Inflammatory Bowel Disease Exam 2

Question 1

What are the etiologies of IBD?

Answer 1

• Infectious agents
• Genetics
• Immunologic
• Psychological
• Environmental

Question 2

Etiologies of IBD: Infectious agents

Answer 2

• Microorganisms likely play a role in the initiation of inflammation
• Many organisms are suspected (measles virus, protozoa, mycobacteria, Listeria monocytogenes, Chlamydia trachomatis, Escherichia coli, toxin-producing bacteria)
• IBD patients have increased numbers of surface-adherent and intracellular bacteria
• IBD lesions occur more in areas of highest bacterial exposure
• Loss of tolerance against normal bacterial flora
• Bacterial peptides have chemotactic properties that cause inflammatory cells to arrive and release inflammatory mediators which cause tissue destruction
• Microbes elaborate superantigens which cause T-lymphocyte activation and inflammatory response

Question 3

Etiologies of IBD: Genetics

Answer 3

• Genetic factors predispose patients to IBD
• First-degree relatives have a 20-fold increase in risk
• Genetic markers have been identified and associated with the development of disease

Question 4

Etiologies of IBD: Immunologic

Answer 4

• Inappropriate reaction of the immune system (autoimmune and nonautoimmune)
• Immunologic mediators have been identified and play a role in the pathogenesis (lymphocytes, plasma cells, mast cells, macrophages, neutrophils)
• Contributes to systemic manifestations
• IBD is responsive to immunosuppressive drugs

Question 5

Etiologies of IBD: Psychological

Answer 5

• Stress, emotional/physical trauma, etc. influence IBD but are not thought to be the actual cause
• Mental health changes correlate with remissions and exacerbations (especially UC)

Question 6

Etiologies of IBD: Environmental

Answer 6

• Dietary habits of people in industrialized countries (where IBD is more common) may play a role
• Smoking is protective in UC but associated with twofold increase in frequency in CD
• NSAIDs – trigger occurrences and lead to flares via inhibition of protective prostaglandins

Question 7

Severity categories of ulcerative colitis

Answer 7

• Mild
• Moderate
• Severe
• Fulminant

Question 8

Severity categories of Crohn’s disease

Answer 8

• Mild / moderate
• Moderate / severe
• Severe / fulminant

Question 9

Ulcerative colitis: Mild

Answer 9

< 4 stools/day +/- blood, with no systemic complications and normal ESR

Question 10

Ulcerative colitis: Moderate

Answer 10

> 4 stools/day with blood, but with minimal systemic complications

Question 11

Ulcerative colitis: Severe

Answer 11

> 6 stools/day with blood, with evidence of systemic complications as indicated by fever, tachycardia, anemia, or ESR > 30

Question 12

Ulcerative colitis: Fulminant

Answer 12

> 10 stools/day with continuous bleeding, systemic toxicity, abdominal tenderness, requirement for transfusions and colonic dilation

Question 13

Crohn’s disease: Mild / moderate

Answer 13

ambulatory patients with no evidence of dehydration, systemic toxicity, weight loss, abdominal tenderness, mass, or obstruction

Question 14

Crohn’s disease: Moderate / severe

Answer 14

patients that fail to respond to treatment for mild/moderate disease, those with fever, weight loss, abdominal pain, tenderness, vomiting, obstruction, or anemia

Question 15

Crohn’s disease: Severe / fulminant

Answer 15

presence of persistent symptoms, evidence of systemic toxicity despite outpatient corticosteroids or biologic treatment, presence of cachexia, rebound tenderness, intestinal obstruction, or abscess

Question 16

Treatment for UC: Mild to moderate

Answer 16

• First line: sulfasalazine or oral mesalamine or topical mesalamine
• Second line: Topical steroids, Olsalazine, Balsalazide

Question 17

Treatment for UC: Moderate to severe

Answer 17

• First line: Sulfasalazine or oral mesalamine, plus Steroids
• Second line: Azathioprine, mercaptopurine, Infliximab

Question 18

Treatment for UC: Severe to fulminant active disease

Answer 18

• First line: parenteral steroids (Methylprednisolone preferred, Hydrocortisone)
• Second line: Cyclosporine, Infliximab

Question 19

Treatment for UC: Maintenance of remission

Answer 19

• First line: topical mesalamine or oral sulfasalazine or mesalamine
• Second line: Azathioprine, mercaptopurine, Infliximab

Question 20

Treatment for CD: Mild to moderate

Answer 20

• First line: sulfasalazine or oral mesalamine and budesonide
• Second line: Oral corticosteroids

Question 21

Treatment for CD: Moderate to severe

Answer 21

• First line: Sulfasalazine or oral mesalamine, plus Systemic corticosteroids
• Second line: Azathioprine or mercaptopurine

Question 22

Treatment for CD: Severe to fulminant active disease

Answer 22

• First line: parenteral corticosteroids (Methylprednisolone preferred, Hydrocortisone)
• Second line: Cyclosporine, Infliximab

Question 23

Treatment for CD: Maintenance of remission

Answer 23

• First line: Sulfasalazine and oral mesalamine

- Second line: Azathioprine or mercaptopurine