319 IBD Flashcards
(120 cards)
1
Q
Two major types of IBD
A
Ulcerative colitis (UC) and Crohn’s disease (CD)
2
Q
Peak incidence of IBD
A
second to fourth decade of life
3
Q
Defined as IBD that occurs in children age less than 6 years
A
very early onset IBD (VEOIBD)
4
Q
Defined as IBD that occurs in children age less than 2 years
A
Infantile IBD
5
Q
Commonly affected part by VEOIBD and infantile IBD
A
colon, resistant to standard medication and have a strong family history of IBD
6
Q
True or false. Infectious gastroenteritis with pathogens such as salmonella, shigella, campylobacter, clostridium increases IBD risk
A
true.
7
Q
True or false. Protective effect of Vitamin D has been reported on risk of CD
A
true.
8
Q
major host components that function together as an integrated supraorganism
A
microbiota, Intestinal epithelial cells, and immune cells
9
Q
Current pathogenesis of IBD
A
inappropriate immune response to the endogenous (autochthonous) commensal microbiota within the intestines, with or without some component of autoimmunity
10
Q
Genetic risk factors that are shared with IBD
A
rheumatoid arthritis, psoriasis, ankylosing spondylitis, type 1 diabetes mellitus, asthma, and systemic lupus erythematosus
11
Q
True or false. Endogenous commensal microbiota within the intestines plays a central role in the pathogenesis of IBD
A
true.
12
Q
True or false. The microbiota is considered as a critical and sustaining component of the human organism
A
true.
13
Q
3 major CD4 T helper cells that promote inflammation
A
TH1 cells, TH2 and TH17
14
Q
Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon
A
Ulcerative colitis
15
Q
associated with backwash ileitis
A
Ulcerative colitis
16
Q
asssociated with skip lesions
A
Crohns disease
17
Q
mucosa is erythematous and has a fine granular surface that resemble sandpaper
A
Ulcerative colitis
18
Q
presence of pseudopolyps as a result of epithelial regeneration
A
both UC and CD
19
Q
in fulminant disease can develop toxic colitis or megacolon where the bowel wall thins and mucosa is severely ulcerated and leads to perforation
A
ulcerative colitis
20
Q
True or false. In ulcerative colitis, the disease process is limited to the mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease
A
true.
21
Q
True or false. Pancreatitis is a rare extraintestinal manifestation of IBD
A
True.
22
Q
agents effective in inducing and maintaing remission in patietn with UC
A
5 ASA agents
23
Q
effective treatment for mild to moderate UC is occasionally used in Crohns colitis
A
sulfasalazine
24
Q
contains azo bond mesalamine; it is effective in the colon
A
balsalazide
25
enteric coated form of mesalamine with the 5 ASA being released at pH more than 7
Delzicol and Asacol HD
26
once a day formulation of mesalamine designed to release mesalamine in colon
Lialda
27
encapsulated mesalamine granules that delivers mesalamine to the terminal ileum and colon
Apriso
28
once a day formation of mesalamine
Lialda and Apriso
29
another mesalamine formation that uses ethylcellulose coating to allow water absorption into small beads containing the mesalamine
Pentasa
30
started in patient with UC unresponsive to 5- ASA
prednisone
31
how are parenteral glucocorticoids given
Hydrocortisone 300 mg/d or methyprednisolone 40-60 mg/d
32
True or false. Antibiotics have no role in the treatment of active or quiescent UC
True.
33
True or false. Pouchitis however responds to treatment with metronidazole and ciprofloxacin
True.
34
what is effective in active inflammatory, fistulizing and perianal CD and what is the dosage
metronidazole at 15-20 mg/kg per day divided in 3 doses
35
beneficial for inflammatory perianal and fistulizing CD but has been associated with tendinitis and tendon rupture
ciprofloxacin
36
purine analogues used as immunosuppresant
azathrioprine and 6 mercaptopurine
37
side effect of azathiorprine and 6 mercaptopurine
pancreatitis
38
used most often concomitantly with biologic therapy to decrease antibody formation and improve disease response; it inhibits dihydrofolate reductase
methotrexate
39
rare complication of methotrexate
hypersensitivity pneumonitis
40
lipophilic peptide with inihibitory efefcts on both the cellular and humoral immune systems and given to severe UC that is refractory to IV glucocorticoids
cyclosporing (CSA)
41
macrolide antibiotic with immunodulatory properties similar to CSA and effective in adults with extensive involvement of the small bowel
tacrolimus
42
initial therapy for patients with moderate to severe CD and UC
biologic therapies such as anti TNF therapies
43
first biologic therapy approved for moderate to severely active CD and UC; chimerici IgG1 antibody against TNF alpha
infliximab
44
recombinant human monoclonal IgG1 antibody containing only human peptides sequences; binds TNF and neutralizes its function
adalimumab
45
pegylated form of anti TNF fab portion of antibody
certolizumab
46
another fully human IgG1 antibody against anti TNF alpha
golimumab
47
side effect of anti TNF therapies leading to increased risk of infusion reactions and a decreased response to treatment
development of antibodies
48
common practice to prevent antibody formation in anti TNF therapies
add an immunomodulator such as azathiorprine, 6 mercaptopurine or MTX
49
True or false. NHL risk in CD is higher than general population and even higher if treated with azathioprine and 6- MP
True.
50
True or false. Patients with IBD have a slighter highest risk for psoriasis and melanoma esp if there are on thiopurine
True.
51
most frequently performed operation in patient with CD
surgical resection of the diseased segment
52
True or false. It is recommended to evaluate for endoscopic recurrence of CD via colonoscopy 6 months after surgery
True
53
true or false. Patient should be in remission for 6 months before conceiving
True.
54
antibiotics allowed in pregnancy
penicillins and cephalosporins
55
when can metronidazole be given in pregnant women
second or third trimester
56
can ciprofloxacin be given to pregnant women
no due to cartilage lesion
57
true or false. Metothrexate is contraindicated in pregnancy and nursing
True.
58
True or false. Patient with long standing UC are at increased risk for developing colonic epithelial dysplasia and carcinoma
True,
59
how often is colonoscopy done in patients with more than 8-10 years of colitis or 12-15 years of protosigmoiditis
annual or biennial with multiple biopsies
60
two major histologic features suggests chronicity in UC and help distingquish it from infectious or acute self limited colitis
first: crypt architecture of colon is distorted; second: basal plasma cells and multiple basal lymphoid aggregates
61
associated with crypt abscesses
ulcerative colitis
62
IBD that can affect any part of the GI tract from the mouth to the anus
Crohns disease
63
what IBD spares or involves the rectum
UC involves the rectum; CD spares the rectum
64
is segmental with skip areas in midst of diseased intestines
Crohns disease
65
Associated with perirectal fistula, fissures and anal stenosis
crohns disease
66
True or false. Crohns disease is a transmural process
true.
67
associated with aphthous ulcers
Crohns disease
68
islands demarcate disease and normal mucosa giving the cobbelstone appearance
Crohns disease
69
Associated with projections of thickened mesentery encasing the bowel, also known as creeping fat
Crohns disease
70
earliest lesions in crohns disease
aphthoid ulcer and focal crypt abscesses which form noncaseating granuloma in all layers of the bowel wall
71
glycoprotein present in activated neutrophils and highly sensitive and specific markers for intestinal inflammation
fecal lactoferrin
72
present in neutrophils and monocytes and level correlate well with histologic inflammation, predict relapse and detect pouchitis
fecal calprotectin
73
True or false. Leukocytosis may be present in IBD but is a specific indicator of the disease
true.
74
when is colectomy indicated in IBD
When 6-8 units of blood is needed in 24-48 hours
75
defined as a transverse or right colon diameter of more than 6 cm loss of haustrations in patients with severe attacks of UC
toxic megacolon
76
Most dangerous of the local complications
perforations
77
True or false. Strictures that prevents passage of the colonoscope is presumed malignant until proven otherwise
true.
78
two patterns of disease in Crohns disease
first: fibrostenotic pattern obstructing pattern or second: penetrating fistulous pattern
79
common site of inflammation in crohns disease
terminal ileum
80
what is the usual presentation of ileocolitis
chronic history of right lower quadrant pain and diarrhea
81
if a mass is palpated in the RLQ in crohns diseas, what is it composed of
mass is composed of inflammed bowel, induration of mesentery and enlarged abdominal lymph nodes
82
sign on barium studies that result from severely narrowed loop of bowel
lumen resembles a frayed cotton string thus called string sign
83
presents as dysuria or recurrent bladder infections or less commonly as pneumaturia or fecaluria
enterovesical fistulas
84
refers to extensive inflammatory disease assocaited with loss of digestive and absorptive surface resulting in malabsorption and steatorrhea
jeujunoilietis
85
what causes diarrhea in jejunoilietis
bacterial overgrowth, bile acid malabsorption, intestinal inflammation
86
True or false. Toxic megacolon is rare Crohns disease
true.
87
more commonly involved part of the duodenum in crohns disease
second portion of the duodenum is more commonly involved in Crohns disease
88
endoscopic features of CD
rectal sparing, aphthous ulcers, fistulas and skip lesions
89
what type of strictures respond to endoscopic dilatation
strictures less than 4 cm in length and those at anastomotic sites
90
diagnostic imaging in CD which offers more yield than CT or MRI
wireless capsule endoscopy
91
danger of WCE in CD
stricture could retain the capsule; option is to have a patency capsule which is made of barium and dissolves 30 hr after ingestion; a x-ray is taken 30 hrs after ingestion to see if capsule is still still which indicate stricture
92
earliest macroscopic findings of colonic CD
aphthous ulcer
93
in CD, where is the perforation commonly occur? Second site
usually in the ileum but occasionally in the jejunum
94
usually in the ileum but occasionally in the jejunum
increased titers of anti saccharomyces cerevisiae antibodies (ASCAs)
95
serology test associated with UC
increased levels of pANCA
96
makes up 15% of cases of IBD wherein it is impossible to distinguish between UC and CD
indeterminate colitis
97
can mimic the endscopic appearance of severe UC
campylobacter colitis
98
parasitic infection that can mimic IBD
hookworm (necator americanus), whipworm (trichuris trichiuria), strongyloides stercoralis
99
true or false. Diverticulitis can be confused with CD clinically and radiographically
true.
100
ulceration observed as large as 5 cm in diameter in the anterior or anterolateral 3-15 cm from the anal verge which may present with abdominal pain, tenemus and diarrhea; can be mistaken as IBD
solitary rectal ulcer syndrome
101
where is the solitary rectal ulcer syndrome often found
anterior or anterolateral 3-15 cm from the anal verge
102
two common drugs used in the hospital that mimic IBD
ipilimumab and mycophenolate mofetil
103
inflammatory process that arises in segments of the large intestines that are excluded from the fecal stream; occurs in patient with ileostomy or colostomy
diversion colitis
104
common ocular manifestations of IBD
conjunctivitis, anterior uveitis/iritis, episcleritis
105
are hot, red, tender nodules measuring 1-5 cm in diameter and are found on the anterior surface of the lower legs, ankles, calves, thighs, and arms; occurs in 15% of CD
erythema nodosum (EN)
106
dermatologic manifestion seen in 12% of CD, begins as pustule and then ulcerate with violaceous edges surrounded by a margin of erythema
pyoderma gangrenosum
107
frequent genitourinary complications in IBD
calculi, ureteral obstruction, and ileal bladder fistula
108
True or false. All of anti TNF agents are associated with an increased risk of infections particulary reactivation of latent PTB and opportunistic fungal infection
True.
109
expressed on the cell surface of leukocytes and serve as mediators of leukocyte adhesion to vascular endothelium
integrins
110
recombinant humanized IgG4 antibodies against a4 integrin that has been shown to be effective induction and maintenance of patients with CD
natalizumab
111
reason natalizumab is no longer widely used
risk for progressive multifocal leukoencephalopathy (PML)
112
most important risk factor for the development of PML
exposure to John Cunningham JC polymavirus
113
another leukocyte trafficking inhibitor, a monioclonal antibody directed against against a4B7 integrin specifically and has the ability to convey gut selective immunosuppresion
vedolizumab
114
fully human IgG1 monoclonal antibody that blocks the biologic activity of IL-12 and IL-23 through their common p40 subunit
ustekinumab
115
oral inhibitor of Janus kinases 1,3
tofacitinib
116
Oral agonist of the sphingosine-1-phosphate receptor subtypes 1 and 5 that causes peripheral lymphocyte sequestration
ozanimod
117
operation of choice in ulcerative colitis
IPAA
118
most frequent complication IPAA
pouchitis
119
drug that targets cytotoxic T lymphocyte antigen 4 (CTLA-4) and reverses T cell inhibition is used to treat metastatic melanoma
ipilimumab
120
True or false. Patient with IBD and PSC are at increased risk of colon cancer and should be surveyed yearly by colonoscopy
True.
