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Block 11 module 5 > Inflammatroy Bowel Disease > Flashcards

Inflammatroy Bowel Disease Flashcards

1
Q

idiopathic inflammatory intestinal disease resulting from an inappropriate immune activation to host intestinal micro flora

A

Inflammatory bowel disease

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2
Q

define IBD

A

it is an idiopathic inflammatory intestinal disease resulting from an inappropriate immune activation to host intestinal micro flora

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3
Q

types of IBD

A

Crohn’s Disease (CD)
Ulcerative Colitis (UC)
Others (Indeterminate colitis)

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4
Q

between UC and CD, which has a higher incidence?

A

incidence of UC is 3 times higher than that of CD

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5
Q

Autosomal recessive missense mutations of the interleukin (IL)-10 receptor gene cuses what?

A

cause severe disease through loss of function and, therefore, failure of IL-10 to down-regulate inflammation.

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6
Q

Highest rates of IBD are seen among ____ population

A

Jewish

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7
Q

1st peak of IBD

A

15-40

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8
Q

2nd peak of IBD

A

55-65

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9
Q

CD is associated with _____ gene polymorphisms and E. coli outer membrane and flagellin

A

NOD2/CARD15

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10
Q

interaction between ____ and ____ is critical to the pathogenesis of Crohn’s

A

T cells and APC

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11
Q

genetic etiology of UC

A

IL-23R gene polymorphisms have been identified, most notably the Arg381Gln polymorphism

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12
Q

pathogenesis of IBD

A

continuous antigenic stimulation by commensal enteric bacteria, fungi or viruses

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13
Q

autoantibody that has received significant attention in UC patients

A

pANCA

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14
Q

Extends into the deeper layers of the intestinal wall and may affect the mouth, esophagus stomach and small intestines

A

CD

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15
Q

Transmural inflammation and skip lesions

A

CD

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16
Q

ulceration and inflammation of the inner lining of the colon and rectum

A

UC

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17
Q

form of characteristic ulcers or open sores

A

UC

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18
Q

Symmetrical, continuous

A

UC

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19
Q

DR2-related genes

A

UC

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20
Q

DR5DQ1 alleles

A

CD

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21
Q

pathologic hallmark of CD

A

Focal intestinal inflammation

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22
Q

what is an aphthae

A

superficial ulcer in the mucosa

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23
Q

Cobblestone appearance

A

CD

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24
Q

35-50% CD is located in

A

both ileum and colon

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25
Q

35% CD is located in

A

SI

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26
Q

late features of CD

A

Large ulcers, sinus tracts, and stricture, adhesion of bowel loops

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27
Q

macroscopic features of CD

A 
skip lesions
narrowing of lumen
linear mucosal ulceration
creeping fat
fat wrapping
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28
Q

creeping of mesenteric fat onto the serosal surface of the bowel

A

fat wrapping

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29
Q

fat wrapping is seen in

A

CD

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30
Q

Granuloma

A

CD

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31
Q

CD compared to TB Ileitis

A

TB has no central and caseating necrosis

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32
Q

key cytokine in the formation of granulomas

A

TNF

33
Q

if a granuloma is not seen what is a reliable sign of CD

A

presence of lymphoid aggregates in the submucosa and external to the muscularis propria

34
Q

UC affects

A

only the colon

35
Q

No skip pattern in

A

YC

36
Q

total involvement of the colon

A

pancolitis

37
Q

pancolitis is seen in

A

UC

38
Q

involves only the rectum

A

proctitis

39
Q

involves the rectum and sigmoid colon (the lower segment of the colon before the rectum)

A

Proctosigmoiditis

40
Q

involves only the left side of the colon

A

Distal colitis

41
Q

universal colitis; involves the entire colon

A

pancolitis

42
Q

extension of UC into the terminal ileum

A

backwash ileus/ileitis

43
Q

Inflammation in UC characteristically is confined to the

A

mucosa

44
Q

pseudopolyps results from

A

coalescence of primary ulcerations in the area and later regeneration

45
Q

epithelial regeneration intestinal mucosa with recurrent attacks results in the formation of

A

pseudopolyps

46
Q

neutrophylic infiltration of colonic crypts leads to

A

cryptitis and crypt abscesses

47
Q

Cryptitis – is associated with discharge of

A

mucus and goblet cells

48
Q

Presence of plasma cells is another characteristic of

A

UC

49
Q

major manifestatoin of IBD

A

recurrent ab pain and diarrhea

50
Q

Grossly bloody stools, occasionally with tenesmus is typical in

A

UC

51
Q

perianal lesions is a char of

A

CD

52
Q

toxic megacolon is present in

A

UC

53
Q

Fistulas are manifestations of the transmural nature of

A

CD

54
Q

string sign is a feature of

A

CD

55
Q

markedly narrowed bowel segment amid widely-spaced bowel loops

A

String sign

56
Q

glucagon is used as an

A

antispasmodic

57
Q

external manifestations of IBD

A

clubbing
Arthritic manifestations
Metabolic bone disease
Granulomatous vasculaitis, periostitis and amyloidosis

58
Q

gold standard for imaging studies in IBD

A

endoscopic evaluation

59
Q

The presence of marked colonic dilatation suggests

A

fulminant colitis or toxic megacolon

60
Q

string sign is due to

A

spasm

61
Q

comb sign is pathognomonic of

A

CD

62
Q

segmental dilatation of the vasa recta involving an intestinal loop

A

Comb sign

63
Q

The earliest endoscopic sign of UC is

A

mucosal erythema and edema

64
Q

what imaging modality would you do if you want to find obscure sources of GI blood loss

A

Tablet enteroscopy

65
Q

complications of CD

A 
Perforation
• Abscess formation
• Stricture and small bowel obstruction
• Nutritional deficiency
• Cancer: small bowel adenocarcinoma
66
Q

complications of UC

A

toxic megacolon
colon adenocarcinoma
perforation
massive hemorrhage

67
Q

Mainstay of therapy for mild to moderate UC and CD

A

5 ASA agents

68
Q

pro drug of 5 ASA

A

Balsalazine

69
Q

the use of this demonstrated a prophylactic effect on endoscopic and clinical recurrence at one year

A

metronidazole

70
Q

Utilized to initiate remissions particularly in persons who are not responding well to 5-ASA

A

glucocorticoids

71
Q

Purine analogs that interfere with nucleic acid metabolism

A

Azathioprine and 6-Mercaptopurine

72
Q

surgery is performed in UC or CD?

A

UC

73
Q

idiopathic inflammation that may develop in patients who undergo IPAA

A

pouchitis

74
Q

ASCA positive in

A

CD

75
Q

Bleeding is more common in

A

UC

76
Q

inflammation in mucosa and submucosa only

A

UC

77
Q

Transmural inflammation

A

CD

78
Q

factors affecting disease relapse and remission

A 
Use of NSAIDS and antibiotics
• Bacterial and viral infection
• Smoking
• Psychosocial stress
• Both the severity and the extent of disease are important prognostic factors after the first attack of UC

Block 11 module 5 (2 decks)

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