Inflammatory Bowel Disease

Question 1

What is the difference between Inflammatory Bowel Disease and Irritable Bowel Syndrome

Answer 1

IBD is Immune mediated resulting in chronic inflammation and ulceration of the GI tract while IBS is a functional disorder of the GI tract

Question 2

What are the two main IBD diseases

Answer 2

Crohn’s Disease and Ulcerative Colitis

Question 3

What are the two age gaps these diseases culminate

Answer 3

13-39, 60-80

Question 4

What are the IBD risk factors

Answer 4

sedentary lifestyle, stress, vitamin D deficiency , NSAIDS and oral contraceptives, family history

Question 5

What is the best way to diagnose IBD

Answer 5

Endoscopy with biopsy

Question 6

How far does a colonscopy go, what does it look at

Answer 6

5 feet, large intestine

Question 7

How far does a sigmoidiscopy go, what does it look at

Answer 7

2 feet, descending colon

Question 8

What is the disease location, endoscopic visualization, and pathology of Crohn’s Disease

Answer 8

mouth to rectum, deep inflammation (cobblestone), granulomas and inflammation with lymphoid aggregates

Question 9

What is the disease location, endoscopic visualization, and pathology of Ulcerative Colitis

Answer 9

confined to the colon, superficial inflammation and erythema, crypt atrophy and neutrophil infiltration

Question 10

What serologic marker is used to distinguish ulcerative colitis and Crohn’s Disease

Answer 10

Antibody tests

Question 11

What are the 4 sub categories of ulcerative colitis

Answer 11

proctitis: inflammation of the rectum, proctosigmoiditis: inflammation of rectum and sigmoid colon, distal disease: inflammation that extends to splenic flexure, pancolitis: inflammation that extends past splenic flexure

Question 12

What are the 6 sub categories of Crohn’s disease

Answer 12

ileocolitis: inflammation in the illieum and colon, ileitis: illeum, gastroduodenal: stomach and duodenum, jejunoileitis: jejenum and illieum, granulomatous: whole colon, perianal: only in the rectum

Question 13

What is the most common sub categorie of Crohn’s disease

Answer 13

ileocolitis

Question 14

What are Crohn’s Disease complications

Answer 14

fistulas: unneeded pathway, abscesses: pockets of infection, fissures, nutritional deficiencies

Question 15

What is extraintestinal manifestation

Answer 15

inflammation in other organ systems

Question 16

What is severe fulminant of crohn’s disease

Answer 16

persistent symptoms despite treatment or high temperatures, persistent vomiting, intestinal obstruction, cachexia or abscess

Question 17

What are the first line drugs of mild to moderate Ulcerative Colitis why

Answer 17

aminosalicylates, induce and maintain remission

Question 18

What are the two main functions of aminosalicylates

Answer 18

anti-inflammatory and immunosuppresive

Question 19

What is the active drug of sulfasalazine, what causes the side effects

Answer 19

mesalamine (5-ASA), sulfapyridine

Question 20

Where do the aminosalicylate formulations work

Answer 20

Colon

Question 21

What are important adverse effects of Sulfasalazine

Answer 21

Male inferetility (reversible), may turn urine orange, may stain contacts and cause yellow tears

Question 22

T/F: One gram of Folic acid must be taken with sulfasalazine

Answer 22

True

Question 23

What are side effects of balsalazide and olsalazine

Answer 23

headache, nausea, abdominal pain

Question 24

When should a patient be switched to a mesalamine agent when taking balsalazide or olsalazine

Answer 24

When watery diarrhea is present

Question 25

Which mesalamine agent is an enema and where is the site of action, how should it be taken

Answer 25

Rowasa, Descending colon and recteum, given at bedtime and lay on left side for 8 hours

Question 26

What is the formulation of Canasa, where is the site of action, when should it be taken

Answer 26

Suppository, rectum, after a bowel movement

Question 27

Which mesalamine agent is a oral formulation and works in the small bowel and colon

Answer 27

Pentasa

Question 28

What is site of action and formulation of Apriso

Answer 28

Jejunum to colon, oral

Question 29

Which mesalamine agents are oral formulations and work in the terminal ileum to colon

Answer 29

Asacol, Delzicol, Lialda

Question 30

When should mesalamine be discountinued

Answer 30

if pancreatitis, pneumonitis, or nephrotoxicity is present

Question 31

What should be monitored for sulfasalazine

Answer 31

CBC and LFTs at initiation of therapy, every 2 weeks for 3 months, every month for 3 months, then every 3 months

Question 32

What should be monitored for mesalmine agents

Answer 32

serum creatinine at 6 weeks, 6 months, 12 months then annually

Question 33

What are corticosteroids used for in IBD

Answer 33

treatment of active UC or CD and/or failed 5-ASA therapy

Question 34

Which steroid product has an oral formulation and is the go to for CD and UC

Answer 34

prednisone

Question 35

When would budesonide become the preferred steroid

Answer 35

symptoms are mild-moderate and long term steroids

Question 36

What are the two formulations of budesonide and where do the work

Answer 36

Entocort EC- terminal ileum, ileum, ascending colon/ Uceris- Colon