
Ulcerative Colitis
6
Q
Ulcerative colitis occurs at what age?
A
Occurs at any age but peaks between ages of 15 and 45 years years
7
Q
What is the etiology or causes of Ulcerative Colitis
A
- Genetic
- Altered dysregulated immune response
- Proinflammatory cytokines (TNF-a) (Tumor Necrosis Factor- Alpha
- Altered response to gut microorganisms
- Smoking
- Diet high in animal protein
8
Q
What is the pathophysiology of Ulcerative Colitis?
A
- inflammation is diffuse; involves the mucosa and submucosa
- Begins in the rectum
- Spreads proximally along the descending colon in a continuous fashion.
9
Q
What is the clinical manifestations of ulcerative colitis?
A
Abdominal pain
10
Q
Clinical manifestations of ulcerative colitis (MILD)
A
one or two semiformed stools, containing small amounts of blood per day
11
Q
Clinical manifestations of ulcerative colitis (MODERATE)
A
- Increased stool output (four or five times per day)
- Increased bleeding
- Systemic symptoms
12
Q
What are the systemic symptoms?
A
-Fever
-Malaise
-Anorexia
13
Q
Clinical Manifestations of ulcerative colitis (SEVERE)
A
- bloody diarrhea with mucus (occurs 10 to 20 times per day)
- fever
- weight loss greater than 10% of the total body weight
- anemia
- tachycardia
- dehydration
14
Q
Complications of ulcerative colitis are divided into two, what are those?
A
- Intestinal
- Extraintestinal
15
Q
What are the complications of intestinal?
A
- hemorrhage
- perforation
- toxic megacolon
- colonic dilation
16
Q
this is due to inflamed and ulcerated mucosa
A
hemorrhage
17
Q
this is due to megacolon
A
perforation
18
Q
extensive dilation and paralysis of the colon
A
toxic megacolon
19
Q
this is due to severe acute inflammation of the entire colon wall
A
colonic dilation
20
Q
Extraintestinal
A
Associated with active inflammation
21
Q
What are the active inflammation in extraintestinal?
A
- skin lesion
- anemia
- leukocytosis
- thrombocytosis
- uveitis
22
Q
called as the inflammation inside the eye
A
uveitis
23
Q
What are the diagnosis of ulcerative colitis?
A
- Double-contrast
- Sigmoidoscopy
- Colonoscopy
24
Q
A process in which x-rays of the rectum and colon are taken after a liquid containing barium given
A
Double-contrast
25
What diet should be instilled before performing double-contrast?
Low-residue diet is advised days before the procedure
26
Other important to do in double-contrast
-Low residue diet is advised days before the procedure
- Consume only clear liquids during 24 hours before the procedure, including the evening before the test.
27
What is sigmoidoscopy?
Visualization of the rectum, sigmoid and distal descending colon
28
What needs to be done before doing the sigmoidoscopy procedure?
Bowel preparation before the procedure
-First enema is given 2 hours before the procedure
-Second enema is given 1 hour before the procedure
29
Allows examination of the entire large intestine
Colonoscopy
30
Colonoscopy helps to identify?
Identifies the extent of inflammation, ulceration, pseudopolyps, strictures, and lesions
31
What needs to watch out for in colonoscopy?
Watch out for any signs of bowel perforation such as (severe abdominal pain, nausea, vomiting, fever and chills)
32
What are the goals for ulcerative colitis?
1. Rest the bowel
2. Control the inflammation
3. Monitor fluids and nutrition
4. Monitor patient stress
5. Provide education about the disease and treatment
6. Provide symptomatic relief
33
What are the medical management of Ulcerative Colitis?
1. Sulphasalazine
2. Corticosteroids
3. Cyclosporine
5. Proctocolectomy
34
The drug of choice for Ulcerative Colitis
Sulphasalazine
35
What is the mechanism of action of the drug sulphasalazine?
Reduces inflammation
36
What discoloration is brought by sulphasalazine?
Causes yellowish-orange discoloration of the skin and urine
37
What needs to be avoided when taking a sulphasalazine?
Patients should avoid exposure to sunlight and UV rays
38
Why patients need to avoid exposure to sunlight and UV rays when taking sulphasalazine?
It can cause photosensitivity
39
This is proven to benefit the management of active UC
Corticosteroids
40
When taking a corticosteroid what needs to be monitored for common adverse effects?
-Cushing's syndrome
-Hypertension
-Hirsutism
-Mood Swings
41
An immunosuppressive
Cyclosporine
42
This is given to patient with severe UC
Cyclosporine
43
What needs to be watch out for when taking a cyclosporine?
Watch out for renal dysfunction, hypertension, headache and muscle cramps
44
Cyclosporine is given in what?
Given via IVTT
45
A surgical procedure to remove the colon and rectum
Proctocolectomy
46
The diet for Ulcerative Colitis
-High calorie, high-protein, low-residue/fiber diet with vitamin and iron supplements
47
What foods needs to be avoided in Ulcerative Colitis?
Avoid cold foods, high-residue food and smoking
48
Give me an example of high-residue food
1. Whole wheat bread
2. Cereal with bran
3. nuts
4. raw fruit
49
Why do cold foods, high residue diet and smoking need to be avoided?
It can increase GI motility
50
Foods that are okay in Ulcerative Colitis
1. White bread
2. White rice or noodles
3. Plain crackers and potato rolls
4. Skinless cooked potato
5. Eggs
51
Foods that are not okay in Ulcerative Colitis
1. Whole wheat bread and pasta
2. Brown rice or wild rice
3. Wheat crackers and rolls
4. Milk and milk products
5. Cereal
52
An autoimmune disease that can affect any part of the GI tract from the mouth to the anus
Chron's Disease
53
Chron's disease occurs most often in what ages?
It occurs most often between the ages of 15 and 30 years
54
What is the etiology of Chron's Disease?
1. Genetic predisposition/defect NOD2 gene
2. Intestinal microorganisms
3. Immune dysregulation
4. Granulomas
55
What is the first gene associated with Chron's disease?
Genetic predisposition/defect NOD2 gene
56
Also known as chronic inflammatory lesions
Granulomas
57
Clinical manifestations of Chron's disease
1. Diarrhea
2. Abdominal Pain
3. Fatigue
4. Weight loss
5. Fever
58
What is the complication of Chron's Disease?
-Gastrointestinal fistulas
-Urinary Tract Infection
- Perforation
- Intra-abdominal abscess
59
What is the diagnosis of Chron's Disease?
-History & Physical Examination
-CBC, ESR
-Hemoccult
- Radiological studies with barium contrast
- Sigmoidoscopy & colonoscopy with biopsy
60
Medical Management of Chron's Disease
1. Sulphasalazine
2. Corticosteroids
3. Azathioprine
4. Metronidazole
61
This drug is more effective if large intestines are affected
Sulphasalazine
62
This drug reduces inflammation
Corticosteroids
63
This drug is immunosuppressant
Azathioprine
64
Metronidazole is in what classification of drug?
Antibiotic
65
This drug is chron's in the perianal area
Metronidazole
66
What is the nutritional management of Chron's Disease?
1. Parenteral Nutrition
2. Elemental diet
3. Low residue diet
4. High calorie and CHON
5. No milk
6. Vitamins B12 monthly injections
67
For with severe disease, small bowel fistulas, or short bowel syndrome
Parenteral nutrition
68
A liquid meal replacement diet that offers a complete nutritional profile
Elemental diet
69
This may not be digested properly due to inflamed intestinal mucosa
No milk
70
Surgical Management of Chron's Disease (Indications)
-Drainage of abdominal abscess
- Failure to respond to conservative therapy
-Massive Hemorrhage
- Perforation
71
Removal of the damaged or diseased portion of the intestine (small intestine. large intestine, and rectum)
Intestinal Resection
72
A surgical connection between two loops of intestine
Intestinal Anastomosis
73
Surgical Management for Chron's Disease
-Intestinal Resection
-Intestinal Anastomosis
