Inflammatory Bowel Disease

Question 1

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Answer 1

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Question 2

(IBD) Inflammatory Bowel Disease:

Answer 2

is a group of inflammatory conditions of the colon and small intestine.

Question 3

The major types of inflammatory bowel disease are ________ and ________.

The classic symptom is __________

Answer 3

Ulcerative colitis

Crohn’s disease

bloody diarrhea

Other symptoms include rectal urgency, tenesmus (a feeling of having to pass stools, even if colon is empty), abdominal pain, fatigue

Question 4

IBD is a chronic, intermittent disease; symptoms can be mil to severe during flares (or exacerbations) and minimal or absent during periods of remission.

Flares can occur at any time and can be triggered by infections, use of NSAIDs or certain foods.

Question 5

(IBD) Inflammatory Bowel Disease can be mistaken for _________.

Although they present with very similar symptoms, unlike Inflammatory bowel disease, ____________ does NOT cause inflammation and is not as serious of a condition.

Answer 5

(IBS) Irritable Bowel Syndrome

(IBS) Irritable Bowel Syndrome

Question 6

Drugs used to treat IBS irritable bowel syndrome primarily treat constipation and diarrhea.

Question 7

Ulcerative Colitis (UC):

• Is characterized by mucosal inflammation confined to ____________________________.
• When UC is limited to the descending colon and rectum, it is called ____________ and can be treated with topical (rectal) treatment.

Inflammation limited to the rectum is called _________.

The larger the affected area (extensive UC), the worse the symptoms. When the disease flares, patients can have numerous stools per day, often with pain, which can significantly decrease quality of life.

Answer 7

the rectum and colon with superficial ulcerations.

distal disease

proctitis

Question 8

(UC) Ulcerative colitis is classified as:

Mild

Moderate = is characterized by > 4 stools per day with minimal signs of toxicity.

Severe = characterized by > or = to 6 bloody stools per day with evidence of toxicity [fever, tachycardia, anemia, or an elevated ESR- erythrocyte sedimentation rate].

Fulminant = refers to patients with > 10 stools per day and severe symptoms [continuous bleeding, abdominal pain, distension and acute, severe toxic symptoms including fever and anorexia]. These patients are at risk of progressing to Toxic Megacolon and bowel perforation.

Question 9

Crohn’s Disease (CD):

• Is characterized by deep, transmural (through the bowel) inflammation that can affect ANY part of the GI TRACT. The ileum and colon are the most commonly affected. Damage to the bowel wall can cause strictures (narrowing of the bowel) and fistulas (abnormal connections or openings in the bowel).

-Symptoms of CD include:

Answer 9

-chronic diarrhea
- abdominal pain
- weight loss

perianal symptoms:
bleeding, fissures (tears) can be present before bowel symptoms.

Question 10

Ulcerative colitis (UC)
- mucosal inflammation confined to rectum and colon
-superficial ulcerations

Diarrhea presentation: generally bloody
Fistulas/Strictures: uncommon
*Location: Colon (especially the rectum)
*Depth: Superficial (occurring on the surface)
*Pattern: Continuous (looks the same throughout)
Smoking: protective

Answer 10

Crohn’s Disease (CD)
- Transmural inflammation in any part of the GI Tract
- Thickened and edematous bowel wall –> narrowed, ulcerated and fibrotic with fistulas = (abnormal openings in the bowel that shouldn’t be there).

Diarrhea presentation: bloody or non-bloody
Fistulas/Strictures: common
*Location: ENTIRE GI TRACT (anywhere from mouth to anus)
*Depth: Transmural (across entire wall/organ)
*Pattern: Non-continuous “cobblestone appearance
Smoking: Risk Factor

Question 11

IBD can be difficult to diagnose because the symptoms mimic other common conditions (e.g. constipation, diarrhea, infections, anorexia/bulimia and peptic ulcer disease).

A colonoscopy with tissue biopsy is needed.

Answer 11

Colonoscopy: entire colon

Sigmoidoscopy: end part of the intestine, closet to the rectum (only for U.C.)

Endoscopy: upper GI, scope though the mouth (only for upper GI symptoms, Crohn’s Disease)

Question 12

Inflammatory markers: C-reactive protein (CRP) and (ESR) Erythrocyte sedimentation rate

Not specific for IBD inflammation, these are markers that just show inflammation is present.

Stool Testing should be done if we are concerned about an infection like C.diff. Needs to be ruled out.

Question 13

Lifestyle measures and supportive care:

Diet:
- eating smaller more frequent meals
- avoid foods that are likely to cause triggers
- prevent nutritional deficiencies
- drink plenty of water
- avoid alcohol and caffeinated beverages since they cause stimulation of GI tract

Symptom Control
- antidiarrheals
- antispasmodics
- nicotine (has been shown to worsen CD but can be protective in ulcerative colitis)

Natural Products
- probiotics
- fish oils with EPA & DHA (omega 3 fatty acids can help minimally with inflammation.
- peppermint, herbal teas
- Vitamin supplements: can help prevent deficiencies related to malabsorption.

Question 14

sorbitol and lactose are classified as excipients (or binders) and are present in various medications to help hold tablets together.

sorbitol is also used as a sweetener in some diet foods; it has laxative properties and can cause considerable GI distress in some patients.

Answer 14

Lactose will worsen GI symptoms if the patient is lactose-intolerant.

Question 16

Drug Treatment for IBD: 2-pronged approach

Have to consider, someone we are treating for an acute flare vs someone we are treating for remission.

Induction: what we start with when patient is in that acute flare
- we induce remission

Question 17

Options for CD: Induction of remission

1) Steroids
- generally, if someone comes in with acute flare, steroids are a way to go. They work quickly and get rid of that inflammation.

Answer 17

Options for UC: Induction of remission

1) Steroids

Question 18

Options for CD: Maintenance of Remission
- so out of that acute phase, just trying to keep patient at healthy state

Mild CD: oral budesonide

Moderate-Severe:

Refractory:

Answer 18

Options for UC: Maintenance of Remission
- so out of that acute phase, just trying to keep patient at healthy state

Mild UC: mesalamine (5-ASA) rectal

Moderate-Severe:

Refractory:

Question 25

Deltasone

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Answer 25

prednisone

Question 26

Entocort EC

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Answer 26

budesonie

Question 27

Uceris

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Answer 27

budesonide
rectal foam, ER tab

Question 28

Pentasa -asa
Apriso

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Answer 28

mesalamine ER
ER capsule

Question 29

Asacol HD -asa
Lialda

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Answer 29

mesalamine ER
ER tablet

Question 30

Rowasa -asa

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Answer 30

mesalamine
enema

Question 31

Canasa -asa

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Answer 31

mesalamine
suppository

Question 32

Azulfidine / Azulfidine EN

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Answer 32

sulfasalazine

Question 33

Dipentum

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Answer 33

olsalazine

Question 34

Colazal

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Answer 34

balsalazide

Question 35

Azasan

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Answer 35

azathioprine

Question 36

Purixan

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Answer 36

mercaptopurine

Question 37

Tysarbi

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Answer 37

natalizumab

Question 38

Entyvio

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Answer 38

vedolizumab