GI: IBD & Celiac

Question 1

This disease is chronic, relapsing-remitting GI inflammatory disorder.

Answer 1

IBD

Question 2

Describe the bimodal peaks of age related to IBD

Answer 2

15-35 and 50-80

Question 3

What three factors are hypothesized to cause IBD?

Answer 3

autoimmune
genetic
environment

Question 4

5 red flag sxs for IBD…

Answer 4

severe bleeding
severe pain
dysphagia
dehydration
obstruction

Question 5

Crohn or UC?

Mouth to Anus
(+) Skip lesions
Full-thickness, transmural inflammation

Answer 5

Crohn

Question 6

Crohn or UC?

Colon + Rectum
Extends proximally
(-) skip lesions, continuous
Mucosal layer only

Answer 6

UC

Question 7

Crohn manifestations in oral cavity…

Answer 7

apthous ulcers

Question 8

MC Crohn manifestation in ileum…

Answer 8

ileitis

Question 9

Crohn manifestation in terminal ileum & proximal asc. colon?

Answer 9

ileocolitis

Question 10

Crohn manifestation in the colon…

Answer 10

crohn colitis

Question 11

Crohn manifestation in anus/rectum

Answer 11

perianal disease (abscess/fistula)

Question 12

Crohn is known as a penetrating disease… this means what four complications can occur?

Answer 12

ulcer
stricture
fistula
abscess

Question 13

Describe the onset of sxs of Crohn disease…

Answer 13

insidious onset, intermittent/relapsing-remitting sxs

Question 14

Mild/Mod/Severe Crohn:

inflammation + stricture

Answer 14

moderate

Question 15

Mild/Mod/Severe Crohn:

Inflammation + stricture + fistula

Answer 15

Severe

Question 16

What is the MC extra-intestinal manifestation of Crohn Disease?

Answer 16

arthralgia

Question 17

What are three Crohn/UC manifestations that can occur in the eyes?

Answer 17

episcleritis, iritis, uveitis

Question 18

What are two Crohn/UC manifestations that can occur on the skin?

Answer 18

erythema nodosum, pyoderma gangrenosum

Question 19

Pt. p/w abd. pain, diarrhea, +/- NV, perianal disease and anemia.

What is this presentation concerning for?

Answer 19

Crohn Disease

Question 20

What is the best way to Dx crohn disease?

Answer 20

colonoscopy + bx

Question 21

What would you expect to see on colonoscopy + Bx with Crohn disease?

Answer 21

Colonoscopy: ulcerations/cobblestoning

Bx: granulomas

Question 22

Describe the effectiveness of 5-ASA on crohn disease?

Answer 22

minimally effective

Question 23

what can corticosteroids be used for in crohn disease?

Answer 23

acute flares

Question 24

What two drugs can be used alone or in combo for moderate/severe crohn disease?

Answer 24

immunomodulators +/- biologics

Question 25

When can Abx (cipro, metronidazole) be used for crohn disease?

Answer 25

if abscess/fistula

Question 26

The below are complications of crohn or UC? ``` abscess strictures fistula obstruction colon CA malabsorption ```

Answer 26

crohn

Question 27

A pt. p/w the below, concerning for... lower abd. pain bloody diarrhea fecal urgency + tenesmus +/- anemia/hypovolemia

Answer 27

UC

Question 28

How can you diagnose UC?

Answer 28

sigmoidoscopy/colonoscopy + bx

Question 29

the below, found on colonoscopy is concerning for... diffuse friability erosions bleeding

Answer 29

UC | also seen on sigmoidoscopy

Question 30

Crypt abscesses seen on Bx are suggestive of...

Answer 30

UC

Question 31

What are two complications of UC?

Answer 31

toxic megacolon | colon CA

Question 32

What can worsen the sxs of both UC and Crohn Disease and should therefore be avoided?

Answer 32

NSAIDs

Question 33

What labs can be helpful in dx of UC/Crohn?

Answer 33

CBC, CMP, CRP/ESR

Question 34

if an IBD patient is developing diarrhea/change in baseline stool habit, what should be ordered?

Answer 34

stool studies

Question 35

The below are indications for what IBD tx? severe hemorrhage perf CA refractory disease

Answer 35

surgery

Question 36

taking Anti-TNF (biologics) drugs can leave patients susceptible to what two diseases, so they must be screened before tx begins?

Answer 36

TB and HBV

Question 37

imaging is not required for CD dx, but which imaging studies can be ordered/may be helpful?

Answer 37

CT/MR enterography UGI + SBFT Capsule endoscopy (C/I if stricture)

Question 38

(+) String Sign on UGI w. SBFT indicates...

Answer 38

Crohn Disease

Question 39

What category of UC? Mild/Mod/Sev... > 4 stools daily + anemia + low grade fever

Answer 39

moderate

Question 40

What category of UC? Mild/Mod/Sev... > 6 stools daily, systemic toxicity

Answer 40

severe

Question 41

What imaging may be helpful in the evaluation of UC?

Answer 41

CT A/P

Question 42

5-ASA is primarily used for...

Answer 42

mild/mod UC

Question 43

Thiopurines can take how long to begin working?

Answer 43

3-6 mo

Question 44

What two genes may genetically predispose somebody for celiac disease?

Answer 44

HLA DQ2 and DQ8

Question 45

A patient presents with: diarrhea, steatorrhea, flatulence/bloating and wt. loss This is concerning for...

Answer 45

malabsorption, celiac disease

Question 46

What are three atypical sxs of celiac?

Answer 46

abd. pain, constipation, dyspepsia

Question 47

These are burning, pruritic lesions that are erythematous and papular +/- vesicles. They are assoc. w. celiac disease

Answer 47

dermatitis herpetiformis

Question 48

What are three main extra-intestinal sxs of celiac disease?

Answer 48

dermatitis herpetiformis IDA Osteoporosis

Question 49

Celiac disease is identified via ________ and confirmed via ________

Answer 49

ID: serology (elevated tTG IgA) Confirm: duodenal biopsy w. villous atrophy

Question 50

testing for celiac is done on a gluten free or gluten containing diet?

Answer 50

gluten containing

Question 51

How is celiac treated?

Answer 51

gluten free diet

Question 52

What are two main complications of celiac disease?

Answer 52

nutrient deficiency | lymphoma