Medical Aspects of IBD

Question 1

Describe the type of inflammation that takes place in Crohns and UC?

Answer 1

UC–> diffuse mucosal irritation

Crohns–> Patchy, Transmural inflammation

Question 2

describe UC:

Answer 2

Ulcerative colitis is a diffuse mucosal inflammation limited to the colon; it almost always affects the rectum, and it may extend proximally in a symmetrical, uninterrupted pattern to involve all or part of the large intestine

Question 3

describe Crohns

Answer 3

Crohn’s disease, by contrast, is a patchy transmural inflammation that may involve any part of the gastrointestinal tract from mouth to anus.

Question 4

What is responsible for causing IBD?

Answer 4

1. genetics
2. environment
   —> leads to an immune response
   causing CD or UC

Several factors – genetic and environmental, among others – may interact to trigger the immune response that leads to IBD. IBD, particularly CD, tends to run in families; the rapidity of the increase in incidence, however, suggests that environmental factors have a strong impact, as genetic changes would not manifest as quickly. It is not yet clear whether the immune response is due to an intrinsic defect or to continued exogenous stimulation.9,10

Question 5

What gene in particular may be linked to crohns?

Answer 5

NOD2 Gene

Question 6

What is unique about the genetics for IBD?

Answer 6

there are over 173 loci related to IBD and 110 of those are shared by both crohns and UC.

Question 7

What are some environmental triggers for crohns?

Answer 7

Infections
 NSAIDs
 Diet
 Smoking
 Stress
Antibiotics

Question 8

Can people with UC smoke?

Answer 8

It may help keep the disease in check…1-2 cigs a day.

Question 9

What is the age incidence associated with IBD?

Answer 9

both have a peak in late teens-twenties and then again in the late 50s-60s

Question 10

What are the clinical signs of UC?

Answer 10

Ulcerative Colitis - bloody diarrhea, fever, tenesmus

Question 11

What are the clinical signs of Crohns

Answer 11

Crohn’s Disease - abdominal pain (RLQ), palpable mass, diarrhea (often non-bloody), weight loss, anemia

Question 12

What is UC called when it reaches the ascending colon? transverse?

Answer 12

pancolitis

extensive

Question 13

Where does crohn’s most commonly appear?

Answer 13

RLQ

Question 14

What are the four clinical patterns of tissue damage that you can see with crohn’s?

Answer 14

1. inflammation
2. microperforation
3. obstruction
4. fistula

Question 15

Perianal complications are common with what disease? In what disease is the rectum involvement present?

Answer 15

CD = perianal
UC = rectum, in CD, it usually spares the rectum

Question 16

Describe the histology of UC

Answer 16

crypt abscesses, neutrophils and lymphocytes in lamina propria

Question 17

Describe the histology of Crohns

Answer 17

transmural inflammation, noncaseating granulomas (25%)

Question 18

In what disease is EIM most common?

Answer 18

CD

Question 19

What are the most common EIMs?

Answer 19

Eyes: episcleritis, uveitis
Mouth: stomatitis, apthous ulcers
Liver: Steatosis
Biliary Tract: gallstones, sclerosing cholangitis
Kidneys: Stones, hydronephrosis, fistulae, UTI
Joints: spondylitis, sacrolitis
Skin: erythema nodosum, pyoderma, grangrenosum

Question 20

How does peripheral arthritis vary with CD?

Answer 20

1. monoarticular
2. asymmetrical
3. large > small joint
4. no synovial destruction
5. no subcutaneous nodules
6. seronegative

Question 21

Is it better to treat mildly in the start of IBD or go hard early on?

Answer 21

go hard early on

Question 22

What is the first line treatment for IBD?

Answer 22

anti-inflammatory using steroid treatment

1. sulfasalazine
2. mesalamine: works at diff parts of the colon
3. olsalazine
4. balasalazide

Question 23

What is the risk associated with the percentage of the population that does not have the 6-TImP enzyme?

Answer 23

their dosage needs to be figure out and measured.

Question 24

What is the side effect of 6-MP and mercaptopurine?

Answer 24

drops the WBC count

Question 25

What Biologic Therapy is available?

Answer 25

1. INfliximab–75% human
2. Natalizumab–95% human
3. Adalimumab–100% human
4. Certlizumab-pegol

Question 26

Which biologic therapy has the risk of an incurable brain infection?

Answer 26

2. Natalizumab

Humanized monoclonal antibody against a4 integrin

Blocks a4b1 and a4b7

Inhibits leukocyte adhesion and migration into inflamed tissue.

Question 27

There is an added risk of osteopenia being on cortiocsteroids, so what should someone do every few years?

Answer 27

they need a DEXA scan

Question 28

How often should someone get screened for colon cancer if they have IBD?

Answer 28

after 8 years of the onset, begin yearly screening.

Question 29

What can we do to help protect someone from the risk of colon cancer if they have IBD?

Answer 29

1. 5-ASA
2. Folate
3. Tight Medical Control

Question 30

People with IBD also can get what infection

Answer 30

C diff, even without antibiotic exposure