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Unit 1 Clin Med III > L6: IBD + Celiacs > Flashcards

L6: IBD + Celiacs Flashcards

1
Q

Bimodal distribution of IBD

A

15-35 years

50-80 years

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2
Q

IBD by gender

A

Men: Ulcerative colitis
Women: Crohn’s

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3
Q

IBD by smoking

A

Crohn’s: increased risk

UC: Decreased risk

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4
Q

Genetically more likely to get IBD

A

Caucasian
Jewish
1st degree relative

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5
Q

Super important about IBD

A

Extent + severity of involvement influences clinical presentation, diagnostic evaluation, management + complications

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6
Q

Crohn’s extends…

A

Entire GI tract mouth→ anus with skip lesions
Aphthous ulcers (mouth)
Transmural→ entire thickness of mucosa→ penetrating disease→ ulcer, stricture, fistula, abscess

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7
Q

Most common form of Crohn’s

A

Ileitis

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8
Q

Crohn’s Ileocolitis

A

Terminal Ileum and proximal ascending colon

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9
Q

Crohn’s Colitis

A

colon

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10
Q

Possible fistulas seen with Crohns

A

Enteroenteric
Enterovesical
Enterovaginal
Enterocutaneous

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11
Q

Crohn’s disease courses

A

Mild→ inflammation
Moderate→ inflammation, strictures
Severe→ inflammation, strictures, fistula

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12
Q

Perianal disease seen in Crohn’s

A

abscess

fistula

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13
Q

Ulcerative Colitis extends….

A

Colon only→ continuous, circumferential pattern

Mucosal surface only→ friability, erosions, bleeding, pseudopolyps

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14
Q

Ulcerative proctosigmoiditis

A

rectosigmoid

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15
Q

Left-sided/distal ulcerative colitis

A

extends to but not beyond splenic flexure

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16
Q

Pancolitis

A

extends to cecum

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17
Q

Extensive colitis

A

extends beyond splenic flexure but not to cecum

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18
Q

Ulcerative colitis disease course

A

Mild→ <4 stools/day, no systemic toxicity
Moderate→ >4 stools/day, anemia, low grade fever
Severe→ >6 stools/day, systemic toxicity

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19
Q

Ulcerative colitis disease course

A

Mild→ <4 stools/day, no systemic toxicity
Moderate→ >4 stools/day, anemia, low grade fever
Severe→ >6 stools/day, systemic toxicity

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20
Q

Crohn’s specific presentation

A

Abdominal pain
→ Terminal ileum: RLQ, RLQ mass if abscess
intermittent, nocturnal diarrhea
+/- perianal pain with anal fissure, perirectal abscess, or fistula
+/- Iron def. Anemia
+/- B12 deficiency (TI involvement)

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21
Q

IBD presentation

A

+/- fever, chills, fatigue, weight loss, N/V/D

+/-Fecal urgency, tenesmus, rectal bleeding

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22
Q

Ulcerative colitis presentation

A

Abdominal pain
→ periumbilical/LLQ pain

Bloody diarrhea→ +/- iron deficiency anemia

Proctitis→ constipation

Extra intestinal:
Sclerosing Cholangitis→
Check alkaline phosphatase

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23
Q

IBD extra-intestinal manifestations

A

Episcleritis, iritis, uveitis
Erythema nodosum
Pyoderma gangrenosum
Arthralgias (most common)

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24
Q

IBD labs

A

CBC, CMP, ESR/CRP
+/- IBD antibodies

Stool cultures, C diff toxin
O+P
Fecal calprotectin or Lactoferrin

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25
Q

Colonoscopy + TI intubation of Crohn’s

A 
Skip lesions
ulcerations
cobblestoning
rectal sparing
chronic inflammation
\+/- fistulas
\+/-granulomas
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26
Q

CT or MR enterography of Crohn’s

A

Mucosal inflammation
strictures
abscess
fistulas

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27
Q

Crohn’s UGI + SBFT

A

String sign

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28
Q

Contraindication to capsule endoscopy

A

stricture

29
Q

UC Flex sigmoidoscopy or Colonoscopy

A

Inflammation begins distally and spreads proximally
Continuous circumferential pattern
Loss of vascular markings
Superficial inflammation: erythematous, exudate, friability, erosions
Biopsy→ crypt abscesses
Strictures rare

30
Q

Crohn’s complications

A

Small bowel obstruction + perforation:

Due to strictures, abdominal/perianal fistulas, abscess

Malabsorption:

Fe, B12

31
Q

IBD complications

A

Colon cancer

Colonoscopy ever 1-2 years beginning 8 years after o

32
Q

UC complications

A

Toxic Megacolon
Rare, high mortality
Colonic dilation >6 cm with signs of toxicity

33
Q

Low risk patients with mild disease tx

A

Step-up approach

34
Q

High risk patients with moderate to severe disease

A

Step-down (top-down) approach

35
Q

Indications for surgery for IBD

A

Severe hemorrhage
perforation
dysplasia/cancer
medical refractory disease

36
Q

IBD red flags that require emergent evaluation

A

Severe bleeding→ significant anemia

Severe abdominal pain→ peritoneal signs

Inability to tolerate PO

Signs of dehydration→ increased creatinine, tachycardia, hypotension

Signs of obstruction→ N/V, distention, no gas/stool passage

37
Q

Risk factors associated with aggressive IBD disease, patients benefit from top-down early immunomodulatory/biologic therapy

A

High risk anatomic locations→ extensive or perianal

Penetrating/fistulaizing

Steroid resistance/dependence

Severe disease→ malabsorption→ weight loss, nutrient deficiency, hypoalbuminemia

Young age

38
Q

For those with IBD developing diarrhea

A

always check stool studies

39
Q

Health maintenance for IBD

A

Immunization

Cancer screening→ colon, skin, cervical

DEXA scan for osteoporosis screening

Anxiety/depression screening

Smoking cessation

Routine laboratory monitoring→ CBC/CMP

40
Q

Can exacerbate IBD disease activity

A

NSAIDS

41
Q

IBD patients at increased infection risk

A

On medications:
Steroids
Immunomodulators
Biologics

42
Q

Celiac disease aka

A

Celiac sprue

Gluten Enteropathy

43
Q

5 ASAs can cause….

A

Diarrhea

Kidney injury

44
Q

Corticosteroids are used for

A

Flares
Short term, have an exit strategy
Slow taper

45
Q

Caution with prednisone

A

systemic effects:
Osteoporosis
Do DEXA scan if using steroids >3 months cumulative
Calcium and Vitamin D supplementation

46
Q

Use immunomodulators _______ to prevent _______

A

in combination with biologics

immunogenicity

47
Q

Immunomodulators are

A

steroid sparing agents

48
Q

6 Mercaptopurine

A

Immunomodulator

takes 3-6 months for optimal response

49
Q

Methotrexate

A

Immunomodulator
requires folate supplementation
teratogenic

50
Q

Recommendations for 6MP and Azathioprine use

A

Frequent monitoring of CBC and liver tests

annual derm exams + pap smear

51
Q

Anti-TNFs

A

for moderate to severe IBD

Have risk of infusion reaction and systemic risks

52
Q

Prior to anti-TNF therapy

A

TB: PPD/quantiferon/CXR

HBV antibodies

53
Q

Clinical monitoring during anti-TNF therapy

A

CBC, CMP

annual derm exams

54
Q

Antibiotics

A

used for perianal infections in Crohn’s

Cipro and Flagyl (metronidazole)

55
Q

Ciprofloxacin side effects

A

Tendinitis or rupture
Photosensitivity
Prolongation of QT interval, arrhythmia

56
Q

Flagly side effects

A

Peripheral neuropathy
metallic taste
Disulfiram reaction (avoid ETOH during and 3 days after)

57
Q

Supplements for Celiac

A 
PRN
Folate
Iron
Zinc
Calcium
B12
Vit D
58
Q

Celiac pathophysiology

A

Gluten is toxic to small intestine→ mucosal inflammation, crypt hyperplasia, abnormal villous architecture

Villous atrophy→ loss of absorptive surface capacity→ small bowel malabsorption

59
Q

Celiac epidemiology

A 
Northern european Caucasian
Infants (classic) 
10-40 years
Autoimmune: DM, thyroid disease
Down syndrome
60
Q

Genes for Celiac Disease

A

HLA DQ2, HLA DQ8

61
Q

Classic malabsorptive Celiac presentation

A 
Diarrhea
steatorrhea
flatulence
bloating
weight loss
62
Q

Atypical gastrointestinal Celiac presentation

A

Abdominal pain
Constipation
Dyspepsia

63
Q

Extra-intestinal manifestations of Celiac

A

Nutrient deficiencies→ Iron, B vit

Vit D/Calcium deficiency→ Osteopenia/Osteoporosis

Transaminase elevation (AST/ALT)

Dermatitis herpetiformis

Neuropsychiatric symptoms

Kids→ FTT

Infertility, miscarriages

64
Q

Pathognomonic for Celiac Disease

A

Dermatitis herpetiformis

65
Q

Gold standard for diagnosis of Celiac

A

EGD + Duodenal biopsy

66
Q

EGD + Duodenal biopsy of Celiac show

A

Intraepithelial lymphocytes
Crypt hyperplasia
Villous atrophy

67
Q

Perform Serologic tests or EGD + Duodenal biopsy for Celiac…

A

while on a gluten containing diet

68
Q

Serologic tests for Celiac Disease

A

IgA tissue transglutaminase (tTG Ab) (primary)

IgA endomysial (EMA Ab titer)

Deamidated Gliadin Peptide (DGP)

IgA levels must be normal for test to be valid

69
Q

Celiac Disease complications

A

Malabsorption
Iron deficiency anemia
B vitamin deficiency
Osteoporosis→ do DEXA

Slight increased risk of malignancy
Non-hodgkin lymphoma
GI malignancies

Unit 1 Clin Med III (7 decks)

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