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Gastroenterology > Natural Tx of IBD > Flashcards

Natural Tx of IBD Flashcards

1
Q

what are the 4 forms of IBD?

A

Crohn’s
indeterminate colitis
UC
microscopic colitis

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2
Q

where does Crohn’s mostly affect the GI?

A

SI, ileocecal valve and surrounding area, splenic flexure of colon, just before sigmoid colon

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3
Q

what can be a tell-tale appearance for Crohn’s?

A

cobblestoning appearance of bowel wall

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4
Q

what will the bowel wall look like in UC?

A

pseudopolyps, ulceration, loss of haustra

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5
Q

microscopically what will Crohn’s look like?

A

crypts are non-existing

lamina propria is extremely thickened

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6
Q

microscopically what will UC look like?

A

severe crypt distortion and less organized

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7
Q

besides the distal ileum and the R colon, where else can Crohn’s appear? what percentages are associated with each spot?

A

besides the R colon and distal ileum (MC spots) Crohn’s can appear gastroduodenally 5% of the time, in the SI alone 5% of the time and in the colon alone 20% of the time

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8
Q

what is progression (complication) that can occur with Crohn’s?

A

stenosis or inflammation of the ileocecal valve both of which can lead to fistula formation of the SI directly with the colon
stenosis occurs 50% of the time, inflammation 30% of the time and fistula formation appears 20% of the time

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9
Q 
what are some common sxs to see in the following organs/systems w/Crohn's?
eyes?
KD?
skin?
mouth?
liver?
biliary tract?
joints?
circulation?
A

eyes: episcleritis, uveitis
KDs: stones, hydronephrosis, fistulae, UTI
skin: erythema nodosum, pyroderma grangrenosum
mouth: stomatitis, apthous ulcers
liver: steatosis
biliary tract: gallstones, sclerosing cholangitis
joints: sponylitis, sarcoilitis, peripheral arthritis
circulation: phlebitis

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10
Q

4 step pathogenesis process of Crohn’s

2 factors that can impact the progression/end of the possible first step?

A
  1. causative agent (bacteria, virus, dietary)
  2. immune response
  3. inflammation
  4. tissue injury

modifying factors: environmental, genetic
luminal factors: luminal bacteria, digestive enzymes, bile acids

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11
Q

what kind of an immune response is Crohn’s? explain the immune cell cascade that happens

A

Th1 response

MOs activate T cells which generate a Th1 response

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12
Q

what demographic is most likely to be dx with Crohn’s?

A

caucasian jews

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13
Q

what are some hostile factors that could lead to a pt developing Crohn’s? what protective factors usually keep the GI healthy?

A

hostile: bacteria, bile acids, bacterial and dietary ags, digestive enzymes, Th1 lymphocytes
protective: impermeable mucosa, mucus, sIgA, PGE2, PGI2, UL-1ra, cortisol, IL-4, IL-10, TGF-b, VIP, somatostatin, glutamine, SCFA, Th2 lymphocytes

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14
Q

compare-contrast the depth to which Crohn’s affects the GI tract vs UC

A

Crohn’s: affects the mucosal and submucosal layers

UC: only affects the mucosal layer

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15
Q

in UC what happens to the normal intestinal crypts and what can form?

A

crypts get distorted and lost their goblets cells

abscesses can form

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16
Q

describe UC pathogenesis

A

microbial pathogens are introduced to the GI, there is an ineffective immune response
dietary ags or non-pathogenic microbes come into contact with the GI and we get an abn immune response
luminal ags are present which leads to an immune response to the luminal ag along with to the person’s own epithelium= auto-immune

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17
Q

3 forms of UC? where does each affect in the GI? which has the greatest risk of colon CA

A

proctitis: rectum
left-sided colitis: descending colon through the rectum
pancolitis: ascending, transverse, descending colon through the rectum
greatest risk of colon CA in pts w/pancolitis, even if they go/are in remission

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18
Q

what is the main complication in UC?

A

toxic megacolon b/c of the loss of haustra and ‘tubularization’ of the LI

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19
Q

how do you dx UC?

A

endoscopy

can go all the way into the terminal ileum

20
Q

antibiotics is more associated with which IBD dz? increases the risk in what population specifically? what abx is not associated with an IBD? which 2 are more strongly associated?

A

Crohn’s
increases risk in children
penicillin was not associated with increased risk
metronidazole and fluoroquinolones are strongly associated with new-onset IBD

21
Q

what OTC can be associated with IBD relapse?

A

NSAIDs, even just one time use

22
Q

what lifestyle factor doubles the risk of Crohn’s? effect on UC?

A

smoking doubles the risk of Crohn’s, actually decreases risk of UC

23
Q

what are 3 supplements that can help decrease the side effects of IBD meds and protect against complications?

A

folic acid
DHEA
withania somniferi (ashwagandha)

24
Q

what CBC marker could you use to assess tissue levels of folic acid?

A

neutrophilic hypersegmentation index (earliest sign of folate deficiency)

25
Q

what gene polymorphism could lead to folate deficiency?

A

MTHFR b/c it controls the synthesis of methylene tetrahydrofolate reductase and is responsible for taking inactive folate to active folate

26
Q

folic acid deficiency can occur during what UC tx?

A

sulfasalazine

27
Q

what dosage of what vitamin could decrease the risk of colorectal CA by 89%?

A

taking >1 mg of folic acid daily

28
Q

what are some side effects of higher doses of prednisone

A 
hyperglycemia
muscle wasting
osteoporosis
HTN
delayed healing
immune suppression
29
Q

what could you supplement with so as to negate the side effects of long term cortisol use without affecting the cortisols efficacy?

A

DHEA

30
Q

risk factors for osteoporosis?

A 
disease activity (acute flare) 
lifetime steroid dosage >10 g
active IBD
multiple bowel resection
age
low body mass index
31
Q

what 2 tests can you do for bone density? what supplements could help?

A

DEXA scans and N-telopeptide urine assays

monitor and supplement vits D and K2 and Ca2+ as well as DHEA

32
Q

what marker could be useful in distinguishing between IBD and IBS? what does it correlate with? what is it?

A

fecal calprotectin
can do this before a colonoscopy if trying to determine if a colonoscopy is indicated
it is able to distinguish IBD from IBS and correlates w/the severity of inflammation
it is a protein and antimicrobial factor in WBCs

33
Q

is fecal calprotectin better for predicting IBD that is ileal or colonic?

A

colonic

34
Q

what level of calprotectin is normal/insignificant? mild/moderate inflammation? more significant inflammation? active dz, impending relapse of IBD?

A

normal/insignificant inflammation= less than 50 ug/g
mild/moderate inflammation= 50-100 ug/g
more significant inflammation= more than 100 ug/g
active dz, impending relapse of IBD= more than 250 ug/g

35
Q

Dr. Lawton’s Crohn’s General formula?

A 
hepaglycerite: 10 mL
silybum gylcerite: 10 mL
withania: 30 mL
rehmannia: 30 mL
matricaria: 10 mL
solid ext. glycyrrhiza: 10 mL
leptandra: 10 mL
calendula: 10 mL
sig: 4 droppersfull BID
36
Q

Dr. Lawton’s Acute Crohn’s Formula

A

chamomilla: 30 mL
foeniculum: 20 mL
kalmerite: 20 mL
viburnum opul: 30 mL
valerian: 20 mL
atropa belladonna: 120 gtt
sig: 4 droppersfull Q20 min (up to 8x’s/d)

37
Q

what medication helps increase endorphin levels in the body?

A

low dose naltrexone

38
Q

adult dosing of naltrexone?

how long until you can expect to see results? how long do they have to take for? pediatric dosing?

A

start w/1.5 mg qhs x 4 nights
if no sleep issues increase to 3 mg qhs x 4 nights
if no sleep issues increase to 4.5 mg qhs
tx should show results in 2-3 mos
tx must be continued indefinitely in order to have lasting benefit
pediatric dosing: 0.1 mg/kg body wt

39
Q

when is it best to take naltrexone?

A

10 pm- 2 am (earlier in day if necessary or taking opiates at night)

40
Q

what does curcumin have inhibitory effects on?

A 
cyclooxygenases 1 and 2
lipoxygenase
TNF-alpha
interferon gamma
inducible nitric oxide synthase
nuclear factor kappa B
also an anti-oxidant
41
Q

what four diets may be beneficial for people with IBD? which showed significantly longer periods of remission and fewer relapses?

A

specific carbohydrate diet, elimination diet, elemental diet (esp helpful in pts w/ileal involvement) and GAPS diet
elimination diet showed significantly longer periods of remission and fewer relapses

42
Q

what are the most reactive foods for people with IBD?

A

corn, wheat, yeast, dairy products, eggs, potatoes, rye, tea and coffee (in this order)

43
Q

what is the optimal intake of the elemental formula?

A

900 Kcal/d

44
Q

what specific type of nutritional protocol has been shown to be successful for pediatric cases of Crohn’s? what is it specifically? duration?

A

exclusive enteral nutrition
resulted in pediatric Crohn’s pts going into remission at as great of a rate as with steroids with much fewer side effects and better intestinal mucosal healing
liquid only diet and no other food intake, formula may be elemental or whole protein
6-8 wks or longer

45
Q

what risk is increased in Crohn’s pts w/fistulae, strictures or motility disturbances?

A

SIBO
SIBO is also more frequent with partial colectomy, multiple intestinal surgeries, ileocecal resection and both colon and SI Crohn’s involvement
SIBO is more likely in Crohn’s pts w/terminal ileum involvement

46
Q

ssxs of Crohn’s?

A

malabsorption, weight loss, watery diarrhea, meteroism, flatulence and abdominal pain

47
Q

what are some natural txs for UC?

A 
boswellic acids
aloe vera 
Dr. Yarnell's UC Relapse Prevention Formula 
salmon (600 gm/wk for up to 8 wks)
fish oil supplementation 
retarded release phosphatidylcholine
VSL#3 probiotic 
fecal microbiota transplantation

Gastroenterology (6 decks)

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