Exam 4 - IBD

Question 1

Location of UC vs CD?

Answer 1

UC=Colon/rectum

CD=entire GIT

Question 2

Depth UC vs CD?

Answer 2

UC=Superficial

CD=Transmural

Question 3

UC vs CD colonoscopy?

Answer 3

UC=continous inflammation, pseudopolyps

CD=”cobblestone” skip lesions

Question 4

Rectal bleed, bloody/watery diarrhea in UC or CD?

Answer 4

UC

Question 5

Fatigue, abd pain, feveral in UC or CD?

Answer 5

CD

Question 6

Toxic megacolon and colon cancer in UC or CD?

Answer 6

UC

Question 7

Perianal dz and fistula in UC or CD?

Answer 7

CD

Question 8

UC or CD and surgery?

Answer 8

UC=cutative

CD=variable, usually not curative

Question 9

Nicotine makes UC and CD worse or better?

Answer 9

UC=better

CD=worse

Question 10

Intestinal perf with UC or CD?

Answer 10

UC

Question 11

Intestinal obstruction with UC or CD?

Answer 11

CD

Question 12

UC or CD has more extraintestinal manifestations?

Answer 12

UC (bone/joint, eyes, skin, DVT/PE)

Question 13

What to assess in IBD?

Answer 13

Location and severity

Question 14

Mild UC vs Fulminant UC bowels/day?

Answer 14

Mild CD <4

Fulminant ≥10

Question 15

Bloody stools in Mild UC? In Moderate to Fulminant?

Answer 15

Possibly in Mild. Yes in Moderate to Fulminant.

Question 16

HgB in Mild UC vs Moderate UC?

Answer 16

Mild=normal

Moderate= >10.5

Question 17

HgB in Severe UC vs Fulminant UC?

Answer 17

Severe= <10.5
Fulminant= <8 (transfuse!)

Question 18

Chrons Disease Activity Index below 150? Above 450?

Answer 18

<150=Remission. ASx.

>450=Severe/Fulminant. Highly sx despite steroid and biologic tx.

Question 19

Tx for Fistulizing CD?

Answer 19

Infliximab for cutaneous/external fistula. May need surgery.

Question 20

Tx for Perianal CD?

Answer 20

Drain abscess if present. Consult GI/surgery. Metronidazole +/- cipro. Use immunosuppressants/biologics.

Question 21

Tx for Mild-Moderate UC not in entire colon (proctitis, proctosigmoiditis, or distal colitis) to induce remission?

Answer 21

1. Topical aminosal
2. Caombine w/PO aminosal
3. Topical/PO steroid
4. Anti-TNF +/- AZA/6MP or MTX

Question 22

Tx for Mild-Moderate UC in entire colon to induce remission?

Answer 22

1. PO Aminosal +/- topical
2. Topical/PO steroids
3. Anti-TNF +/- AZA/6-MP or MTX

Question 23

Mild to Moderate UC bowel movements per day?

Answer 23

4-6/day

Question 24

Severe to Fulminant UC bowel movements per day?

Answer 24

7-10/day

Question 25

Tx for Severe-Fulminant UC to induce remission?

Answer 25

1. IV steroids 3-7 days 2. IV Remicade (Anti-TNF) or IV Entyvio (Anti-alpha 4) +/- AZA/6-MP or MTX 3. IV Cyclosporine 4. Colectomy (last time)

Question 26

Last-line tx for severe-fulminant UC?

Answer 26

Colectomy

Question 27

UC maintenance on steroids switch to?

Answer 27

Consider transition from steroids to biologic (Anti-TNF, Anti-alpha-4) +/- immunomodulator (AZA, MTX, Cyclo)

Question 28

Use Tysabri in UC?

Answer 28

Nope, but can use Entyvio.

Question 29

When to reassess for symptomatic response in UC?

Answer 29

4-8 weeks

Question 30

Mild-Moderate CD in Ileum or R Colon? (CDAI 150-220)

Answer 30

1. Budesonide | 2. PO Aminosal or other PO steroid

Question 31

Mild-Moderate CD *not* in Ileum or R Colon?

Answer 31

1. PO Aminosal | 2. PO Steroid

Question 32

Inducation for Moderate-Severe CD in Ileum or R Colon? (CDAI 220-450)

Answer 32

1. PO steroid for 28 days 2. Anti-TNF (Remicaide, Humira, etc) 3. Anti-alpha-4 (Entyvo>>Tysabri)

Question 33

Maintenance for Moderate-Severe CD in Ileum or R Colon? (CDAI 220-450)

Answer 33

1. Steroid to AZA/6-MP or MTX | 2. Continue biologic if used for induction. AZA mono tx bad idea. Inflix +/- AZA good idea!

Question 34

Severe to Fulminant CD tx?

Answer 34

1. IV steroid x3 days 2. IV Cyclosporine 3. Biologic (no evidence helps) 4. Surgery

Question 35

Tx for Fistulizing CD?

Answer 35

Remicade

Question 36

Use Tysabri in CD?

Answer 36

No!

Question 37

What to test before and during Tysabri use? How often retest?

Answer 37

JVC-antibodies. | Test q6m if negative and stop if suddenly positive. If positive at baseline only use for 9-12mo max!

Question 38

When to d/c Tysabri?

Answer 38

Test positive for JCV at 6 month check. Only use for 9-12mo max is positive at baseline.