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Fall 2020 Exam 2 > Crohns Disease > Flashcards

Crohns Disease Flashcards

(46 cards)

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1
Q

Crohns Disease

A

transmural inflammation that can affect any part of the GI tract (UC is colon only)

Relapsing/remitting GI infl. episodes

Will see patchy infl. cobblestoning, ulcers, exudates, altered vascular patterns, edema and bleeding

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2
Q

% of patients under 20 years old

A

25%

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3
Q

presentation in kids <6 years

A

“very early onset IBD” VEO-IBD

more severe and refractory

More genetic

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4
Q

cause of Crohns

A

unknown

enviornmental triggers, microbiome, immune response, genetic succeptability

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5
Q

Enviornmental triggers

A

diet, hygiene, smoking, Vit D, stress, depression

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6
Q

dysbiosis

A

disruption of the microbiome balance

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7
Q

IBD is limited to

A

westernized industrial populations

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8
Q

Risk factors

A

smoking, prior appy, stress, depression

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9
Q

Presenting s/s

A

abd pain, diarrhea, rectal bleeding, wt loss, skin tags, peds patients have extensive s/s

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10
Q

Diagnostic lab tests

A

None for IBD or Chrons

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11
Q

CBC

A

leukocytosis, chronic anemia, thrombocytosis

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12
Q

HGB

A

Correlate HGB with MCV to assess chronicity

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13
Q

ESR and CRP

A

elevated inflammatory markers

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14
Q

serum albumin

A

marker of long standing intestinal damage

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15
Q

calprotectin and lactoferrin

A

neutrophil associated proteins

stool sample test for luminal inflammation

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16
Q

Scoping

A

esophagus, stomach, proximal duodenum

mucosal biopsies of upper and lower

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17
Q

Treatment:

Aminosalicytes (2)

A

Sulfasalazine and mesalamine

treat colonic Chrons

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18
Q

Treatments:

corticosteriods

Maintenance therapy or induction of remission?

A

prednisone/prednisilone

methylprednisolone sodium succinate

budesonide

Used to induce remission, NOT for maint therapy d/t serious advers effects

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19
Q

Treatments:

Immunomodulators (3)

Maintenance therapy or remission induction?

Study These Flashcards
A

Azathioprine

6-mercaptopurine

methotrexate

Used to maint. steriod free remission

Use in conbo with biologic to decrease immunogenecity

20
Q

Treatments

Biologic agents (5)

Maintenance or remission induction therapy?

Study These Flashcards
A

nfliximab (infusion), adalimumab (subq)

certolizumab, vedolizumab, natalizumab

“rescue” therapy for severe steriod dependent or steriod refractory disease

Anit TNF agents considered first line depending on situation

Used for either induction or maintenance

Requires monitoring for infectious compl.

must be sure TB neg prior to admin

21
Q

Surgery

Study These Flashcards
A

for fibrotic disease if pharm therapy is not successful

22
Q

Treatments

Antibiotics

Study These Flashcards
A

metronidazole, cipro, rifaximin

controversial use

used in patients with active perianal disease

23
Q

Treatments

Others

Study These Flashcards
A

Calcineurin inhibitor - thalidomide

probiotics, lactobacillus, saccharomyces boulardil

“rescue” therapy for severe steriod dependent or refractory disease

bridging therapy for patients with refractory colitis

recurrent pouchitis p colectomy

role as maint therapy unknown

24
Q

Diet

Study These Flashcards
A

specific carbs, elimination diets, low-sulfur, ayurvedic diets

patients report benefit, no research support

25
supplements
ommega 3 fatty acids, probiotics, aloe- anti-infl, antioxidant, immune stimulatory herbals- indian ayurveda accupuncture
26
biobehavioral methods
stress alters gut permiability and immune modulation embarassing for adolescents increased risk of psyc discorders relaxation, meditation, prayer CBT, gut focused hypnotherapy
27
Growth concers
impaired lineral growth may preceed GI symptoms- may be only presenting sign of IBD
28
Bone concerns
affected by disease and treatment bone mass defects nutr def, physical inactivity, infl cytokines and steriods negatively impact bone growth and formation bone density can be marker of disease failure to control infl = increased risk of fracture bone delay may persist despite treatment
29
Vaccinations
aviod all live vaccines if immunosupressed or significant protien-cal malnutrition give flu shot (no mist) Pneumococcal, HPV- rates higher in immunosupresssed EBV- higher risk of developing hemophagocytic lymphohistiocystosis ( body makes too many immune cells)
30
What is immunocompromised?
prednisone 20mg/day or 2mg/kg/day for two weeks or within 3 moths of stopping thiopurines, methotetrexate, anti TNF, a agents or other biologics, or within 3 months of stopping
31
Referals- opthomology
annual eye exam - slit lamp, IOP meas conjuctivitis, uveitis (can be asymptomatic), episcleritis increased IOP from steriods
32
Referals - Derm
annual exam, monitor for skin cancer derm manefestations of IBD - erythema nodosum, pyoderma gangrenosum, psoriasis higher risk of non-melinoma skin cancer
33
Referral - Joint involvement
3 conitions: ankylosing spondylitis, peripheral arthritis, enthesitis differentiate between mechanical and infl pain inspect symmetry and ROM rheumathology if they have poor response to therapy or have persistant joint complaints after control of GI symptoms
34
Liver
transient elevation of liver enzymes, certain anomalies require further workup
35
Dietary and nutrition
Nutritional assessment at diagnosis and regularly after May have decreased appetite May need supplementation or enteral nutrition
36
iron deficiencies
iron deficiency anemia most common type fatigue, lethargy, dizziness higher rate of anemia with CD versus UD
37
folate and B12
rare in those newly diagnosed common if patient is on antifolate medication - methotrexate or with terminal ileal disease
38
vitamin D
abd in small int to promote bone health improvinf Vit D status may improve s/s and infl
39
Zinc
essential for the immune system at risk in patients with IBD d/t losses from GI tract
40
Exclusive enteral nutrition (EEN)
use of nutritional interv. as antiinfl. therapy elemental or polymeric formula for 6-8 weeks to induce remission especially in Chrons guided by dietitian
41
patients with fibrotic strictures
may benefit from low residue diet
42
Infl in small intesting reults in
protien loosing enteropathy fat malabsorption risk of Vit D def patients with active s/s have poor apetite and low energy
43
Psyc
increased risk of depression med adherance issues poor sleep quality- may impact school CBT can be helpful meds: seratonin and dopamine reuptake inhibitors help with anixety and depressive symptoms
44
Impact 3 questionare
for pateints with IBD 10+
45
IBD quality of life index
18 years and older
46
Resources
GIkids.org crohnscolotosfoundation.org

Fall 2020 Exam 2 (7 decks)

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