Inflammatory Bowel Disease

Question 1

What are the two branches of IBD?

Answer 1

ulcerative colitis and crohns disease

Question 2

what part of the GI tract is always affected in UC?

Answer 2

rectum (extends proximally)

Question 3

What are the two potential patterns one sees in crohns disease?

Answer 3

obstructive/fibrostenotic

pentrating/fistulizing

Question 4

Which gender is affected by IBD more offten?

Answer 4

effected equallye

Question 5

WHen is the peak incidence for IBD?

Answer 5

age 15-25

but there’s a bimodal distribution with a second less significant peak from age 60-70

Question 6

What countries have more IBC?

Answer 6

Westernized countries like US, canada and Europe

Question 7

What are the sypoms of UC?

Answer 7

bloody mucoid diarrhea
tenesmus
fecal incontinence
abdominal pain
weight loss
arthralgias, uveitis and dkin ulcers
jaunduce if you get scelrosin cholangitis

Question 8

What are the symptoms of CD?

Answer 8

nonbloody diarrhea
abdominal pain
weight loss
perianal abscesses or fistulas
growth failure in kids
fever
nausea/vomiting
arthralgias, mouth ulcers, erythema nodosum

Question 9

What layers of the wall are affected in UC?

Answer 9

only the mucosa

Question 10

What percentage of epople with UC will udnergo colectomy over 30 years?

Answer 10

30%

Question 11

What is the risk for colon cancer after 30 year of ulcerative colitis?

Answer 11

18% - nearly 1 in 5

Question 12

What percentage of people with UC will have primary sclerosing cholangitis?

Answer 12

4%

Question 13

UC typically starts in the rectum and then spreads proximally until it abruptly stops. What are the two exceptions to this rule?

Answer 13

1. periappendiceal ulceration
2. Backwash ileitis just past the ileocecal junction

probably because these areas have high levels of lymphocytes which mean they can inflame easily

Question 14

What will happen to the crypts histologically in UC

Answer 14

you get mucosal inflammation with cryptitis and crypt abscesses

PMNs will fill the crypts and branching can occur if chronic

Question 15

What layers of the wall are affected in CD?

Answer 15

all of them - transmural

Question 16

What part of the GI tract is affected in CD?

Answer 16

can be anywhere - usually spares the rectum though

Question 17

What is the most common location for CD?

Answer 17

termianl ileum (70%)

Question 18

What are the complications associated with the transmural involvement in CD?

Answer 18

fistulae, abscess and strictures

Question 19

Which is more likely to have bloody diarrhea - CD or UC?

Answer 19

UC

Question 20

What percentage of people will need surgery after 15 years of CD?

Answer 20

80%

and once you have a resection, you’ll likely need another eventually

Question 21

What’s the almost-pathonomonic histology tip off that it’s crohn disease?

Answer 21

non-caseating granuloma (but you often don’t see them)

Question 22

What serology will be positive in CD?

Answer 22

anti-saccharomyces cerevisiae

Question 23

What serology will be positive in UC?

Answer 23

pANCA

Question 24

What are the musculoskeletal manifestations of IBD?

Answer 24

arthritis, ankylosing spondylitis, osteoporosis, sacroilitis

Question 25

What are the skin and mouth manifestiosn of IBD?

Answer 25

erythema nodosum, pyoderma gagnrenosum, apthous ulcers, vitiligo, psoriasis, amyloidosis

Question 26

What are the ocular manifestations of IBD?

Answer 26

uveitis, iritis

Question 27

What are the hepatobiliary manifestations of IBD?

Answer 27

``` primary sclerosing cholangitis cholangiocarcinoma heptatitic pericholangitis gallstones ```

Question 28

Which are the complications of IBD - both UC and CD?

Answer 28

``` hemorrhage hypercoagulability amyloidosis colon cancer osteoporosis ```

Question 29

Which will will have higher risk for toxic megacolon?

Answer 29

UC

Question 30

Which will have the risk for primarily sclerosing cholangitis?

Answer 30

UC

Question 31

Which will have the risk of obstruction?

Answer 31

CD

Question 32

What are the four issues that can crop up in CD affecting the ileum or after ileal resection?

Answer 32

1. bile salt diarrhea 2. gallstones 3. vitamin B12 deficiency 4. oxylate stones (calcium binds to the malabsorbed fat instead of the oxylate)

Question 33

True or false: the colon cancer that arises in ulcerative colitis or crohn's typically develops in the same fashion as other CRC?

Answer 33

false other cRC usually starts as an adenomatous polyp or serrated polyp progresses thoruhg the adenoma-carcinoma sequence in IBD you get fields of dysplasia from the chronic inflammation which then gives rise to a flat or depressed adenoma which can progress to carcinoma

Question 34

What are some characteristics of an IBD case that would suggest higher risk for CRC?

Answer 34

1. disease proximal to splenic flexure 2. over 8 years of disease ( young age at diagnosis) 3. primary sclerosin cholangitis as complicaitons 4. family hx of CRC 5. pseudopolyp son colonoscopy (wouldn't be able to pick out an adenomatous polyp if it was there)

Question 35

What drug is protective against CRC in IBD?

Answer 35

5-ASA

Question 36

What should the colonoscopy schedule be in IBD?

Answer 36

every 1-2 years after 7 years of disease

Question 37

True or false: surgery is essentially curative in UC?

Answer 37

true

Question 38

Describe the environemtnal influences that may affect IBD incidence?

Answer 38

1. clean kid hypothesis 2. more common in cold climates 3. more common in industrialized areas 4. smoking worsens CD, may be protective against UC

Question 39

True or false: treatment for IBD is considered more dangerous to a fetus than the disease itself, so we typically don't treat pregnant women.

Answer 39

false 0 active disease increases risk to fetus and mother in pregnancy continue all treatments with the exception of methotrexatee

Question 40

What are the general treatment expectations for IBD?

Answer 40

1. induce clinical remission 2. maintain clinical remission 3. improve patient quality of life if you can do those.... 4. heal mucosa (endoscopic remission) 5. decrease hospitalization/surgery/cost 6. minimized disease-related and therapy-related complication

Question 41

Describe the IBD therapeuti pyramid.

Answer 41

mild disease = start with 5-ASAs moderate disease = steroids to induction and immunomodulators like methorexate, azathrioprine and 6-mercaptopurine. also infliximab severe disease = surgery

Question 42

Can the steroids be used for maintenance therapy

Answer 42

no

Question 43

What are hte two 5-ASAs as know?

Answer 43

sulfasalazine | mesalamine

Question 44

What is infliximab an antibody against?

Answer 44

TNFalpha

Question 45

Why do you need to give a patient an immune modulator if they're on infliximab?

Answer 45

to minimize the risk of them developing antibodies against the infliximab with subsequent loss of response

Question 46

What are the UC indications for surgery?

Answer 46

exsanguinating hemorrhage unresponsive acute diasease perforaiton cancer or dysplasia (no question) chronic intractability steroid dependency growth retardation systemic complicatoins

Question 47

What are the CD indications for surgery?

Answer 47

free perforation massive hemorrhage cancer or dysplasia chronic high grade obstruction intractability complex fistulae and abscesses perianal complicaitons grwoth retardation in kids