Inflammatory Bowel Disease HPIM 20th ed Flashcards
In a patient with Crohn’s disease with jejunoileitis, what nutritional deficiencies are expected arising from intestinal malabsorption?
Anemia
Hypoalbuminemia
Hypocalcemia
Hypomagnesemia
Coagulopathy
Hyperoxaluria with nephrolithiasis
Definition of toxic megacolon (complication in UC)
transverse or right colon with a diameter of >6 cm, with loss of haustration in patients with severe attacks of UC
Most dangerous local complication of Ulcerative Colitis
PERFORATION
__________ is a highly sensitive and specific marker for detecting intestinal inflammation. It is a glycoprotein in activated neutrophils.
Fecal lactoferrin
_________ is present in neutrophils, monocytes and correlates well with histologic inflammation, predict relapses and detect pouchitis.
FECAL CALPROTECTIN
What are endoscopic features of Crohn’s disease?
Rectal sparing, aphthous ulcerations, fistulas, and skip lesions
True or False. CT enterography allows direct visualization of the entire small-bowel mucosa.
False. Wireless Capsule Endoscopy.
_________ from longitudinal and transverse ulcerations most frequently involves the small bowel.
Cobblestoning
The earliest macroscopic findings of colonic CD are ____________.
Aphtous ulcers
Standard therapy for intraabdominal and pelvic abscess which occur in CD.
CT-guided percutaneous drainage of the abscess
_______________ increases the risk of intraabdominal and pelvic abscesses in CD patients who have never had an operation.
Systemic Glucocorticoid therapy
Serologic test: Inc titer of ASCAs (anti-Saccharomyces cerevisiae antibodies) associated with which IBD?
Crohn’s Disease
Inc in P-ANCA is associated with ________
Ulcerative Colitis
This infectious disease causes watery diarrhea, abdominal pain and fever followed by rectal tenesmus and by the passage of blood and mucus per rectum.
Shigellosis
Infectious disease that mimics IBD which occurs mainly in the terminal ileum and causes mucosal ulceration, neutrophil invasion and thickening of the ileal wall.
Yersinia enterocolitica
Epidemiology of IBD
Different Clinical Features between Ulcerative Colitis vs Crohn’s Disease
Herpes simplex infection of the GI tract is limited to which areas?
Oropharynx
Anorectum
Perianal areas
Histologic components in Collagenous Colitis
Increased subepithelial collagen deposition
Colitis with increased intraepithelial lymphocytes
Main symptom: chronic watery diarrhea
Risk factors of Collagenous colitis
Smoking
Use of NSAIDs
PPIs
Beta Blockers
History of autoimmune disease
Histologic feature of Lymphocytic Colitis
NO subepithelial collagen deposition
Intraepithelial lymphocytes INCREASED
Two drugs that may have complication which mimic IBD
IPILIMUMAB
MMF (Mycophenolate Mofetil)
Describe the lesion of Erythema nodosum which occurs in CD and UC
Lesions are hot, red, tender nodules measuring 1-5 cm in diameter and are found on the anterior surface of the lower legs, ankles, thighs and arms.
Lesion of Pyoderma gangrenosum
PG usually begins as a pustule and then spreads concentrically to rapidly undermine healthy skin. Lesions then ulcerate with violaceous edges surrounded by a margin of erythema. Centrally, they contain necrotic tissue with blood and exudate. Lesions may be single or multiple and grow as large as 30 cm.
True or False. Patients with peripheral arthritis associated with IBD worsens with exacerbations of bowel activity.
True, as opposed to Ankylosing spondylitis which is not related to bowel activity.
___________ is a disorder characterized by both intrahepatic and extrahepatic bile duct inflammation and fibrosis, frequently leading to biliary cirrhosis and hepatic failure.
Primary sclerosing cholangitis
Traditional gold standard diagnostic test for Primary Sclerosing Cholangitis
ERCP
What are the most frequent genitourinary complications in IBD are ______, ________, and __________.
Calculi, Ureteral obstruction, and ileal bladder fistulas.
Pathophysiology of formation of nephrolithiasis in patients with CD following small bowel resection
Normally, dietary calcium combines with luminal oxalate to form insoluble calcium oxalate, which is elimated in the stool. In patients, with ileal dysfunction, however, nonabsorbed fatty acids bind calcium and leave oxalate unbound. The unbound oxalate is then delivered to the colon, where it is readily absorbed, especially in the presence of inflammation.
Factors responsible for the hypercoagulable state in IBD.
Abnormalities of the platelet-endothelial interaction
Hyperhomocysteinemia
Alterations in the coagulation cascade
Impaired fibrinolysis
Involvment of tissue-bearing microvesicles
disruption of the normal coagulation system by autoantibodies
