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Flashcards in Bernadino: IBD Deck (33):
1

What is IBD?

Idiopathic and chronic intestinal inflammation

2

What is UC?

MUCOSAL disease
involves the rectum and extends proximally to involve part of the entire colon

Chronic and relapsing

3

What is CD?

Effects ANY portion of the luminal GI tract

*more aggressive b/c has ability to generate TRANSMURAL inflammation and BEYOND

Presents in two patterns:
1. obstructive/fibrostenotic (inflammatory> hard woody strictures)
2. Penetrating/fistulilzing

4

Who is IBD most commonly seen in?

15-25 yrs but SECOND peak 60-70 (more aggressive)

Men= women
Jews>non jews

*usually chronic

5

A pt presents w/ bloody mucoid diarrhea and tenesmus.

Dx?

UC (mucosal involvement> blood)

6

A pt presents w/ nonbloody diarrhea, abdominal pain, weight loss/anorexia, perianal abscess, and growth failure.

Dx?

Crohns (mores systemic, penetration> fistulas)

7

What infections can mimic IBD/cause bloody diarrhea/have a RIGHT pref.?

Bacteria: c. diff
Parasites: e. histolytica, trichinella
Viruses: CMV (punched out ulcers and bloody diarrhea)

8

What are complications of UC?

Mucosal shedding> bloddy diarrhea

Starts in the rectum and moves UP> chronic/relapsing

30% will undergo colectomy over 30 years

Colon cancer: 18% over 30 years (1 in 5 people)*

Primary Sclerosing Cholangitis 4%** (almost never seen w/ crohns)

*cryptitis

9

What is Crohn's Disease?

A pan-enteric transmural inflammatory disease
(Mouth to sigmoid, usually spares rectum)

Usually (70%) involves the terminal ileum

Skip lesions (patchy distribution)

Perianal involvement (fistulas/fissures/red boil around anus)

80% require surgery by 15 yrs

10

What complications are associated w/ CD?

fistulae
abscess
strictures

11

A pt presents w/ painful diarrhea, anemia and less bleeding than seen in UC.

Dx?

CD


*biopsy> granuloma

12

What is the microscopic morphology of IBD?

noncaseating granulomas and lymphoid aggregates (Th1 medaited)

13

What serologies can be useful in diagnosing CD?

*ASCA (anti-saccharomyces cerevisiase Abs)

14

What serologies can be useful in diagnosing UC?

*pANCA

15

What are Extraintestinal manifestations of IBD?

Pancreatitis

Thyroiditis
Bronchiolitis

Erythema Nodosum

Pyoderma Gangrenosum

Oral/Opthalmmalogic: APTHOUS ulcers, uveitis, iritis

16

What are common complications of UC?

Toxic megacolon

17

What are common complications of CD?

Fistulae
Obstruction

18

How does IBD increase the risk of CRC?

Happens more w/ duration and extent of disease

Increased risk with:
Disease proximal to splenic flexure
> 8 years duration; young age at diagnosis
Primary sclerosing cholangitis
Family history of CRC
Pseudopolyps at colonoscopy

Flat or depressed adenomas--fields of dysplasia> CRC

19

What is a protective treatment against CRC used to tx pts w/ IBD?

5-ASA

20

How does CRC present in IBD?

Doesn't follow adenoma-carcinoma sequence:

Dysplasia/ DALM (dysplasia associated lesion or mass)--> colon comes out

Dysplasia--> colectomy

21

What type of surveillance for CRC occurs in a pt who has had IBD for more than 7 yrs?

colonoscopy and biopsies every 1-2 years

22

IBD induction therapy?

1. 5-ASA (mild disease):
Sulfasalazine, mesalamine

2. Steroids:
Prednisone, budesonide

3. Biologics – Infliximab

4. Cyclosporine (pt not getting better w/ anything, transition to surgery)

5. Surgery:
UC – cure
Crohn’s – to treat complications

23

What is maintenance therapy for IBD?

5-ASA:
Sulfasalazine, mesalamine

Immunomodulators:
Azathioprine
6 Mercaptopurine
Methotrexate

Biologics – Infliximab

*NO ONE WILL BE ON MAINTENANCE STEROIDS

24

What medications are used to specifically treat the sml bowel and R colon?

Pentasa (mesalmine)
Budesonisde (steroid)

25

What medications are used to specifically tx the left colon?

asacol (mesalmine)
prednisonse (prednisone)

26

What are complications from ileal disease/resection?

bile salt diarrhea
galstones
vit B12 def
oxylate stones

27

What do biologics do (infliximab)?

Most are Abs to TNFa or to where it binds

28

What are toxicities of TNF-a inhibitors (infliximab)?

renal toxicity
bone disease
neurologic injury
liver injury
infection
malignancy- lymphomas, leukemias

29

Infliximab

Make sure they dont have latent TB or HBV. Make sure they don't have an active infection.

30

What are indications for surgery in UC?

unresponsive acute disease
cancer or dysplasia

31

What is the MC surgical option for UC?

ileal pouch anal anastamosis

32

What are indications for surgery w/ crohns disease?

perforation
hemorrhage
dysplasia
unhappy w/ medical therapy

33

In ppl w/ active crohns disease, what percent will have a recurrent surgery?

55%

*surgery is usually hte beginning of multiple surgeries