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1. Clin Med III > 1- IBD & Celiac Disease > Flashcards

1- IBD & Celiac Disease Flashcards

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1
Q

What age ranges does IBD mainly affect?

A

Bimodal. 15-35 yo & 50-80 yo

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2
Q

What role does smoking play in CD & UC?

A

Increases risk in CD. Decreases risk in UC

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3
Q

What IBD involves the GI from mouth to anus, has patchy/skip lesions and transmural inflammation?

A

Crohns Disease

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4
Q

What IBD is limited to the colon, involves the rectum, extends proximally with continuous circumfrential involvement and has inflammation of the mucosal layer only?

A

Ulcerative colitis

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5
Q

What will impact the clinical presentation, diagnostic evaluation, management and associated complication of IBD?

A

Extend and severity of involvement

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6
Q

What part of the GI tract is most commonly impacted by CD?

A

Ileum → ileitis

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7
Q

What would you expect to find on exam of a pt w/ Crohns perianal disease?

A

Abscess, fistula

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8
Q

What does transmural mean?

A

Affects the entire thickness of mucosa

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9
Q

Ulcer, stricture, fistual, and abscess can also result from what?

A

Penetrating Crohn’s disease

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10
Q

What is a fistula?

A

tunnel/ abnormnal communication b/w 2 epitheal lined organs

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11
Q

What two organs are connected by an enterovesical fistula?

A

bowel and bladder

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12
Q

T or F: CD and UC have an incidious onset and alternates b/w periods of exacerbations and relative remission?

A

TRUE

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13
Q

What determines severity of Crohn’s disease?

A

Mild → inflammation. Moderate → inflamation, strictures. Severe → inflammation, strictures, fistula

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14
Q

PE on pt w/ abdominal pain reveals RLQ tenderness w/ palpable mass, anal fissues, and B12 deficiency. What disease are you concerned about?

A

Crohns Disease

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15
Q

What is the most common estra-intestinal manifestation of CD?

A

Arthralgias (also: oral apthous ulcers, occular manifestations, erythema nodosum, pyoderma gangrenosum)

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16
Q

What imagind should be ordered if suspicious for CD?

A

Colonoscopy w/ TI intubation. If w/ evidence of CD then order EGD

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17
Q

When would you not order a capsule endoscopy?

A

In pts w/ suspected intestinal strictures

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18
Q

What tests will indicate inflammation?

A

ESR/CRP, Fecal calprotectin and lactroferrin

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19
Q

What are skip lesions?

A

Areas that are disease free

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20
Q

What colonoscopy results would you expect in pt w/ CD?

A

skip lesions, ulcerations, cobblestoning, rectal sparing (in most pts), +/- fistula

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21
Q

If biopsy is taken from a pt w/ CD, what would you expect to see?

A

Granulomas and chronic inflammation

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22
Q

What finding on UGI w/ SBFT (Upper GI Series / Small Bowel Follow-through) would you expect in pt w/ CD?

A

String sign

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23
Q

What would CT or MRI show in pt w/ CD?

A

mucosal inflamnmation, strictures, abscess, fistula

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24
Q

Colon CA, intestinal strictures, abdominal and perianal fistuala, abscess, and malabsorption are complications associated w/ what disease?

A

Crohns Disease

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25
When is a colonoscopy recommended in pts w/ IBD?
Every 1-2 yrs starting 8 yrs after disease/sx onset
26
In CD pt w/ intestinal strictures, fistula or abscess. How might they present?
Will small bowel obstruction and perforation
27
Pt w/ CD might have what nutritional deficiencies?
Iron and B12
28
What disease only affects the colon in a continuous circumfrential pattern?
Ulcerative colitis
29
What portion of the colon is affected in ulcerative proctitis?
Rectum
30
What portion of the colon is affected in ulcerative proctosigmoiditis?
Rectosigmoid
31
What portion of the colon is affected in left-sided or distal UC?
Extends to but not beyond splenic flexure
32
What portion of the colon is affected in extensive colits?
Extends beyond splenic flexure but not to cecum
33
What portion of the colon is affected in panoctitis?
Disease that extends to cecum
34
Friability, erosions or bleeding to the mucosal surface of the colon only is concerning for what disease?
Ulcerative colitis
35
How is the extent and severity of UC determined?
Mild →<4 stools/day, no systemic toxicity. Moderate → >4 stools/day, anemia, low grade fever Severe →> 6 stools/day, systemic toxicity
36
Pt presents w/ abdominal pain and diarrhea w/ fecal urgency. ON exam you find perimbilical & LLQ tenderness, rectal bleeding, tenesmus, and iron deficiency anemia. What disease are you concerned about?
Ulcerative colitis
37
If pt w/ Proctitis will they have diarrhea or constipation?
Constipation
38
What are the most common extra-intestinal manifestions of UC?
Arthralgias & Sclerosing cholangitis (also: occular manifestations, erythema nodosum, pyoderma gangrenosum)
39
What imaging should you order in pt w/ UC?
Flex sigmoidoscopy or colonoscopy, +/- CT A/P
40
What tests should you order when evaluating stools samples in pts w/ IBD?
Stool cultures, C. Diff toxin, ova, & parasites. Fecal calprotectin or lactoferrin
41
Flex sig shows loss of vascular markings, erythema, exudate, friability/erosions and inflammation that begins distally and spreads proximally. What disease are you concerned about?
Ulcerative collitis
42
What will biopsy show in pt w/ UC?
Crypt abscesses
43
Colon CA, hemorrhage, and toxic megacolon are complications of what disease?
Ulcerative collitis
44
What disease will show colonic dilation > 6 cm w/ signs of toxicity?
Toxic megacolon
45
What are the medical therapies for IBD?
Salicylates, corticosteroids, immunomodulators, biologics, ABX (CD)
46
Tx for IBD requires what?
multidisciplinary team support (PCP, GI, nutrition, surgeon)
47
When would you use a step-up approach for the tx of a pt w/ IBD?
Low risk pts w/ mild disease
48
When would you use a step-down approach for the tx of a pt w/ IBD?
High risk pts w/ moderate to severe disease
49
What is the indication for Salicylates (5-ASA)?
Mild to moderate UC > CD
50
What are the side effects of salicyclates (5-ASA)?
Diarrhea, kidney injury, pancreatitis
51
What is the indication for corticosteroids?
Flares in UC and CD
52
What are the cautions associated w/ corticosteroid use?
Short term use only, exit strategy to avoid dependence, requires slow taper
53
What are the SEs of oral prednisone?
mood changes, insomnia, weight gains, worsening DM, increased infection risk, osteoporosis, cataracts, psychosis, adrenal insuffiency
54
What itest is recommended if pt is going to take oral prednisone ≥ 3 months?
DEXA scan
55
What supplemntation should a pt on chronic oral prednisone take?
Ca and Vit. D
56
What is the indication for immunomodulators?
Moderate to severe UC & CD, steroid sparing agent, used in combo w/ biologics to prevent immunogenicity
57
What immunomodulator produces the optimal response in 3-6 months, requires gnetic testing, & has systemic risks?
Thiopurines
58
What immunomodulators requires folate supplementation and is teratogenic?
Methotrexate
59
What are the SEs of thiopurines (immunomodulator)?
bone marrow suppression, hepatoxicity, non-melanoma skin CA, (Other: seconday infection, pancreatitis, non-hodgkin lymphona, HPV related cervical dysplasia)
60
What is recommended for pt taking a thiopurines (immunomodulator)
Frequent monitoring of CBC and liver tests, annual derm exam, cervical CA screening, avoid live vaccine
61
What is the indication for biologics (Anti-TNFs, -umabs) in the tx of IBD?
moderate to severe IBD, steroid sparing
62
What biologic has a risk of inusion reaction?
Infliximab
63
What are the SEs of biologics (Anti-TNFs)
reactivation of TB and HBV, non-melanoma skin CA (other: secondary infection, non-hodgkin lymphoma)
64
What medication is contrainidicated if active infection, hx of CHF, MS/optic neuritis?
Anti-TNFs
65
What labs should you run before starting a biologic (Anti-TNF)?
Quantiferon TB gold, HepB labs
66
What clinical monitoring is recommended w/ use of Biologics/Anti-TNFs?
Regular CBC, CMP, annual derm exam
67
When are other biological agents used?
Inadequate or loss of response to conventional therapies
68
What are the indications for use of ABX (Cipro & Flagyl) in pt w/ IBD?
Perianal disease (fistula, abscess)
69
What are the SEs of Cipro?
Tendinits, photosensitivity, prolongation of QT interval
70
What are the SEs of Flagyl?
Peripheral neuropathy, metallic taste, disulfiram rxn (avoid ETOH)
71
What are the red flag sx of IBD?
Severe bleeding/significant anemia, severe abd pain/peritoneal signs, unable to tolerate POs, dehydrations, signs of obstruction
72
Severe henomrrhage, perofation, dysplasia/cancer, and medical refractory disease all all indications for what with regard to IBD?
Surgery
73
High risk anatomic locations, extensive disease, penetrating/fistula disease, steroid resistance/dependence, sever disease activity, and young age all are risk factors for what?
Agressive IBD
74
As a PCP, in pts w/ IBD that are developing diarrhea (change from baseline), what do you always want to check?
Stool studies
75
As a PCP, what medication should you avoid in IBD?
NSAIDs (can exacerbate disease activity)
76
Immunization, CA screening, osteoporosis/anxiety/smoking cessation screening and routine labs are all apart of what?
Health maintenance screen performed by PCP for Pts w/ IBD
77
UC, CD or Both: Pt presents w/ strictures, fistula, abscess?
UC
78
UC, CD or Both: Mucosal layer only?
UC
79
UC, CD or Both: Toxic megacolon?
UC
80
UC, CD or Both: Mouth to anus?
CD
81
UC, CD or Both: Estra-intestinal manifestations (arthlagias most common)
BOTH
82
UC, CD or Both: Transmural?
CD
83
UC, CD or Both: Continuous circumferential involvement?
UC
84
UC, CD or Both: NSAIDs may worsen sx/
Both
85
UC, CD or Both: colon only?
UC
86
UC, CD or Both: Skip lesions?
CD
87
UC, CD or Both: Insidious onset, chronic?
BOTH
88
Celiac disease is aka what?
Gluten enteropathy, celiac sprue
89
Celiac disease is classical a disease of what age group?
Infants
90
What is an immune mediate disease triggered by the ingestion of gluten in genetically susceptilble individuals?
Celiac disease
91
In celiac disease gluten is considered toxic to the small intestine. This causes what disease progression?
Mucosal inflammation → villous atrophy → small bowel malabsorption
92
What disease has the following associations? HLA DQ genes (genetic predisposition), autoimmune diseases, down syndrome?
Celiac disease
93
What are the "classic malabsorptive sx" associated w/ celiac disease?
Diarrhea, steatorrhea, flatulence/bloating, weight loss
94
What are the "atypical" GI sx associated w/ celiac disease?
Abd pain, constipation, dyspepsia
95
What are the slient sx associated w/ celiac disease?
Extra-intestinal sx: dermatitis herptiformis rash, ion/B12 deficiency, lethary/fatigue, osteopenia/osteporosis (vit D and Ca defiencies), neuropsychiatric sx, FFT in kids, reproductive disorders
96
Pt presents with skin lesions that are erythematous, papular and forms small pustles & vesicles. What are you concerned about?
Dermatitis herpetiformis
97
What is required for serology and biopsy of the small intestine when diagnosis celiac disease?
Pt must be on gluten containing diet
98
What AB will be positive in pt w/ celiac disease while on gluten diet?
tTG AB (IgA tissue trasglutaminase) Other: EMA Ab titer, DGP (total IgA level must be normal for test to be valid)
99
What is gold standard for dx of celiac disease?
EGD w/ duodenal biopsy
100
What will biopsy show in pt w/ celiac disease?
villous atrophy, hyperplastic crypts and increased infiltration of lymphoid cells in lamina propria and epithelium
101
What is the tx for celiac disease?
Gluten free diet
102
What is the goal of celiac disease tx?
alleviate sx, reverse nutrition deficiencies, encourage gluten free diet from naturally occuring foods, caution against hidden sources of gluten (sauces, cosmetics, meds)
103
Folate, Iron, Zinc, Ca, B12, and Vit. D are supplemented as needed for what disease?
Celiac disease
104
What does "CELIAC" stand for in the regards to the management of celiac disease?
``` Consult w/ dietition, Educate about the disease, Lifelong gluten free diet, Identity and tx nutritional defiencies, Access to resources/support Continuous long term follow up ```
105
Malabsorption (Fe deficiency anemia, B vitamine deficiency, osteoporosis) and increased risk of non-hodgkin lymphoma and GI malignancies are complications assocaited w/ what disease?
Celiac disease
106
How quickly after starting celiac diet will serology levels change in pt w/ celiac disease?
3-6 months

1. Clin Med III (29 decks)

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