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GI and Nutrition > 3.1.1+2 Protective Mechanisms, Inflammatory Bowel Dz (IBD), Irritable Bowel Syndrome (IBS) > Flashcards

3.1.1+2 Protective Mechanisms, Inflammatory Bowel Dz (IBD), Irritable Bowel Syndrome (IBS) Flashcards

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1
Q

A functional disorder absent of histologic and radiologic findings?

A

IBS, irritable bowel syndrome

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2
Q

What typically cures UC?

A

Removal of colon

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3
Q

What are some surgical indications in UC?

A
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4
Q

What the three biolgic therapies used in the treatment of IBD? What do they target?

A

Infliximab (remicade), certolizumab (cimzia), adalimumab (humira); TNF-alpha

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5
Q

What dis b? What is it often associated with?

A

Pseudomembranous colitis; C. Diff infection

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6
Q

IBD increases the risk of what type of cancer?

A

Colorectal cancer

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7
Q

Fill Dis Out, yo

A

Chron is thicka than a sticka

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8
Q

What are the three dz’s included in IBD?

A

UC, Chron’s Dz, Indeterminate Colitis

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9
Q

What is the role of the defensins released by paneth cells?

A

Help defend against food and water borne pathogens

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10
Q

What is one of the diseases associated with chron dz?

A

Perianal Dz

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11
Q

What three factors must be considered when choosing a medical therapy?

A

Dz distribution, dz severity, prior therapy

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12
Q

What is not present histologically in UC that can be present in Chron?

A

Granulomas

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13
Q

What % of patients experience a clinical response to biologics? % of remission?

A

60% response, 30% remission

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14
Q

Inflammation, fibrosis of biliary tree

(assoicated w/ cholangiocarcinoma)

A

Primary Sclerosing Cholangitis; course of dz is independent of course of UC

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15
Q

What type of dz are biologics particularly useful for?

A

Fistulizing dz in CD

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16
Q

What is the pathology of Chrons? How often are granulomas present?

A

Transmural (entire wall) inflammation with neutrophilic abcesses (crypt abscesses, architectural distortion)

15-50%

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17
Q

How might the gut flora be altered in IBS?

A

Reduced: lactobacilli and bifidobacterium

Increased: clostridium

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18
Q

Describe the positive/negative balance that exists in the GI system.

A

Negative: Bad flora, Inflammation, NF-kB, infection

Positive: Good flora, mucus, barrier function, IgA, defensins, B cells, T cells, NF-kB, Acid, Motility, Cell turnover

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19
Q

What are some of the symptoms associated with the different severities associated with UC?

A
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20
Q

What is the typical onset pattern of UC?

A

Slow and insidious (symptom onset to diagnosis is typically 9 months)

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21
Q

What are the three complications of IBD?

A

toxic megacolon, primary sclerosing cholangitis, colon cancer

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22
Q

What are the four different classes of medical therapies for IBD? Their ideal usage?

A

Aminosalicylates (less severe dz cases), GCs (induce remission, not as good for maintaining), Immunomodulators (maintenance of remission); Biologics (induction/maintanence of remission)

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23
Q

Defined as dilation of the colon with fulminant (severe and sudden onset) colitis

A

Toxic megacolon

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24
Q

Where are certain bacteria located along the GI tract? (vaguely know)

A
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25
UC is a chronic inflammatory dz of what?
Colon
26
What is the principal protein of motile comensal and pathogenic bacteria implicated in the pathogenesis of IBD? What does it bind to?
Flagellin; TLRs
27
Which is which?
Left: Chron Right: UC
28
Fill it out
29
What will you not see with UC that you see in Chron?
Fistulas, perianal dz, and abcesses
30
What are the three clinical subtypes (behaviors) of Chron?
**Stenosis (50%)**, inflammation, and fistula
31
This is the endoscopic appearence of what?
Chron
32
What are the five sources of information that can lead to diagnosis?
Clinical findings, radiologic findings, endoscopic findings, histologic findings, stool evaluation
33
What are the main indications for surgery?
Complications (perforation, obstruction, abcess/fistula, cancer) Often have recurrence at site of surgery
34
What effects can flagellin have on the GI tract?
1. Alter the junctional complexes 2. Modulate innate and adaptive immunity
35
What are the four sites of extraintestinal manifestions?
Eyes, skin, joints, and hepatobiliary
36
What are some of the infectious and non-infectious causes that could be included in the differential diagnosis?
37
What the different treatments for the different types of IBS?
38
What % of dz is found to be indeterminate colitis?
10-15%
39
What are the three sources of functional disorder in IBS?
40
What are some of the antioxidants that can counteract the oxidants which activate NF-kB?
Vitamin E and dihydrolipic acid
41
What are some of the different serological markers in IBD?
42
What are some of the defensive mechanisms of the GI tract?
Saliva, mucus, immune system, defensins/lysozyme from Paneth cells, acid production, motility, junctional complexes, detoxification by the liver
43
Identify the the two abnormals.
Middle: Chron (full thickness) Right: UC (mucosa only)
44
Where is the highest incidence of IBD?
Europe and US
45
What is the therapeutic pyramid for IBD?
46
What type of cell is this? What is its function?
Paneth cell; anti-microbial cells releasing lysozyme, defensins, cryptdins
47
What are some of the effects of increased expression of NF-kB?
inflammatory cytokines, leukocyte activation and recruitment, NOS, cell adhension molecule expression, viral activation
48
What is the typical disease course of IBD (80%)?
Intermittent flares interposed b/t variable periods of remission (Dz extent may progress over time)
49
Fill it out
50
What are the two newer agents and their target?
Vedolizumab, binds integrin in peyer's patch, gut specific Ustekinumab binds IL-12/23, activates certain T cells
51
What is invariably involved in UC? Then it can do what?
Rectum; Extends in a proximal and continuous fashion
52
There is convincing evidence to associate what with IBD conditions (Chrons Dz and Ulcerative Colitis). [However, the specifics remain unclear]
Bacteria
53
What is the key way in which IBD is often diagnosed?
Colonoscopy
54
Genome Wide Association Studies have found genes and specific gene loci implicated in IBD which are crucial for intestinal homeostasis:
Barrier function, epithelial restitution, microbe defense, innate immunity, ROS, autophagy, adaptive immunity, ER stress, metabolic pathways
55
What two types of management? Goals?
Medicine or Surgery Goals: Induce remission, maintain remission, decrease dz, improve quality of life
56
Where does chron occur along the bowel?
It can occur at any point along the bowel, but the most common location is the terminal ileum
57
What are the four stages in the pathogenesis of IBD?
58
Reduced expression of defensins by paneth cells has been identified as a potential cause in which subgroup of IBD?
Ileal Chron's Disease
59
What is commonly used to treat C. Diff infections? Has 70-80% success rate.
Metronidazole (Flagyl)
60
What plays a key role in the pathogenesis of IBD and genetic suceptibiilty?
Intestinal commensal bacteria
61
What are the two age groups that most commonly suffer from IBD?
Teens and 20s 50s-60s
62
What are the four surgical options for UC?
Conventional ileostomy or ileal pouch-anal anastomosis

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