Inflammatory Bowel Disease Exam 2 Flashcards

1
Q

What are the etiologies of IBD?

A
  • Infectious agents
  • Genetics
  • Immunologic
  • Psychological
  • Environmental
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2
Q

Etiologies of IBD: Infectious agents

A
  • 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
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3
Q

Etiologies of IBD: Genetics

A
  • 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
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4
Q

Etiologies of IBD: Immunologic

A
  • 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
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5
Q

Etiologies of IBD: Psychological

A
  • 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)
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6
Q

Etiologies of IBD: Environmental

A
  • 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
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7
Q

Severity categories of ulcerative colitis

A
  • Mild
  • Moderate
  • Severe
  • Fulminant
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8
Q

Severity categories of Crohn’s disease

A
  • Mild / moderate
  • Moderate / severe
  • Severe / fulminant
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9
Q

Ulcerative colitis: Mild

A

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

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10
Q

Ulcerative colitis: Moderate

A

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

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11
Q

Ulcerative colitis: Severe

A

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

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12
Q

Ulcerative colitis: Fulminant

A

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

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13
Q

Crohn’s disease: Mild / moderate

A

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

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14
Q

Crohn’s disease: Moderate / severe

A

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

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15
Q

Crohn’s disease: Severe / fulminant

A

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

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16
Q

Treatment for UC: Mild to moderate

A
  • First line: sulfasalazine or oral mesalamine or topical mesalamine
  • Second line: Topical steroids, Olsalazine, Balsalazide
17
Q

Treatment for UC: Moderate to severe

A
  • First line: Sulfasalazine or oral mesalamine, plus Steroids
  • Second line: Azathioprine, mercaptopurine, Infliximab
18
Q

Treatment for UC: Severe to fulminant active disease

A
  • First line: parenteral steroids (Methylprednisolone preferred, Hydrocortisone)
  • Second line: Cyclosporine, Infliximab
19
Q

Treatment for UC: Maintenance of remission

A
  • First line: topical mesalamine or oral sulfasalazine or mesalamine
  • Second line: Azathioprine, mercaptopurine, Infliximab
20
Q

Treatment for CD: Mild to moderate

A
  • First line: sulfasalazine or oral mesalamine and budesonide
  • Second line: Oral corticosteroids
21
Q

Treatment for CD: Moderate to severe

A
  • First line: Sulfasalazine or oral mesalamine, plus Systemic corticosteroids
  • Second line: Azathioprine or mercaptopurine
22
Q

Treatment for CD: Severe to fulminant active disease

A
  • First line: parenteral corticosteroids (Methylprednisolone preferred, Hydrocortisone)
  • Second line: Cyclosporine, Infliximab
23
Q

Treatment for CD: Maintenance of remission

A
  • First line: Sulfasalazine and oral mesalamine

- Second line: Azathioprine or mercaptopurine