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Flashcards in IBD Deck (58):
1

def. IBD

chronic inflamm of the intestinal tract, variable systemic involvement

2

location of 2

UC - colon and rectum
CD - any portion

3

peak ages

bimodal - 20-30 and 60s

4

epi

more UC

5

Sx of CD

- abdo pain
- diarrhea
- mass in RLQ
- obstrcution
- weight loss
- fever
- stricture
- fistula and anal involvment

6

4 most common extraintestinal

1. eye - episcleritis
2. skin - erethyma nodosum
3. mouth ulcers
4. MSK - arthiritis

7

4 aspects to patho

1. genes - CD>UC : NOD2 gene
2. host immune system
3. luminal bact
4. env

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what is the immune response

inappropiate extreme immune response

9

3 env factors

1. altered mucous
2. incr. permeability
3. impaired repair mech.

10

what is actual path

normal>triggers>acute inflammation> not cleared> chronic inflammation

11

what to ask on Hx

- travel
- AB use
- diet
- sex hx
- fam hx
- extra intestinal Sx

12

labs

- CBC
- iron
- folate
- B12
- CRP
- ESR
- stool WBC

13

imaging

US, CT MR, endo

14

3 main goals and 2 additional of therapy

1. remission induction
2. remission maintenance
3. prevent treat compl.

a. mucoal healing
b. QOL

15

5 classes of meds

1. 5-ASA
2. corticosteroids
3. immunosuppresants - methotrexate
4. ABs
5. imunobiologics - mab's

16

preps, uses, action, effect, formulation and SE of 5-ASA

preps - mesalamine
uses - UC, mild crohn ilitis
action - oxy free radical scavenger
effect - local only
formulation - oral, rectal
adverse effects - pancreatitis, nephritis

17

preps, uses, action, effect, and SE of steroids

preps - prednisone, budesonide
uses - remission induction, no use for maintenance
action - inhib inflam. cytokines
adverse effects - cushins, ** avasc. necrosis

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action, use and SE of azathroprine

action - purine analog- DNA syn. inhib
use - remission and maintenance, healing of fistula
SE - bone marrow sup., pancreatitis, lymphoma,

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ction, use and SE of methotrexate

action - folic acid antag - no DNA, cort. sparing
use - remission and maintenance
SE - liver, leukopenia, N/V, diarrhea, hypersensitivity

20

action, use and SE of cyclosporine

action - inhib of t -cell mediated responses
use - acute and refractory UC
SE - nephrotox, infections, hypertension

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action, use and SE of immunobiologics

action - antiTNF ABs
use - CD - active and perianal, UC severe
SE - delayed hypersenstivity and lotof others

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use of ABs (

metronidazole and cipro
- no use in UC
-

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what to do when refractory

Surgey

24

2 indications for surg

1. failure of meds
2. disease complications - CA, perfs, stenosis

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what is surg CD mantra

- do not harm
- can't cure
- preserve function

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2 gen classes of IBD for a surg

1. fibrosteonitic - obstructive - pain, blaoating,
2. perforative - fistula, abscess, free perf

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3 main types of surg

1. resection
2. strictureplasty
3. diversion alone - rare

28

2 types of resection

1. restorative - +/- protected anastamosis
2. non-restorative

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what is surg for obstructing terminial illeum CD

illeocolic resection with anastamosis

30

**2 keys to a good anastamosis

1. tension-free
2. well-vascularized

31

what is role of the protecting stoma

lower leak rates

32

complications of ileo-colic resection

- leak - bad
- localized abscess
- diffuse peritonitis

33

how common is recurrence

very high over time - esp @ ileocolic jct

34

surg for segmental colon, diffuse colon, anorectal colon

segmental - segmental resection
diffuse - subtotal colectomy
anorectal +/- colon - prectectomy

35

3 CD mantra for anal CD

1. control Sx
2. preserve function
3. do no harm - don't injure sphinter

36

gross appearnce of CD

stiff, thick walled bowel, linear ulcers

37

patho of CD (5)

1. shallow aphthous ulcers from mouth to anus
2. full thickness inflammation
3. fissuring ulcers - epithelium enters
4. patchy lesions (skip)
5. granuloma

38

4 common UC sx

1. abo pain
2. diarrhea, freq, small volume
3. rectal bleeds
4. mucous

39

major complications of UC

toxic mega colon

40

4 malignant aspects of toxic megacolon

1. duration - 8-10 years
2. extensive disease
3. comorbid liver disease
4. chronic indolent disease

41

3 aspects to guide therapy

1. extent
2. severity
3. complications

42

3 extents of disease

1. proctitis - rectum only
2. severity
3. complications

43

5 aspects to consider for severty

1. # BM (>6)
2. rectal bleeds
3. fever. tachy
4. anemia
5. extraintestinal

44

use of ASA for UC

remisson and maintenance

45

use of ABs for UC

none

46

use of steroids for UC

induction only

47

use of innumonosuppression for UC

all remission and maintenance - except methotrexate, no maint

48

use of anti-TNF

both

49

what to do for severe attack of UC

try rescue therapy, and if fails > colectomy

50

2 options for colectomy

1. permanent ileostomy
2. modified pouch attached to the anus

51

complications of colectomy

- bowel obst.
- infection/leak
- pouchitis
- fistula
- infert and SD

52

classic histo of UC

- diffuse and continuous inflammation the entire length of region affected
- flat broad based ulcers
- usually limited to the mucosa
- crypt abscesses

53

what is prioblem in diagnosing IBD

- not always classical
- can get illeal backwash in UC
- can get patches in UC after treatment
-

54

DDX for both IBDs (6)

1. infection! - esp TB
2. iscemia
3. diverticular assoc. sigmoid
4. behcet's disease
5. NSAID
6. tumours

55

what is issue with fulminant

can be severe and go deep which makes it hard to diff. between UC and CD
- most act like UC
- need to diff. because doing colectomy can be bad in CD

56

4 dysplasia risk factors for UC

1. duration
2. early age of onset
3. extent
4. primary sclerosin cholangitis

57

3 dysplasia risk factors for CD

1. duration
2. most in colon
3. 20-500x risk of smal bowel adenocarcinoma

58

what to do with polyps and flat dysplastic lesions

polyp - remove endo
flat - consider colectomy

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