Inflammatory Bowel Disease Flashcards
What is the difference between Inflammatory Bowel Disease and Irritable Bowel Syndrome
IBD is Immune mediated resulting in chronic inflammation and ulceration of the GI tract while IBS is a functional disorder of the GI tract
What are the two main IBD diseases
Crohn’s Disease and Ulcerative Colitis
What are the two age gaps these diseases culminate
13-39, 60-80
What are the IBD risk factors
sedentary lifestyle, stress, vitamin D deficiency , NSAIDS and oral contraceptives, family history
What is the best way to diagnose IBD
Endoscopy with biopsy
How far does a colonscopy go, what does it look at
5 feet, large intestine
How far does a sigmoidiscopy go, what does it look at
2 feet, descending colon
What is the disease location, endoscopic visualization, and pathology of Crohn’s Disease
mouth to rectum, deep inflammation (cobblestone), granulomas and inflammation with lymphoid aggregates
What is the disease location, endoscopic visualization, and pathology of Ulcerative Colitis
confined to the colon, superficial inflammation and erythema, crypt atrophy and neutrophil infiltration
What serologic marker is used to distinguish ulcerative colitis and Crohn’s Disease
Antibody tests
What are the 4 sub categories of ulcerative colitis
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
What are the 6 sub categories of Crohn’s disease
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
What is the most common sub categorie of Crohn’s disease
ileocolitis
What are Crohn’s Disease complications
fistulas: unneeded pathway, abscesses: pockets of infection, fissures, nutritional deficiencies
What is extraintestinal manifestation
inflammation in other organ systems
What is severe fulminant of crohn’s disease
persistent symptoms despite treatment or high temperatures, persistent vomiting, intestinal obstruction, cachexia or abscess
What are the first line drugs of mild to moderate Ulcerative Colitis why
aminosalicylates, induce and maintain remission
What are the two main functions of aminosalicylates
anti-inflammatory and immunosuppresive
What is the active drug of sulfasalazine, what causes the side effects
mesalamine (5-ASA), sulfapyridine
Where do the aminosalicylate formulations work
Colon
What are important adverse effects of Sulfasalazine
Male inferetility (reversible), may turn urine orange, may stain contacts and cause yellow tears
T/F: One gram of Folic acid must be taken with sulfasalazine
True
What are side effects of balsalazide and olsalazine
headache, nausea, abdominal pain
When should a patient be switched to a mesalamine agent when taking balsalazide or olsalazine
When watery diarrhea is present
Which mesalamine agent is an enema and where is the site of action, how should it be taken
Rowasa, Descending colon and recteum, given at bedtime and lay on left side for 8 hours
What is the formulation of Canasa, where is the site of action, when should it be taken
Suppository, rectum, after a bowel movement
Which mesalamine agent is a oral formulation and works in the small bowel and colon
Pentasa
What is site of action and formulation of Apriso
Jejunum to colon, oral
Which mesalamine agents are oral formulations and work in the terminal ileum to colon
Asacol, Delzicol, Lialda
When should mesalamine be discountinued
if pancreatitis, pneumonitis, or nephrotoxicity is present
What should be monitored for sulfasalazine
CBC and LFTs at initiation of therapy, every 2 weeks for 3 months, every month for 3 months, then every 3 months
What should be monitored for mesalmine agents
serum creatinine at 6 weeks, 6 months, 12 months then annually
What are corticosteroids used for in IBD
treatment of active UC or CD and/or failed 5-ASA therapy
Which steroid product has an oral formulation and is the go to for CD and UC
prednisone
When would budesonide become the preferred steroid
symptoms are mild-moderate and long term steroids
What are the two formulations of budesonide and where do the work
Entocort EC- terminal ileum, ileum, ascending colon/ Uceris- Colon
