IBD

Question 1

Medical Treatment for UC and Crohn’s

Answer 1

Question 2

How do you approach TDM in anti-TNF therapy?

Answer 2

Question 3

Considerations for using small molecules in UC.
Tofacitinib
Upadacitinib
Ozanimod

Answer 3

Question 4

Answer 4

Question 5

Colon biopsy

Answer 5

low grade dysplasia

Question 6

Answer 6

Chronic colitis
altered crypt architecture (branching crypts)
microabcesses

Question 7

Mayo score?

Answer 7

Question 8

Mayo score?

Answer 8

Question 9

Mayo score?

Answer 9

Question 10

Definition of mild, mod, severe UC.

Answer 10

Question 11

Describe the AZA, 6MP enzyme pathway.

Answer 11

6MMP- leads to hepatotoxicity
6 TGN leads to bone marrow toxicity.

If high 6MMP, normal 6TGN, then given allopurinol to stop the shunting

high levels of both= toxicity
low levels of both= non-compliance

Question 12

Answer 12

Sacrolititis

Question 13

Answer 13

Ankylosing spondylitis

Question 14

Answer 14

normal spine

Question 15

Answer 15

normal SI joint

Question 16

Answer 16

Sweet syndrome
Acute febrile neutrophilic dermatosis
skin nodules, fever, vision changes, and desquamating rash
treat underlying IBD w/ steroids

Question 17

Rutgeert’s score?

Answer 17

Question 18

How do you managed post-op therapy for CD who undergoes ileocolonic resection?

Answer 18

if <5 apthous ulcers in neoTI or ulcers confined to the anastomosis then ok to defer treatment

Question 19

Which EIM track with IBD luminal disease activity?

Answer 19

type 1 peripheral arthropathy (<5 joints, large joints)
Erythema nodosum
+/- Pyoderma Gangrenosa
episcleritis
scleritis

Question 20

peristomal PG

Answer 20

+/- tracks with luminal disease
treatment with (in escalating order)- topical steroid, oral steroids, anti-TNF, surgery

pathology with neutrophils

Question 21

Crohn’s like disease of the pouch

Answer 21

pre-ileal stricture, pre-pouch ileitis

Question 22

UC s/p colectomy and IPAA

Answer 22

Cuffitis
RF- >2cm cuff remaining, refractory disease
treat with mesalamine suppositories
then anti-TNF

Question 23

acute pouchitis - definition and treatment
chronic antibiotic refractory pouchitis - definition and treatment and RF

Answer 23

acute pouchitis- ciprofloxacin 500 mg every 12 hours for 2 weeks
no response–> give cipro +flagyl

chronic antibiotic refractory pouchitis- abx >4 weeks with no response; treat with hydrocortisone or mesalamine enemas and if fails then biologic
RF- PSC or IgG4 disease (would then favor budesonide)

Question 24

who qualifies for maintenance therapy for pouchitis?

Answer 24

respond to therapy but relapse >3 times per year
treat with VSL #3 or rifampin, low dose cipro

Question 25

which biologics can treat IBD and central arthropathy like sacroilitis?

Answer 25

anti-TNF and JAK inhibitors

Question 26

how do you manage invisible dysplasia

Answer 26

repeat colonoscopy by expert with spray chromo
if no visible lesion, then extensive nontargeted biopsies in area of prior dysplasia
if unresectable visible dysplasia or multifocal dysplasia or HGD –> colectomy
if no dysplasia then repeat at surveillance intervals

Question 27

when do you get dexa for steroid exposure

Answer 27

> 3 months cumulative exposure

Question 28

how should you manage medications around surgery?

Answer 28

no change to medication, specifically AZA, MTX, 6-MP or anti-TNF

increased risk of post-operative infection with pred

Question 29

ARM
what is the diagnosis?

Answer 29

There is an adequate rise in rectal pressure and corresponding relaxation of the external anal sphincter (diagonal line with red end markers) on the anorectal manometry image. Chronic straining can cause rectal mucosal intussusception seen in the anorectal manometry with rectal mucosa descending into the anal sphincter complex.

Question 30

how can you reduce calcium oxalate stones in IBD?

Answer 30

reduced dietary oxalate, increased calcium, and lower fat