Inflammatory bowel disease

Question 1

definition: IBD

Answer 1

dysregulated, inappropriate response of the intestinal mucosal immune system to otherwise innocuous luminal antigens in a genetically susceptible host

Question 2

what is the inflammation pattern in UC? what about CD?

Answer 2

UC - diffuse mucosal inflammation limited to colon

CD - patchy transmural inflammation in any part of GI tract

Question 3

does UC affect the rectum? CD?

Answer 3

UC - yes

CD - usually rectum sparing

Question 4

how does smoking affect risk of UC? CD?

Answer 4

UC - decrease / no effect

CD - significant increase

Question 5

how does appendectomy affect UC risk?

Answer 5

decreases risk

Question 6

how does high sanitation level in childhood affect CD risk?

Answer 6

increases

Question 7

what are the etiological hypotheses for IBD?

Answer 7

persistent infection
defective mucosal integrity
dysbiosis
dysregulated immune response

Question 8

the pathogenesis of IBD involves what three main factors?

Answer 8

luminal antigens
genetic susceptibility
environmental triggers

Question 9

what is the presentation for UC?

Answer 9

bloody diarrhea
rectal discomfort
fecal urgency
cramping / distention

Question 10

extensive UC involves what areas?

Answer 10

left and transverse

Question 11

what are the four presentations of CD?

Answer 11

inflammation
fistulization
obstruction
microperforation

Question 12

psoas abscess signs would indicate what possible condition?

Answer 12

retroperitoneal fistulization in CD

Question 13

strictures, fistulizations, skip lesions, and granulomas are indicative of what IBD disease?

Answer 13

CD

Question 14

what are the most common extraintestinal manifestations related to IBD?

Answer 14

aphthous stomatitis 
episcleritis 
arthritis 
vascular complications 
e. nodosum 
p. gangrenosum

Question 15

what are the IBD related osteopenia risk factors?

Answer 15

inflammation (CD more than UC) 
IBD medication (corticosteroids)

Question 16

what are the goals of therapy for IBD?

Answer 16

induce clinical remission
maintain remission
enhance quality of life
avoid long term toxicity

Question 17

which agents are used for remission induction in UC?

Answer 17

aminosalicylates
corticosteroids
6MP / azathioprine
cyclosporine

Question 18

which agents are used for remission maintenance in UC?

Answer 18

aminosalicylates

6MP / azathioprine

Question 19

which agents are used for remission induction in CD?

Answer 19

aminosalicylates 
antibiotics 
corticosteroids 
immunomodulators 
defined diets

Question 20

which agents are used for remission maintenance in CD?

Answer 20

immunomodulators
aminosalicylates
antibiotics

Question 21

what are the indications for metronidazole?

Answer 21

active crohns colitis and ileocolitis
perineal disease
post-op CD prevention
pouchitis

Question 22

what are the adverse effects of metronidazole?

Answer 22

nausea, anorexia 
metallic taste 
furry tongue 
candidiasis 
peripheral neuropathy

Question 23

what are the indications for topical corticosteroids?

Answer 23

proctitis and left sided colitis

Question 24

what are the indications for oral systemic corticosteroids?

Answer 24

moderate to severe UC or CD

Question 25

what are the indications for parenteral systemic corticosteroids?

Answer 25

severe or toxic UC or CD

Question 26

what is an advantage of 6MP / azathioprine?

Answer 26

no steroid like complications

Question 27

what is used for the treatment of fistulae in CD?

Answer 27

infliximab

Question 28

what are the indications for surgery for UC?

Answer 28

exsanguinating hemorrhage
perforation
cancer or dysplasia
unresponsive acute disease

Question 29

what are the indications for surgery for CD?

Answer 29

free perforation
massive hemorrhage
cancer or dysplasia
chronic high grade obstruction