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Flashcards in 27. IBD Deck (31):
1

What are the two type of IBD?

Ulcerative colitis 50%
Crohn disease 50%

2

What countries have the highest incidence of IBD?

US
Canada
Europe

3

What is UC?

Continuous inflammation in the colon only
Limited to the superficial mucosa, LP, submucosa
Increased risk for cancer and has extraintestinal manifestations

4

What is the clinical presentation of UC?

Diarrhea with blood and mucus
Abdominal pain and tenderness
Loss of appetite and weight
Fever and fatigue
Urgency for bowel movement

5

What is the presentation of UC in children?

Growth and development failure

6

What are the endoscopic findings in UC?

Erythema
Loss of fine vascular pattern
Granularity of the mucosa
Friability
Edema
Pseudopolyps
Erosions and ulcers
Spontaneous bleeding
Cecal patch
Backwash ileitis

7

What is fulminant colitis?

Severe UC with:
- Fever, elevated WBC, and unstabile vitals
- High risk of preforation

8

What is Crohn's disease?

Patchy, full thickness inflammation with mouth to anus involvement
Cobblestone appearance
Fistulae, strictures
Extraintestinal manifestations

9

What area is MC involved in Crohn's disease?

Ileocecal

10

What is the presentation of Crohn's in a pediatric patient?

Abdonminal pain **
Diarrhea
Weight loss and anorexia
Vomiting
Rectal bleeding
Stunted growth
Fevers

11

What are the three major endoscopic findings that are specific to Crohn's disease?

Aphthous ulcers
Cobblestoning
Discontinuous lesions (skip lesions)

12

What are 5 findings that favor Crohn's over UC?

1. Rectal sparing (UC will always affect rectum)
2. Normal vasculature next to affected tissue
3. Fistulas or strictures
4. Isolated involvement of the terminal ileum
5. Granulomas on biopsy

13

When is backwash ileus seen?

Pancolitis (severe UC)

14

What are the MC extraintestinal manifestations of IBD?

Acute arthropathy 15-20% **
Erythema nodosum 15% **
Choledocholithiasis 15-30% **
Ocular complications 5-15% **
Sacroilitis 9-11% **
Nephrolithiasis 5-10%
Ankylosing spondylitis 3-5%
Pyroderma gangrenosum 1-2%
PSC 1-2%
Amyloidosis (rare)

15

What is the main difference of presentation of epischleritis and uveitis, two manifestations of IBD?

Episcleritis: white part of the eye is inflamed, but not painful
Uveitis: more painful

16

What are the goals of management of IBD?

Confirm accurate dx
Induce remission
Maintain remission
Surgery?
Enhance quality of life
Avoid complications

17

What is the best characterized mutation that is associated with Crohns?

NOD2

18

What are the 4 potential forms of pathogenesis of IBD?

1. Genetic: NOD2
2. Mucosal immune responses: Th17 cells
3. Epithelial defects: in tight junctions
4. Microbiota

19

What cytokine released from Th1 in IBS is the main target for therapy?

TNF

20

Of the penetrating, stricturing, and inflammatory forms of IBD, what do most poeple present with?

Inflammatory
can progress to stricturing and penetrating

21

What are the key biologics that are used to treat IBD?

Infliximab (anti-TNF)
Certolizumab pegol (anti-TNF)
Adalimumab (anti-TNF)
Natalizumab (anti alpha 4 integrin)

22

What % of patients require maintenence thereapy

95%

23

What are the two kinds of microscopic colitis?

Collagenous colitis
Lymphocytic colitis

24

What is the presentation of microscopic colitis?

Chronic, nonbloody, watery diarrhea without weight loss
Normal radiological and endoscopic findings

25

What happens histologically in collagenous colitis, a type of microscopic colitis?

Dense subepithelial collagen layer, increased numbers of intraepithelial lymphocytes, and mixed inflammatory infiltrate within the lamina propria

26

What is found histologically in lymphocytic colitis, a type of microscopic colitis?

Subepithelial collagen layer is of normal thickness and the increase in intraepithelial lymphocytes may be greater than in collagenous colitis

27

What diseases is lymphocytic colitis associated with?

Celiac
Autoimmune

28

What tx do the microscopic colitises respond to?

Budesonide

29

The small intestine is relatively sterile compated to the colon, and is protected by:

Gastric acid
ICV
Fast transit

30

What are some things that can lead to small intestinal bacterial overgrowth?

Surgery
Antacid
Slow motility

31

Small intestinal bacterial overgrowth is difficult to diagnose--what two tests can be used?

Duodenal aspirate
Hydrogen breath test