319 - Inflammatory Bowel Disease Flashcards
(96 cards)
1
Q
What are the two age decades groups in which IBD may appear?
A
- 2-4
2. 7-9
2
Q
What are the risk factors for IBD? (5)
A
- High socioeconomic status
- Living is the city
- Bacterial gastroenteritis
- Westerns diet
- Ethnicity
3
Q
Smoking is a risk factor for ____, and a protective factor for _____
A
Crohn’s disease
Ulcerative colitis
4
Q
There are three main types of Abx that may change the microbiota and lead to inflammation:
A
Metronidazole
Ciprofloxacin
Clindamycin
5
Q
UC (ulcerative colitis) is a ____ disease, usually involving the ____ and spreads ____ in a continuous fashion.
A
Mucosal
Rectum
Proximally
6
Q
Most UC (___%) is limited to the rectum and recto-sigmoid
A
(40-50%)
7
Q
Some of the UC (___%) cases continue past the sigmoid but does not extend past the ___
A
30-40%
Colon
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
9
Q
In prolonged UC, we may find ____ (____)
A
Inflammatory polyps
Pseudopolyps
10
Q
In fulminant UC ___ may occur- the thin membrane may be severely ulcered- risk for ____
A
Toxic mega colon
Perforation
11
Q
In UC there is a correlation between the ___, ___, and ___ features
A
Histological
Endoscopic
Clinical
12
Q
Histological feature that may suggest chronic UC include: (2)
A
- Architecture disturbance of the crypts
2. Basal aggregate of the chronic inflammation cells (lymphoid/plasma)
13
Q
Vascular ____, edema, focal ____ and inflammatory infiltration of inflammatory cells (___,__,___,___) is possible in UC
A
Congestion Bleeding Lymphocytes Neutrophils Plasma cells Macrophages
14
Q
____ infiltration to the epithelium, usually in crypts (___), and sometimes even crypt ____
A
Neutrophilic
Cryptitis
Abscess
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
16
Q
CD spread is ____ characterized by ___ and trans-____ involvement
A
Segmental
Skipped lesion
Mural
17
Q
Perirectal disease (___,___,___) and anal stenosis is found in 1/3 of the patients with CD
A
Fistula
Fissure
Abscess
18
Q
In CD it is rare to see ___ or ___ involvement.
A
Pancreatic
Liver
19
Q
When preforming endoscopy in patients with CD, it is common to find the typical appearance of ____.
A
Cobblestone
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
21
Q
The microscopic features of early lesions in CD include: (3)
A
- Aphthoid ulcerations
- Crypt abscess
- Macrophage aggregate
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
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%
24
Q
The main clinical symptoms of UC include: (5)
A
- Diarrhea
- Rectal bleeding
- Tenesmus
- Mucus secretion
- Crampy abdominal pain
25
In proctitis, patients will complain about ___ when passing stool, bloody ____ and ___. Abdominal pain is ___.
Fresh blood
Mucus
Tenesmus
Rare
26
In CD toxic colitis is defined by __ and ___. Megacolon can be found when hearing ___ in the physical examination.
Dull pain
Bleeding
Hepatic tympany
27
In both cases (Toxic colitis/Megacolon) we might see ____ if there is ____
Peritonitis
| Perforation
28
What lab results we must pay attention to in an active UC disease? (4)
1. Inflammatory markers (CRP,PLT,ESR)
2. Hemoglobin (anemia)
3. Fecal calprotectin
4. Leukocytosis
29
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
```
Recurrence
Pouchitis
Management
Active
IBS
bacterial overload
```
30
Sigmoidoscopy is used in UC to evaluate the degree of the disease, usually before ___ initiation
Treatment
31
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.
Acute
Erythema
Lack of vascularity
Erosions
32
MRI and CT are ____ efficient for diagnosis of UC
Less
33
In order to diagnose UC, we need: ____, ____ (CD toxin/parasites/bacteria), ____, ____ (rectum/colon)
Clinical features
Negative fecal sample
Endoscopy
Biopsy
34
How many of UC patients will present with severe complication?
15%
35
What are the common severe complications UC patients will suffer from? 1%-____, 5%-____, most dangerous-___, ____(severe ulcerations), ____ (5-10% on neoplastic background)
```
Massive bleeding
Toxic megacolon
Perforation
Toxic colitis
Strictures
```
36
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
Colectomy
6-8
24-48
37
In UC patient with toxic mega colon- transverse colon >___ cm. Possible triggers may include ___, and narcotics.
6
| Electrolytes disturbance
38
In ____ of UC patients with toxic megacolon pharmacological treatment will be sufficient, while in other cases ___ is needed
50%
| Colectomy
39
Pharmacological treatment for UC patients with toxic megacolon includes: (5)
```
NPO
Zonda
Fluids
Abx
Steroids/ 5ASA
```
40
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 ___.
Neoplasia
| Surgery
41
CD clinical features include 2 main patterns: penetrating- ____, obstructing - ____. The ___ of the disease will affect the clinical presentation.
Fistulous
Fibrostenotic
Location
42
The most common location of inflammation in CD is ___ (___).
Terminal ileum
| Ileocolitis
43
The primary presentation of ileocolitis may imitate ___. Attacks of ___ with ___. The pain is usually ___
Appendicitis
RLQ pain
Diarrhea
Crampy
44
In ileocolitis in CD patients ___ passage ___ the pain
Stool
| Lowers
45
Weight loss of ____ can be seen in CD patients with ileocolitis
10-20%
46
Ileocolitis in patients with CD can suffer from urinary symptoms such as: ____ leading to cystitis. and ileum blockage with ___ sign.
Urinary ureter blockage
| String
47
In patients with CD suffering from jejunoileitis the gut losses ___ for absorption, leading to ___ and ____
Surface area
Malnutrition
Steatorrhea
48
What kind of nutritional deficits can be caused by jejunoileitis in CD patients? (5). Remember also- B3 deficiency causing pellagra and coagulopathy
1. Anemia
2. Hypoalbuminemia
3. Hypocalcemia + vit D deficiency
4. Hypomagnesemia
5. Hyperoxaluria + nephrolithiasis
49
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
```
Diarrhea
Bacterial overgrowth
Bile salts
Fluids
Electrolytes
```
50
In patients with CD suffering from acute colitis & perianal disease we will see: (4)
1. Low fever and lethargy
2. Diarrhea
3. Cramping abdominal pain
4. Hematochezia
51
In CD patients ____ is less common than with UC patients. Only ___% with Crohn colitis, 1-2% with ___
Hematochezia
50
Massive bleeding
52
What are the 3 complications In patients with CD suffering from colitis & perianal disease? (3)
1. Toxic megacolon
2. Strictures
3. Fistulas
53
Which lab results are worth following in patients with CD? (4)
Inflammatory markers (CRP/ESR)
Hypoalbuminemia
Leukocytosis
Anemia
54
In an endoscopic examination of CD patients we may find: (4)
Rectal sparing
Aphthous ulcers
Fistulas
Skipped lesions
55
Using WCE (___) when examining CD patients has a better value than using ___ or ___
Wireless Capsule Endoscopy
MRI
CT
56
In CD, perforation occur in ___ of patients, abdominal/pelvic abscess in ___, ___ in 40%
1-2%
10-30%
Bowel obstruction
57
P-ANCA is found in 60-70% of ___ patients, and 5-10% of ___ patients
UC
| CD
58
ASCA is found in ___ of CD patients, 10-15% of ___ patients.
60-70%
| UC
59
```
Where is it more common to find to following (UC vs CD):
Fecal blood -___
Mucus in feces- ___
Systemic symptoms-___
Pain-___
Abdominal mass___
```
```
UC
UC
CD
CD
CD
```
60
```
Where is it more common to find to following (UC vs CD):
Perineal disease-___
Fistulas-___
Bowel obstruction-___
Colom obstruction- ___
Abx responsiveness- ___
```
```
CD
CD
CD
CD
CD
CD
```
61
```
Where is it more common to find to following (UC vs CD):
Relapse post surgery- ___
ANCA-___
ASCA-___
Rectal sparing-___
Continues disease-___
```
```
CD
UC
CD
CD
UC
```
62
Where is it more common to find to following (UC vs CD):
Cobblestone-___
Granuloma-___
Pathologic ileum-___
CD
CD
CD
63
```
Where is it more common to find to following (UC vs CD):
Pathologic terminal ileum-___
Segmental colitis- ___
Asymmetric colitis-___
Strictures-___
```
CD
CD
CD
CD
64
Erythema nodosum is found in ___ of CD patients, and in __ of UC patients. Relapse is ___with the disease and appear after gut clinic.
15%
10%
Correlated
65
Erythema nodosum are characterized by ___ warm and sensitive ___, 1-5 cm in the anterior plain of the lower ___, ankles, ___, ___, and arms.
```
Red
Nodules
Legs
Calves
Thighs
```
66
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 ___
CD
UC
Independent
Severe
67
Pyoderma gangrenosum usually appear in the ___ part of the feet, but may also occur on the ___, ___, and ___.
Dorsal
Arms
Chest
Face
68
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.
Pustular
Ulcers
Necrotic
30
69
Pyoderma gangrenosum treatment includes: (4). Other treatments include: cyclosporine, infliximab
1. Abx IV
2. Steroids IV
3. Thalidomide
4. Dapsone
70
What are the 2 most common rheumatologic manifestations in IBD patients?
```
Peripheric arthritis (more in CD)
Ankylosing spondylitis (more in CD)
```
71
What are the 3 most common ophthalmologic manifestations in IBD patients?
1. Conjunctivitis
2. Ant. uveitis/iritis
3. Episcleritis (more CD)
72
What are the 3 most common hepatobiliary manifestations in IBD patients?
1. Fatty liver
2. Gallstone
3. PSC (more in UC)
73
What are the 3 most common urological manifestations in IBD patients?
Lithiasis
Ureter obstruction
Fistula
74
What are the 2 most common metabolic manifestations in IBD patients?
Bone marrow decrease
| Osteonecrosis
75
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)
```
Not correlated
Peripheric arthritis
Erythema nodosum
CD
Pyoderma gangrenosum
PSC
Sacroiliitis
```
76
Treating IBD with 5-ASA can lead to ___ in both __ and __. It is used mostly in light-medium __ and maintenance of __
```
Remission
UC
CD
UC
UC
```
77
Name 1 sulfa and 3 non sulfa drugs for IBD treatment
Sulfasalazine
Olsalazine
Balsalazide
Delizicol
78
How long do 5-ASA drugs are active for?
2-4 weeks
79
Steroids are used in both IBD for ___ but not for ___
Remission
| Maintenance
80
Steroids are useful in ___ levels of IBD when ___ has failed to treat
Medium-severe
| 5-ASA
81
Which antibiotics are used for treating IBD? (2)
Metronidazole
| Ciprofloxacin
82
What are the S/E of metronidazole? (3)
Nausea
Metallic taste
Peripheral neuropathy
83
What is the most common S/E of ciprofloxacin?
Achilles tendinitis and rapture
84
Using Abx in UC is useful when treating ___ post ___. it has no role in treating active disease.
Pouchitis
| Colectomy
85
Using Abx in CD is useful when treating ___ or___. it is also useful post ___ for prevention
Perianal disease
Fistulas
Ileum resection
86
Imuran (6MP + azathioprine) are ___ analogues. It is used for ___ in both IBD, postsurgical prophylaxis in ___, and perianal/fistulas in ___
Purine
Maintenance
CD
CD
87
What are the most common S/E of Imuran? (5)
```
Pancreatitis
General (fever/nausea/rash)
Hepatitis
BM depression
Lymphoma
```
88
MTX is good for ___ in CD patients. it also helps in reducing ___ dosage. S/E include: (3)
1. Leukopenia
2. Liver fibrosis
3. Hypersensitivity pneumonitis (ILD)
89
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 ____
UC
Colectomy
150-350 ng/mL
90
Name 5 of the most common S/E of cyclosporine: (5).
| Other important S/E include: PCP opportunistic infection, anaphylaxis, death.
```
RF
HTN
Gum hyperplasia
Paresthesia
Electrolytes disturbance
```
91
Tacrolimus is a macrolide, useful or treating ___ with ___ disease, adults with dispersed ilium disease.
Children
| Refractory
92
Anti TNF is preferred over ___ treatment
Biological
93
CD patients can gain remission when receiving ___ while ___.
TPN
| Fasting
94
In 50% of UC patients with widespread disease ____ is necessary within the first ___ years of the disease. The treatment of choice is ____
Surgery
10
IPAA (ilea pouch anal anastomosis)
95
In UC there is a high risk for ___ carcinoma
Colon
96
In CD there is a high risk for different types of malignancies: ___, ___, ___
Non Hodgkin's lymphoma
MDS
Leukemia
