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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
Colonoscopy + TI intubation of Crohn's
``` Skip lesions ulcerations cobblestoning rectal sparing chronic inflammation +/- fistulas +/-granulomas ```
26
CT or MR enterography of Crohn's
Mucosal inflammation strictures abscess fistulas
27
Crohn's UGI + SBFT
String sign
28
Contraindication to capsule endoscopy
stricture
29
UC Flex sigmoidoscopy or Colonoscopy
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
Crohn's complications
Small bowel obstruction + perforation: Due to strictures, abdominal/perianal fistulas, abscess Malabsorption: Fe, B12
31
IBD complications
Colon cancer Colonoscopy ever 1-2 years beginning 8 years after o
32
UC complications
*Toxic Megacolon* Rare, high mortality Colonic dilation >6 cm with signs of toxicity
33
Low risk patients with mild disease tx
Step-up approach
34
High risk patients with moderate to severe disease
Step-down (top-down) approach
35
Indications for surgery for IBD
Severe hemorrhage perforation dysplasia/cancer medical refractory disease
36
IBD red flags that require emergent evaluation
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
Risk factors associated with aggressive IBD disease, patients benefit from top-down early immunomodulatory/biologic therapy
High risk anatomic locations→ extensive or perianal Penetrating/fistulaizing Steroid resistance/dependence Severe disease→ malabsorption→ weight loss, nutrient deficiency, hypoalbuminemia Young age
38
For those with IBD developing diarrhea
*always check stool studies*
39
Health maintenance for IBD
Immunization Cancer screening→ colon, skin, cervical DEXA scan for osteoporosis screening Anxiety/depression screening Smoking cessation Routine laboratory monitoring→ CBC/CMP
40
Can exacerbate IBD disease activity
NSAIDS
41
IBD patients at increased infection risk
On medications: Steroids Immunomodulators Biologics
42
Celiac disease aka
Celiac sprue | Gluten Enteropathy
43
5 ASAs can cause....
Diarrhea | Kidney injury
44
Corticosteroids are used for
Flares Short term, have an exit strategy Slow taper
45
Caution with prednisone
systemic effects: Osteoporosis Do DEXA scan if using steroids >3 months cumulative Calcium and Vitamin D supplementation
46
Use immunomodulators _______ to prevent _______
in combination with biologics | immunogenicity
47
Immunomodulators are
steroid sparing agents
48
6 Mercaptopurine
Immunomodulator | takes 3-6 months for optimal response
49
Methotrexate
Immunomodulator requires folate supplementation teratogenic
50
Recommendations for 6MP and Azathioprine use
Frequent **monitoring of CBC and liver tests** | annual derm exams + pap smear
51
Anti-TNFs
for moderate to severe IBD | Have risk of infusion reaction and systemic risks
52
Prior to anti-TNF therapy
TB: PPD/quantiferon/CXR | HBV antibodies
53
Clinical monitoring during anti-TNF therapy
CBC, CMP | annual derm exams
54
Antibiotics
used for perianal infections in Crohn's | Cipro and Flagyl (metronidazole)
55
Ciprofloxacin side effects
Tendinitis or rupture Photosensitivity Prolongation of QT interval, arrhythmia
56
Flagly side effects
Peripheral neuropathy metallic taste Disulfiram reaction (avoid ETOH during and 3 days after)
57
Supplements for Celiac
``` PRN Folate Iron Zinc Calcium B12 Vit D ```
58
Celiac pathophysiology
Gluten is toxic to small intestine→ mucosal inflammation, crypt hyperplasia, abnormal villous architecture *Villous atrophy*→ loss of absorptive surface capacity→ small bowel malabsorption
59
Celiac epidemiology
``` Northern european Caucasian Infants (classic) 10-40 years Autoimmune: DM, thyroid disease Down syndrome ```
60
Genes for Celiac Disease
HLA DQ2, HLA DQ8
61
Classic malabsorptive Celiac presentation
``` Diarrhea steatorrhea flatulence bloating weight loss ```
62
Atypical gastrointestinal Celiac presentation
Abdominal pain Constipation Dyspepsia
63
Extra-intestinal manifestations of Celiac
Nutrient deficiencies→ Iron, B vit Vit D/Calcium deficiency→ Osteopenia/Osteoporosis Transaminase elevation (AST/ALT) *Dermatitis herpetiformis* Neuropsychiatric symptoms Kids→ FTT Infertility, miscarriages
64
Pathognomonic for Celiac Disease
Dermatitis herpetiformis
65
Gold standard for diagnosis of Celiac
EGD + Duodenal biopsy
66
EGD + Duodenal biopsy of Celiac show
Intraepithelial lymphocytes Crypt hyperplasia Villous atrophy
67
Perform Serologic tests or EGD + Duodenal biopsy for Celiac...
while on a gluten containing diet
68
Serologic tests for Celiac Disease
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
Celiac Disease complications
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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