Medical Aspects of IBD Flashcards
Describe the type of inflammation that takes place in Crohns and UC?
UC–> diffuse mucosal irritation
Crohns–> Patchy, Transmural inflammation
describe UC:
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
describe Crohns
Crohn’s disease, by contrast, is a patchy transmural inflammation that may involve any part of the gastrointestinal tract from mouth to anus.
What is responsible for causing IBD?
- genetics
- 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
What gene in particular may be linked to crohns?
NOD2 Gene
What is unique about the genetics for IBD?
there are over 173 loci related to IBD and 110 of those are shared by both crohns and UC.
What are some environmental triggers for crohns?
Infections NSAIDs Diet Smoking Stress Antibiotics
Can people with UC smoke?
It may help keep the disease in check…1-2 cigs a day.
What is the age incidence associated with IBD?
both have a peak in late teens-twenties and then again in the late 50s-60s
What are the clinical signs of UC?
Ulcerative Colitis - bloody diarrhea, fever, tenesmus
What are the clinical signs of Crohns
Crohn’s Disease - abdominal pain (RLQ), palpable mass, diarrhea (often non-bloody), weight loss, anemia
What is UC called when it reaches the ascending colon? transverse?
pancolitis
extensive
Where does crohn’s most commonly appear?
RLQ
What are the four clinical patterns of tissue damage that you can see with crohn’s?
- inflammation
- microperforation
- obstruction
- fistula
Perianal complications are common with what disease? In what disease is the rectum involvement present?
CD = perianal UC = rectum, in CD, it usually spares the rectum
Describe the histology of UC
crypt abscesses, neutrophils and lymphocytes in lamina propria
Describe the histology of Crohns
transmural inflammation, noncaseating granulomas (25%)
In what disease is EIM most common?
CD
What are the most common EIMs?
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
How does peripheral arthritis vary with CD?
- monoarticular
- asymmetrical
- large > small joint
- no synovial destruction
- no subcutaneous nodules
- seronegative
Is it better to treat mildly in the start of IBD or go hard early on?
go hard early on
What is the first line treatment for IBD?
anti-inflammatory using steroid treatment
- sulfasalazine
- mesalamine: works at diff parts of the colon
- olsalazine
- balasalazide
What is the risk associated with the percentage of the population that does not have the 6-TImP enzyme?
their dosage needs to be figure out and measured.
What is the side effect of 6-MP and mercaptopurine?
drops the WBC count
What Biologic Therapy is available?
- INfliximab–75% human
- Natalizumab–95% human
- Adalimumab–100% human
- Certlizumab-pegol
Which biologic therapy has the risk of an incurable brain infection?
- Natalizumab
Humanized monoclonal antibody against a4 integrin
Blocks a4b1 and a4b7
Inhibits leukocyte adhesion and migration into inflamed tissue.
There is an added risk of osteopenia being on cortiocsteroids, so what should someone do every few years?
they need a DEXA scan
How often should someone get screened for colon cancer if they have IBD?
after 8 years of the onset, begin yearly screening.
What can we do to help protect someone from the risk of colon cancer if they have IBD?
- 5-ASA
- Folate
- Tight Medical Control
People with IBD also can get what infection
C diff, even without antibiotic exposure
