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GI II Exam 1. > Lecture 8: Inflammatory Bowel Disease > Flashcards

Lecture 8: Inflammatory Bowel Disease Flashcards

1
Q

What are 4 extraintestinal manifestations of the skin associated with IBD?

A
  • Erythema nodosum
  • Apthous (oral) ulcers
  • Pyoderma gangrenosum
  • Cutaneous CD vasculitis
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2
Q

What are 4 extraintestinal manifestations of the eye associated with IBD?

A
  • Conjunctivitis
  • Episcleritis
  • Iritis
  • Uveitis
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3
Q

What are 5 extraintestinal manifestations of the liver associated with IBD?

A
  • Fatty liver
  • Pericholangitis (intrahepatic sclerosis cholangitis)
  • Primary Sclerosis Cholangitis
  • Cholangiocarcinoma
  • Chronic hepatitis
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4
Q

Which extraintestinal manifestation of the kidney is associated specifically with Chron Disease?

A

Nephrolithiasis w/ urate or calcium oxalate stones

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5
Q

What are some of the hematologic extraintestinal manifestations associated with IBD?

A
  • Hemolytic anemia
  • Phlebitis
  • Thromboembolic events (DVT)

- Pulmonary embolus (PE)

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6
Q

Can infectious enterocolitis be distinguished clinically and endoscopically from UC?

A
  • NO!
  • Need stool studies and biopsy
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7
Q

What are some diseases other than Chron Disease that have non-caseating granulomas?

A
  • Sarcoid
  • PBC
  • Vasculidites (giant cell arteritis, “Wegener’s”)
  • Fungus
  • Hypersensitivity pneumonitis
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8
Q

Erythema nodosum is an extraintestinal manifestation most commonly seen in which form of IBD?

A

UC > CD

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9
Q

What are some of the potential complications associated with UC?

A
  1. Toxic megacolon
  2. Colonic perforation
  3. Cancer risk –> related to extent and duration of colitis
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10
Q

Which procedure before the age of 20 is associated w/ reduced risk for developing UC?

A

Appendectomy

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11
Q

How does location of UC affect the risk of developing colon cancer?

A

Increased risk in disease proximal to rectum

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12
Q

What is the recommendation for colonoscopies in a person w/ UC?

A

Every 1-2 years, beginning 8 years after diagnosis

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13
Q

What is the key diagnostic modality used for diagnosis of UC?

How will the mucosal surface appear?

A
  • Sigmoidoscopy
  • Edematous, friable, mucopus, and eroded
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14
Q

Which type of IBD can present with acute ileitis sometimes mimicking appendicitis?

A

Chron Disease

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15
Q

Anorectal fissure, fistulas and abscesses are all associated with what form of IBD?

A

Chron Disease

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16
Q

Patients with Chron Disease are at risk for what type of cancers?

A
  • Colonic carcinoma
  • Lymphoma and Small Bowel Adenocarinoma (both are rare)
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17
Q

Which imaging modality is usually performed first with suspect Chron Disease?

A

Colonoscopy –> to evaluate the colon and terminal ileum and to obtain mucosal biopsies

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18
Q

What are the typical endoscopic findings in someone with Chron Disease?

A
  • Apthoid linear or stellate ulcers
  • Strictures
  • Segmental involvement or normal-appearing mucosa adjacent to inflammed mucosa

*Granulomas on biopsy are highly suggestive of Chron disease

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19
Q

In patients with fulminant disease associated with UC, which imaging modality should not be performed?

Why not?

A

Colonoscopy due to risk of perforation

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20
Q

In patients with severe UC, barium enemas may precipitate which complication?

Otherwise this imaging modality will show what characterisitc sign?

A
  • Toxic megacolon
  • Otherwise show –> “lead pipe” = loss of haustra in UC
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21
Q

In a patient with Chron Disease a tender abdominal mass with fever and leukocytosis suggest what complication?

What is needed to confirm this diagnosis?

A
  • Abscess
  • Emergent CT of abdomen needed to confirm
22
Q

In patient with Chron Disease that has developed an abscess what is the treatment?

A
  • Broad-spectrum antibiotics
  • Percutaneous drainage or sugery
23
Q

A patient with CD presenting with an intestinal obstruction should be treated how?

Placed on what type of diet?

A
  • IV fluids w/ nasogastric suction
  • Placed on a low-roughage diet (i.e., no raw fruits/vegetables, popcorn, nuts, etc.)
24
Q

A fistula in CD between the small intestine and the colon is called what?

A

Enterocolonic fistula

25
Q

A fistula in CD between the colon and bladder is called what?

A

Colovesical fistula

26
Q

A fistula in CD between the bladder and small intestine is called what?

A

Enterovesical fistula

27
Q

Fistulas to the skin in CD occurring at sites of surgical scars can be of what 2 types?

A

1) Enterocutanous
2) Colocutaneous

28
Q

Which type of fistula seen in CD is manifested by fever, chills, a tender abdominal mass, and leukocytosis?

A

Retroperitoneal phlegmon or abscess

29
Q

What is the treatment for symptomatic fistulas associated with CD?

A

After percutaneous drainage, a long-term antibiotic is administered until the fistula is closed or surgically resected

30
Q

What are the manifestations of perianal disease associated with CD?

A

Large painful skin tags, anal fissures, perianal abscesses, and fistulas

31
Q

Specific treatment of perianal disease associated with CD is best approached jointly with whom?

A

Colorectal surgeon

32
Q

What is the best noninvasive study for evaluating perianal fistulas?

A

Pelvic MRI

33
Q

Which 2 oral antibiotics can be given for perianal disease?

A

1) Metronidazole
2) Ciprofloxacin

34
Q

Refractory anal fissues may benefit from which treatments?

A
  • Mesalamine suppositories, or…
  • Topical tacrolimus ointment
35
Q

Severe hemorrhage is a complication most often seen in which form of IBD?

A

UC

36
Q

Often the terminal ileum must be resect in patients with CD, malabsorption may result from removal of how much?

What are the recommendations to deal with the malabsorption issues in these patients?

A
  • More than 100 cm of terminal ileum resected
  • Low-fat diet
  • Parenteral vitamin B12
37
Q

Reduced absorption of bile acids due to involvement of the terminal ileum in patients with CD may cause what type of diarrhea?

A

Secretory

38
Q

In CD patients with severe bile salt malabsorption w/ steatorrhea, which agents should not be given as they will exacerbate the diarrhea?

A

Bile-salt binding agents

39
Q

All of the unabsorbed fatty acids in a CD patient with severe ileal involvement or ileal resection can lead to what complication?

A
  • Unabsorbed FA’s bind w/ Ca2+, reducing its absorption and enhancing the absorption of oxalate
  • Oxalate kidney stones may develop
40
Q

Which drugs are given for severe cases of IBD?

*This will likely be on exam!!!

A

Glucocorticoids –> Prednisone PO or IV hydrocortisone

41
Q

What are the adverse effects associated with short-term glucocorticoid administration for severe IBD?

A
  • Mood changes
  • Insomnia
  • Buffalo hump + Weight gain (striae) + Acne + Moon facies
  • Edema
  • Increase serum glucose levels
42
Q

5-ASA drugs are given for mild to moderate UC and may have what adverse effects?

A
  • Nausea
  • Rash
  • Diarrhea
  • Pancreatitis
  • Acute interstitial nephritis
43
Q

AZO compounds (Sulfasalazine) used in the treatment of IBD are always administered with what?

A

Folate

44
Q

What type of surgery is done for UC and is it curative?

A

Procto-Colectomy w/ ileostomy (curative)

45
Q

Is surgery as a treatment for CD usually done?

Indicated when?

A
  • Rarely, as recurrence = likely at site of surgery
  • Sometimes NEEDs to be done (i.e., resection for fixed obstruction, abscesses, persistent symptomatic fistulas, intractability)
46
Q

What are the indications for surgery in pt w/ UC?

A
  • Intractability
  • Fulminant colitis and Toxic Megacolon (if no improvement w/ aggressive med therapy in 24-48 hrs)
  • Cancer, dysplasia, severe hemorrhage, or perforation
  • Ileal pouch - anal anastomosis is operation of choice
47
Q

Prior to the use of anti-TNF agents for IBD what do the patients need to be screened for?

During therapy what must be monitored?

A
  • Screened for latent TB w/ PPD testing and CXR
  • During tx liver biochemical tests should be monitored routinely
48
Q

Anti-TNF agents increase the risk for what types of cancers?

A
  • non-melanoma skin cancer
  • non-Hodgkin lymphoma
49
Q

Measurement of the functional activity of what is recommended prior to initiation of Azathioprine or 6-mercaptopurine?

A

Thiopurine methyltransferase (TPMT)

50
Q

Why should prophylaxis be administered to all hospitalized IBD patients?

A

Due to high risk of venous thromboembolic disease

GI II Exam 1. (25 decks)

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