Inflammatory Bowel Disease Flashcards
What is inflammatory bowel disease?
A dysregulated, inappropriate response of the intestinal immune system, to an otherwise innocuous luminal antigens, in a genetically susceptible host
What are the three types of crohn’s disease?
ileitis
colitis
ileocolitis
UC or CD: diffuse mucosal inflammation limited to the colon
UC
UC or CD: affects rectum
UC
UC or CD: patchy, transmural inflammation
CD
UC or CD: may affect any part of the GI tract
CD
UC or CD: may involve all or part of the colon, but no further
UC
Who usually has UC?
Young people 20-30s
What is the effect of smoking on UC? CD?
Lowers UC, increases CD
What is the effect of an appy on UC? CD?
Lowers CD, no effect on CD
What is the effect of high sanitation in childhood on UC? CD?
No effect on UC
Increases CD
What is the effect of high carb intake on UC? CD?
UC no effect
Increases CD
What is the effect of perinatal infection on UC? CD?
UC = ? CD = increases
What is the dysbiosis theory of IBD?
Decrease protective bacteria, increased aggressive bacteria
What are the effect of dysregulated immune response on IBD?
Loss of tolerance
Defective apoptosis
What is the cytokine that causes Th0 cells to turn into Th1 cells?
IL-12
What is the cytokine that causes Th0 cells to turn into Th3 cells?
IL-10
What is the role of Th1 cells in IBD?
cell mediated granulomas
What is the role of TH2 cells in IBD?
Hypersensitivity
Which has a higher genetic influence: CD or UC?
CD
What is the gene that transmits IBD susceptibility?
Polygenic
What are the three factors that lead to the development of IBD?
Luminal antigen
Genetic susceptibility
Environmental triggers
What is the usual presentation of UC?
Bloody diarrhea
Rectal discomfort
Fecal urgency
Abd cramping
Is UC transmural?
no
What is proctitis? Proctosigmoiditis?
Pancolitis?
UC at the various flexures
What are the four presentations of CD?
Inflammation
Obstructuion
Fistualization
Microperforation
What is the most common site of CD?
ileum and cecum
Which has perianal diseases: CD or UC?
CD
Obstruction usually occurs in CD or UC? Why?
CD d/t fibrosis of the wall
What are the signs of a retroperitoneal fistualization with CD?
Psoas abscess sign
Skips lesions = ?
CD
Cobblestoning appearance =?
CD
Granulomas is found in CD or UC?
CD
True or false: the rectum is usually spared in CD
True, but it can involve
What are the mouth symptoms of IBD?
APthous stomatitis
What are the eye symptoms of IBD?
Episcleritis and uveitis
What are the joint symptoms of IBD?
Arthritis
What affects the risk of osteopenia with IBD?
cytokines IBD meds (corticosteroids)
WHich joints are usually affected in IBD?
Wrist, knee, ankle
What are the skin manifestations of IBD?
P. Gangrenosum
vascular complications
E. Nodosum
What are the goals of IBD treatment?
Obtain remission
Avoid long term toxicity
What are the drugs used to obtains remission induction in UC?
aminosalicylates
Corticosteroids
6MP
What are the drugs that are used to maintain remission in UC?
6MP
Aminosalicylates
What are the drugs used to obtains remission induction in CD?
Aminosalicylates
Abx
Corticosteroids
What are the drugs that are used to maintain remission in CD?
Abx
Immunomodulators
Aminosalicylates
What are the indications for metronidazole use in IBD?
Active DC
Perianal disease
What are topical corticosteroids indicated for IBS? Systemic?
Proctitis and left-sided colitis
moderate to severe CD
What is the MOA of azathioprine?
Purine analogue (HGPRT)
What is the MOA of 6 mercaptopurine
Purine analogue (HGPRT)
What are the adverse effects of 6MP?
Fever, rash
Pancreatitis
Hepatitis
What is the MOA of methotrexate?
inhibits dihydrofolate reductase
What are the antibody drugs used in IBD? What is this particularly useful for?
Infliximab
Fistulas
What are the indications for surgery in UC? (4)
- Exsanguinating hemorrhage
- Perforation
- CA
- Unresponsive acute disease
What is the most common surgery for UC?
Ileal pouch-anal anastomosis
What are the indications for surgery in CD?
- Free perforatio
- Massive hemorrhage
- CA
- Chronic obstructions
What is strictureplasty?
Maintain the bowel, but push it together and sew it up vertically (see slide) This saves intestines
What is the antibody that is effective for CD?
anti-TNF