Inflammatory Bowel Disease

Question 1

What are the 3 proposed eitological causes for inflammatory bowel disease?

Answer 1

Question 2

What is the target for drugs to treat inflammatory bowel disease?

Answer 2

immune system & bacteria

Question 3

Specific immune targets for IBD drugs?

Answer 3

• tumor necrosis factor alpha
• anti-IL12
• anti-IL-18
• block egress of white blood cells from blood stream to mucosa by blocking receptors to white cells

Question 4

Why are abscesses & fistulas seen in Crohn’s Disease but not in Ulcerative Colitis?

Answer 4

• UC: attacks only mucosa of the colon
• CD: attacks GI tract anywhere from mouth to anus
  
  • transmural: doesnt’ stick with mucosa, it goes into submucosa, into the serosa & into adjacent organs
  • causes complications like absceses & fistulas

Question 5

What is the difference between where Crohn’s Disease & Ulcerative Colitis is seen in the GI tract?

Answer 5

• UC: only colon
  
  • rectum
  • left side
  • entire colon
• CD: mouth to anus
  
  • mouth lesions
  • esophagus
  • small bowel
  • terminal ileum
  • colon

Question 6

What is the difference in response to environmental triggers (medications, infections, diet) from a normal bowel and IBD bowel?

Answer 6

• IBD failure to down-regulat inflammation
  
  • also, leakier so probably more antiens to begin with
• normal bowel: contorlled inflammation

Question 7

Clinical presentation of Ulcerative Colitis?

Answer 7

usually in late teens/early 20s

if presents as older adult, usually milder

Average time between when someone has bloody diarrhea & gets diagnosed with UC is 7 days

Question 8

Clinical Presentation of Crohn’s Disease?

Differentiate for pediatric & adult

Answer 8

Average time between when someone has symptoms & gets diagnosed with CD is 2 months

usually not bloody – nonbloody diarrhea, abdominal pain & fever

Question 9

Complications that can result from IBD?

UC & CD

Answer 9

Question 10

What are the 2 next steps you should take when someone comes into your practice with bloody diarrhe?

Answer 10

• Where is bloody diarrhea coming from?
  
  • sample – looking for particular infections
    
    • C. dif
    • enteric infections
  • is this IBD?
    
    • scope - esp if thinking UC
    • UC looks the same any place that you look
    • CD can be patchy/skip areas

Question 11

Locations in the GI most often associated with Crohns?

with UC?

Answer 11

• CD: (99%)
  
  • terminal ileum
  • colon
  • terminal ileum & right colon
• UC– can progress, moves in a counter cross wise fashion
  
  • rectum
  • rectum & sigmoid
  • left colon
  • pancolitis

Question 12

What is the drug of choice for Crohn’s disease?

UC?

Answer 12

Crohn’s: Budesonide

UC: 5’-ASA - mesalamine (enema & oral)