EXAM #1: INFLAMMATORY BOWEL DISEASE

Question 1

What is IBD?

Answer 1

Dysregulated response of the intestinal mucosa to otherwise innocuous luminal antigens

Question 2

What are the two major diseases that make-up IBD?

Answer 2

1) Ulcerative Colitis

2) Crohn’s Disease

Question 3

What are the “other” minor diseases associated with IBD?

Answer 3

1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis

Question 4

What are the characteristic features of UC?

Answer 4

• Diffuse mucosal inflammation

- Limited to colon

Question 5

What are the characteristic features of CD?

Answer 5

• Patchy transmural inflammation

- May affect any part of the GI tract, but most commonly ileum

Question 6

What are the alternate causes of colitis other than UC and CD?

Answer 6

1) Radiation
2) Ischemia
3) Medications

Question 7

What environmental factor is protective in UC and a risk factor for CD?

Answer 7

Smoking

• Protective in UC
• Risk factor for CD

Question 8

What surgical procedure is protective against UC?

Answer 8

Appendectomy

Question 9

What are the different processes that lead to the development of IBD?

Answer 9

1) Persistent infection
2) Defective mucosal integrity
3) Dysbiosis (imbalance between protective and aggressive flora)
4) Dysregulated immune response

Question 10

What lymphocyte system plays the biggest role in the development of IBD?

Answer 10

T-lymphocytes

Question 11

Which type of T-cell response is associated with CD?

Answer 11

Th1

Question 12

Which type of T-cell response is associated with UC?

Answer 12

Th2

Question 13

What is the genetic influence on IBD?

Answer 13

Familial occurrence that is POLYGENIC

Question 14

Describe the typical clinical presentation of UC.

Answer 14

• Bloody diarrhea= most common symptom
• Recal discomfort
• Fecal urgency
• Abdominal cramping

Question 15

Where does UC start?

Answer 15

Begins in the rectum and extends proximally

Question 16

What is Proctitis?

Answer 16

UC involving rectum only

Question 17

What is Proctosigmoiditis?

Answer 17

UC involving rectum and sigmoid colon

Question 18

What is Extensive disease in UC?

Answer 18

UC extending into transverse colon

Question 19

What is pancolitis?

Answer 19

UC involving the entire colon/

Question 20

What is a “lead pipe sign” pathogmnemonic for?

Answer 20

UC

Question 21

Are obstruction and fistulization associated with CD or UC?

Answer 21

CD

Question 22

Small bowel involvement of IBD leads to what diagnosis?

Answer 22

CD

Question 23

Describe the typical clinical presentation of CD.

Answer 23

• Abdominal pain (RLQ)
• Diarrhea
• Low grade fever
• Anorexia

Question 24

What are clinical signs of obstruction seen in CD?

Answer 24

• Post-parandial cramps
• Abdominal distention
• Borborygmi
• Vomiting
• Weight loss from food avoidance

Question 25

What are clinical signs of an enterovesical fistula?

Answer 25

1) Recurrent UTI | 2) Pneumaturia (air w/ urination)

Question 26

Describe the gross appearance of CD.

Answer 26

"Cobblestone mucosa"

Question 27

What are the distinguishing features of CD?

Answer 27

1) Granuloma formation 2) Skip lesions 3) Fistulization 3) Small bowel involvement 4) Perianal disease

Question 28

What are the extraintestinal manifestation of IBD?

Answer 28

- Aphthous stomatitis (CD) - Episcleritis and uveitis - Arthritis - Vascular complications - Erythema nodosum - P. gangrenosum

Question 29

Why are patients with IBD at risk for osteopenia?

Answer 29

1) Inflammation/ cytokines | 2) IBD medications i.e. corticosteroids

Question 30

What is primary sclerosing cholangitis?

Answer 30

Disease of bile ducts that causes inflammation and obliterative fibrosis *Seen most often with UC*

Question 31

What are the major categories of medications that are used to manage IBD?

Answer 31

1) Aminosalicylates 2) Corticosteroids 3) Immunomodulators 4) Antibiotics 5) Supportive agents

Question 32

How is remission induced in UC?

Answer 32

1) Aminosalicylates 2) Corticosteroids 3) 6MP/ Azathioprine 4) Cyclosporine

Question 33

How is remission maintained in UC?

Answer 33

1) Aminosalicylates | 2) 6MP/ Azathioprine

Question 34

How does the management of CD significantly differ from UC?

Answer 34

Addition of Antibiotics

Question 35

What are the indications for Metronidazole?

Answer 35

1) Active Crohn's 2) Perineal disease 3) Post-op Crohn's 4) Pouchitis

Question 36

What are the adverse effects of Metronidazole?

Answer 36

``` Nausea Metallic taste Furry tongue Candidiasis Peripheral neuropathy ```

Question 37

What are the indications for topical corticosteroids?

Answer 37

Proctitis | Left-sided colitis

Question 38

What are the indications for systemic corticosteroids?

Answer 38

Moderate to severe UC or CD

Question 39

What are the indications for parenteral corticosteroids?

Answer 39

Severe/ toxic UC or CD

Question 40

What are the adverse effects of 6MP/ Azathioprine?

Answer 40

1) Hypersensitivity 2) Bone marrow suppression 3) Opportunistic infection 4) Lymphoma risk

Question 41

What are the indications for surgery in UC?

Answer 41

1) Severe bleeding 2) Perforation 3) Cancer/ dysplasia 4) Unresponsive acute disease

Question 42

What are the surgical option is the standard of care for UC today?

Answer 42

Ileal pouch-anal anastamosis (most common)

Question 43

What are the indications for surgery in CD?

Answer 43

1) Perforation 2) Hemorrhage 3) Cancer/ dysplasia 4) High grade obstruction risk

Question 44

What is the preferred surgical procedure for a stricture in CD?

Answer 44

Strictureplasty