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SALMAN HARRISON'S > 319 - Inflammatory Bowel Disease > Flashcards

319 - Inflammatory Bowel Disease Flashcards

1
Q

What are the two age decades groups in which IBD may appear?

A
  1. 2-4

2. 7-9

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2
Q

What are the risk factors for IBD? (5)

A
  1. High socioeconomic status
  2. Living is the city
  3. Bacterial gastroenteritis
  4. Westerns diet
  5. Ethnicity
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3
Q

Smoking is a risk factor for ____, and a protective factor for _____

A

Crohn’s disease

Ulcerative colitis

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4
Q

There are three main types of Abx that may change the microbiota and lead to inflammation:

A

Metronidazole
Ciprofloxacin
Clindamycin

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5
Q

UC (ulcerative colitis) is a ____ disease, usually involving the ____ and spreads ____ in a continuous fashion.

A

Mucosal
Rectum
Proximally

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6
Q

Most UC (___%) is limited to the rectum and recto-sigmoid

A

(40-50%)

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7
Q

Some of the UC (___%) cases continue past the sigmoid but does not extend past the ___

A

30-40%

Colon

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8
Q

> __% of UC cases are classified as total colitis. In these cases, ____ cm of the terminal ileum may be inflamed

A

20%

2-3

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9
Q

In prolonged UC, we may find ____ (____)

A

Inflammatory polyps

Pseudopolyps

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10
Q

In fulminant UC ___ may occur- the thin membrane may be severely ulcered- risk for ____

A

Toxic mega colon

Perforation

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11
Q

In UC there is a correlation between the ___, ___, and ___ features

A

Histological
Endoscopic
Clinical

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12
Q

Histological feature that may suggest chronic UC include: (2)

A
  1. Architecture disturbance of the crypts

2. Basal aggregate of the chronic inflammation cells (lymphoid/plasma)

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13
Q

Vascular ____, edema, focal ____ and inflammatory infiltration of inflammatory cells (___,__,___,___) is possible in UC

A 
Congestion
Bleeding 
Lymphocytes
Neutrophils
Plasma cells
Macrophages
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14
Q

____ infiltration to the epithelium, usually in crypts (___), and sometimes even crypt ____

A

Neutrophilic
Cryptitis
Abscess

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15
Q

In CD (Crohn’s disease), all parts of the GI may be involved: 30-40% ____, 40-55% ____, 15-25% ___. In patients with ileum involvement -90% of them will have ___ involvement

A

Ileum only
Ileum + colon
Colitis only
Terminal ileum

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16
Q

CD spread is ____ characterized by ___ and trans-____ involvement

A

Segmental
Skipped lesion
Mural

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17
Q

Perirectal disease (___,___,___) and anal stenosis is found in 1/3 of the patients with CD

A

Fistula
Fissure
Abscess

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18
Q

In CD it is rare to see ___ or ___ involvement.

A

Pancreatic

Liver

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19
Q

When preforming endoscopy in patients with CD, it is common to find the typical appearance of ____.

A

Cobblestone

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20
Q

When CD is in the active phase, there will be ____ and ____. As time progresses, they will go through fibrosis and may turn into strictures that can eventually cause recurrent ____

A

Focal inflammation
Fistulas
Bowel obstruction

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21
Q

The microscopic features of early lesions in CD include: (3)

A
  1. Aphthoid ulcerations
  2. Crypt abscess
  3. Macrophage aggregate
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22
Q

Macrophage aggregate in CD patients lead to ____ in all layers of the ileum. Other locations may include: (3)

A

Noncaseating granuloma
Lymph nodes
Mesenterium/peritoneum
Liver/pancreas

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23
Q

Noncaseating granuloma is a ____ finding in CD, but is ___ to find them in biopsy. In surgical resections they are seen in ____ of cases

A

Pathognomonic
Rare
50%

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24
Q

The main clinical symptoms of UC include: (5)

A
  1. Diarrhea
  2. Rectal bleeding
  3. Tenesmus
  4. Mucus secretion
  5. Crampy abdominal pain
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25
Q

In proctitis, patients will complain about ___ when passing stool, bloody ____ and ___. Abdominal pain is ___.

A

Fresh blood
Mucus
Tenesmus
Rare

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26
Q

In CD toxic colitis is defined by __ and ___. Megacolon can be found when hearing ___ in the physical examination.

A

Dull pain
Bleeding
Hepatic tympany

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27
Q

In both cases (Toxic colitis/Megacolon) we might see ____ if there is ____

A

Peritonitis

Perforation

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28
Q

What lab results we must pay attention to in an active UC disease? (4)

A
  1. Inflammatory markers (CRP,PLT,ESR)
  2. Hemoglobin (anemia)
  3. Fecal calprotectin
  4. Leukocytosis
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29
Q

Fecal calprotectin is a fecal marker that can predict IBD ___, identify ____, and has a good correlation with UC histology. In recent years it is an integral feature in IBD ___. It can identify ____ inflammation TO rule out IBD, when ___ or ___ are suspected

A 
Recurrence
Pouchitis
Management 
Active
IBS
bacterial overload
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30
Q

Sigmoidoscopy is used in UC to evaluate the degree of the disease, usually before ___ initiation

A

Treatment

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31
Q

In UC, colonoscopy is used in non-___ sate in order to evaluate the severity of the disease. When light- ___, medium- significant erythema, ___, friability, ____, spontaneous bleeding.

A

Acute
Erythema
Lack of vascularity
Erosions

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32
Q

MRI and CT are ____ efficient for diagnosis of UC

A

Less

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33
Q

In order to diagnose UC, we need: ____, ____ (CD toxin/parasites/bacteria), ____, ____ (rectum/colon)

A

Clinical features
Negative fecal sample
Endoscopy
Biopsy

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34
Q

How many of UC patients will present with severe complication?

A

15%

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35
Q

What are the common severe complications UC patients will suffer from? 1%-____, 5%-____, most dangerous-___, ____(severe ulcerations), ____ (5-10% on neoplastic background)

A 
Massive bleeding
Toxic megacolon
Perforation
Toxic colitis
Strictures
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36
Q

In UC most patients with massive bleeding treating the attack will cease the bleeding. In some cases ___ will be needed- patients who received ____ blood units within ___ hours

A

Colectomy
6-8
24-48

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37
Q

In UC patient with toxic mega colon- transverse colon >___ cm. Possible triggers may include ___, and narcotics.

A

6

Electrolytes disturbance

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38
Q

In ____ of UC patients with toxic megacolon pharmacological treatment will be sufficient, while in other cases ___ is needed

A

50%

Colectomy

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39
Q

Pharmacological treatment for UC patients with toxic megacolon includes: (5)

A 
NPO
Zonda
Fluids
Abx
Steroids/ 5ASA
40
Q

In UC patients with strictures we will always suspect neoplasia. When colonoscopy is blocked- it is considered as ____ until proven otherwise. It is also an indication for ___.

A

Neoplasia

Surgery

41
Q

CD clinical features include 2 main patterns: penetrating- ____, obstructing - ____. The ___ of the disease will affect the clinical presentation.

A

Fistulous
Fibrostenotic
Location

42
Q

The most common location of inflammation in CD is ___ (___).

A

Terminal ileum

Ileocolitis

43
Q

The primary presentation of ileocolitis may imitate ___. Attacks of ___ with ___. The pain is usually ___

A

Appendicitis
RLQ pain
Diarrhea
Crampy

44
Q

In ileocolitis in CD patients ___ passage ___ the pain

A

Stool

Lowers

45
Q

Weight loss of ____ can be seen in CD patients with ileocolitis

A

10-20%

46
Q

Ileocolitis in patients with CD can suffer from urinary symptoms such as: ____ leading to cystitis. and ileum blockage with ___ sign.

A

Urinary ureter blockage

String

47
Q

In patients with CD suffering from jejunoileitis the gut losses ___ for absorption, leading to ___ and ____

A

Surface area
Malnutrition
Steatorrhea

48
Q

What kind of nutritional deficits can be caused by jejunoileitis in CD patients? (5). Remember also- B3 deficiency causing pellagra and coagulopathy

A
  1. Anemia
  2. Hypoalbuminemia
  3. Hypocalcemia + vit D deficiency
  4. Hypomagnesemia
  5. Hyperoxaluria + nephrolithiasis
49
Q

In patients with CD suffering from active jejunoileitis, we will see ___ due to: 1) ____ in stasis due to obstruction or fistula, 2) malabsorption of ____- due to resection or disease, 3) ____ malabsorption + ____ secretion

A 
Diarrhea
Bacterial overgrowth
Bile salts
Fluids
Electrolytes
50
Q

In patients with CD suffering from acute colitis & perianal disease we will see: (4)

A
  1. Low fever and lethargy
  2. Diarrhea
  3. Cramping abdominal pain
  4. Hematochezia
51
Q

In CD patients ____ is less common than with UC patients. Only ___% with Crohn colitis, 1-2% with ___

A

Hematochezia
50
Massive bleeding

52
Q

What are the 3 complications In patients with CD suffering from colitis & perianal disease? (3)

A
  1. Toxic megacolon
  2. Strictures
  3. Fistulas
53
Q

Which lab results are worth following in patients with CD? (4)

A

Inflammatory markers (CRP/ESR)
Hypoalbuminemia
Leukocytosis
Anemia

54
Q

In an endoscopic examination of CD patients we may find: (4)

A

Rectal sparing
Aphthous ulcers
Fistulas
Skipped lesions

55
Q

Using WCE (___) when examining CD patients has a better value than using ___ or ___

A

Wireless Capsule Endoscopy
MRI
CT

56
Q

In CD, perforation occur in ___ of patients, abdominal/pelvic abscess in ___, ___ in 40%

A

1-2%
10-30%
Bowel obstruction

57
Q

P-ANCA is found in 60-70% of ___ patients, and 5-10% of ___ patients

A

UC

CD

58
Q

ASCA is found in ___ of CD patients, 10-15% of ___ patients.

A

60-70%

UC

59
Q 
Where is it more common to find to following (UC vs CD):
Fecal blood -\_\_\_
Mucus in feces- \_\_\_
Systemic symptoms-\_\_\_
Pain-\_\_\_
Abdominal mass\_\_\_
A 
UC
UC
CD
CD
CD
60
Q 
Where is it more common to find to following (UC vs CD):
Perineal disease-\_\_\_
Fistulas-\_\_\_
Bowel obstruction-\_\_\_
Colom obstruction- \_\_\_
Abx responsiveness- \_\_\_
A 
CD
CD
CD
CD
CD
CD
61
Q 
Where is it more common to find to following (UC vs CD):
Relapse post surgery- \_\_\_
ANCA-\_\_\_
ASCA-\_\_\_
Rectal sparing-\_\_\_
Continues disease-\_\_\_
A 
CD
UC
CD
CD
UC
62
Q

Where is it more common to find to following (UC vs CD):
Cobblestone-___
Granuloma-___
Pathologic ileum-___

A

CD
CD
CD

63
Q 
Where is it more common to find to following (UC vs CD):
 Pathologic terminal ileum-\_\_\_
Segmental colitis- \_\_\_
Asymmetric colitis-\_\_\_
Strictures-\_\_\_
A

CD
CD
CD
CD

64
Q

Erythema nodosum is found in ___ of CD patients, and in __ of UC patients. Relapse is ___with the disease and appear after gut clinic.

A

15%
10%
Correlated

65
Q

Erythema nodosum are characterized by ___ warm and sensitive ___, 1-5 cm in the anterior plain of the lower ___, ankles, ___, ___, and arms.

A 
Red
Nodules
Legs
Calves 
Thighs
66
Q

Pyoderma gangrenosum is less common in ___, but appear in 1-12% of ___ patients . It is ___ to the clinical state of the disease, but is usually found when the disease is ___

A

CD
UC
Independent
Severe

67
Q

Pyoderma gangrenosum usually appear in the ___ part of the feet, but may also occur on the ___, ___, and ___.

A

Dorsal
Arms
Chest
Face

68
Q

Pyoderma gangrenosum has a ____ lesion that spreads and then ___. At the center of the lesion there is a ___ tissue with blood. They can grow up to ___ cm and are hard to treat.

A

Pustular
Ulcers
Necrotic
30

69
Q

Pyoderma gangrenosum treatment includes: (4). Other treatments include: cyclosporine, infliximab

A
  1. Abx IV
  2. Steroids IV
  3. Thalidomide
  4. Dapsone
70
Q

What are the 2 most common rheumatologic manifestations in IBD patients?

A 
Peripheric arthritis (more in CD)
Ankylosing spondylitis (more in CD)
71
Q

What are the 3 most common ophthalmologic manifestations in IBD patients?

A
  1. Conjunctivitis
  2. Ant. uveitis/iritis
  3. Episcleritis (more CD)
72
Q

What are the 3 most common hepatobiliary manifestations in IBD patients?

A
  1. Fatty liver
  2. Gallstone
  3. PSC (more in UC)
73
Q

What are the 3 most common urological manifestations in IBD patients?

A

Lithiasis
Ureter obstruction
Fistula

74
Q

What are the 2 most common metabolic manifestations in IBD patients?

A

Bone marrow decrease

Osteonecrosis

75
Q

In most cases extraintestinal manifestations are ___ with the degree of the gut disease (beside in __ and __. They are more common in ___ ( beside __, ___, __ which are more common in UC)

A 
Not correlated
Peripheric arthritis
Erythema nodosum 
CD
Pyoderma gangrenosum
PSC
Sacroiliitis
76
Q

Treating IBD with 5-ASA can lead to ___ in both __ and __. It is used mostly in light-medium __ and maintenance of __

A 
Remission
UC
CD
UC
UC
77
Q

Name 1 sulfa and 3 non sulfa drugs for IBD treatment

A

Sulfasalazine
Olsalazine
Balsalazide
Delizicol

78
Q

How long do 5-ASA drugs are active for?

A

2-4 weeks

79
Q

Steroids are used in both IBD for ___ but not for ___

A

Remission

Maintenance

80
Q

Steroids are useful in ___ levels of IBD when ___ has failed to treat

A

Medium-severe

5-ASA

81
Q

Which antibiotics are used for treating IBD? (2)

A

Metronidazole

Ciprofloxacin

82
Q

What are the S/E of metronidazole? (3)

A

Nausea
Metallic taste
Peripheral neuropathy

83
Q

What is the most common S/E of ciprofloxacin?

A

Achilles tendinitis and rapture

84
Q

Using Abx in UC is useful when treating ___ post ___. it has no role in treating active disease.

A

Pouchitis

Colectomy

85
Q

Using Abx in CD is useful when treating ___ or___. it is also useful post ___ for prevention

A

Perianal disease
Fistulas
Ileum resection

86
Q

Imuran (6MP + azathioprine) are ___ analogues. It is used for ___ in both IBD, postsurgical prophylaxis in ___, and perianal/fistulas in ___

A

Purine
Maintenance
CD
CD

87
Q

What are the most common S/E of Imuran? (5)

A 
Pancreatitis
General (fever/nausea/rash)
Hepatitis 
BM depression
Lymphoma
88
Q

MTX is good for ___ in CD patients. it also helps in reducing ___ dosage. S/E include: (3)

A
  1. Leukopenia
  2. Liver fibrosis
  3. Hypersensitivity pneumonitis (ILD)
89
Q

Cyclosporine is especially efficient in ___ patients that do not react to steroidal treatment. It can be used as an alternative for ____. It is important to make sure levels are between ____

A

UC
Colectomy
150-350 ng/mL

90
Q

Name 5 of the most common S/E of cyclosporine: (5).

Other important S/E include: PCP opportunistic infection, anaphylaxis, death.

A 
RF
HTN
Gum hyperplasia
Paresthesia
Electrolytes disturbance
91
Q

Tacrolimus is a macrolide, useful or treating ___ with ___ disease, adults with dispersed ilium disease.

A

Children

Refractory

92
Q

Anti TNF is preferred over ___ treatment

A

Biological

93
Q

CD patients can gain remission when receiving ___ while ___.

A

TPN

Fasting

94
Q

In 50% of UC patients with widespread disease ____ is necessary within the first ___ years of the disease. The treatment of choice is ____

A

Surgery
10
IPAA (ilea pouch anal anastomosis)

95
Q

In UC there is a high risk for ___ carcinoma

A

Colon

96
Q

In CD there is a high risk for different types of malignancies: ___, ___, ___

A

Non Hodgkin’s lymphoma
MDS
Leukemia

SALMAN HARRISON'S (163 decks)

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