IBD

Question 1

What does IBD stand for?

Answer 1

Inflammatory Bowel Disease

Question 2

Etiology of ulcerative colitis?

Answer 2

idiopathic

some genetic tendency

Question 3

What are the groups in which ulcerative colitis typically presents?

Answer 3

Adolescence or young adulthood.

Whites, Jews of Eastern European descent

Question 4

Presentation of UC?

Answer 4

BLOODY DIARRHEA
ABD PAIN RELIEVED BY BM
fever, anorexia, wt loss, anemia
arthritis
uveitis
jaundice 
skin lesions

Question 5

What is the most common location effected by UC?

Answer 5

Almost always involves distal colon and rectum

Question 6

What percentage of pt’s go into complete remission?

Answer 6

90%

Question 7

There are 3 disease severities for UC describe all 3

Answer 7

Mild-fewer than 4BMS qd, intermittent bleeding Normal labs
Moderate-4-6BMs qd frequent bleeding, HCT drop and ESR 20-30
Severe-more than 6BM’s qd, HCT drop , wt loss greater than 10%, ESR greater than 30

Question 8

Why is ESR increased during mod-acute attack of UC?

Answer 8

sed rate is marker for inflammation

Question 9

What distinguishes UC from Ulcerative proctitis?

Answer 9

limited extent of inflammation, good prognosis and lack of serious complications
relapses are more common

Question 10

What are the main differences between UC and Crohn’s dz?

Answer 10

Crohn’s is chronic

and can effect the entire GI system (and extends through all layers of bowel wall)

Question 11

What is believed to be the etiology of Crohn’s disease?

Answer 11

autoimmune

Question 12

Peak incidence of Crohn’s occurs at what age?

Answer 12

20-40yo

Question 13

Most common site effected by Crohn’s dz?

Answer 13

Distal ileum and Right colon - can involve small bowel (infrequent)

Question 14

Symptoms of Crohn’s dz?

Answer 14

ABD PAIN 
diarrhea (may be bloody)
wt loss/anorexia
vomiting
feer
perianal discomfort/bleeding
constipation

Question 15

Describe 3 severities of Crohn’s dz

Answer 15

Mild to mod-wt loss less than 10%, no dehydration
Moderate to severe-fever, anemia, wt loss greater than 10%
Severe-fever, obstruction, abscess

Question 16

What might be seen on PE for Crohn’s

Answer 16

RLQ abd mass
Perianal fistula tract
inflamed joint
erythema nodosum
pyoderma
uveitis
aphthous ulcer
Nephrolithiasis
obstruction
osteoporosis/penia

Question 17

What does GALS stand for in “only GALS can be Crohn’s”

Answer 17

Granulomas
All
Layers
Skin lesions

Question 18

DX for UC

Answer 18

clinical dx
sigmoidoscopy
colonoscopy 
rectal bx
Seriolgoy-elevated CRP, Leuk, ESR, Platelet, and decrease in HgB and albumin

Question 19

What additional test should be done to rule out Cause of diarrhea when considering UC?

Answer 19

stool for toxins, bacteria O&P

Question 20

Dx for Crohn’s

Answer 20

clinical presntation
rad contrast *UGI, air contrast BE
serology-elevated CRP, Leuks, ESR, Platelet and decrease in HgB and albumin (same as UC)
Endoscopic-rectal sparing, fistulization, skip lesions

Question 21

UC tx options:

Answer 21

Sulfasalazine
Sulfapyridine-Free 5-aminosalicylate agents
oral corticosteroids
immunosuppressives
opiates
physch. support
surgery
screen for ca.

Question 22

What is the first medication typically prescribed for UC moderate-mild symptoms?

Answer 22

sulfasalazine

Question 23

What might sulfasalazine be combined with for UC with more severe sx.?

Answer 23

steroids.

Question 24

Why might sulfasalazine not be initiated to start with mod-mild UC?

Answer 24

some pt’s don’t tolerate it well

Question 25

What is the more expensive and more effective new tx for UC?

Answer 25

Sulfapyridine-free 5-aminosalicylates

Question 26

What is the benefit/drawback to prescribing Suflapyridine-free 5-aminosalicylates as opposed to sulfasalazine?

Answer 26

Doesn't have the side effects as sulfasalazine | MUCH MORE EXPENSIVE

Question 27

For distal UC what is an additional alternate to sulfasalazine bat can be used for maintenance of UC and prevents the concern about systemic steroid absorption?

Answer 27

5-ASA enemas

Question 28

When is the use of glucocorticosteroids indicated in UC?

Answer 28

moderately severe to severe cases

Question 29

For those that require chronic high-dose steroid tx and have had inadequate response to conventional therapies what is an additional modality that can be tried?

Answer 29

Immunomodulator agents.

Question 30

What must be monitored in the use of immunomodulator agents?

Answer 30

potential side effects of infection, heptotoxicity, bone marrow suppression

Question 31

For those unable to function at all due to diarrhea what may also be prescribed?

Answer 31

opiods/opiates

Question 32

What are indications for surgery for UC?

Answer 32

high grade dysplasia, toxic megacolon, hemorrhage, obstruction, unresponsiveness to maximal medical management.

Question 33

What screening in necessary for pt's with UC or crohn's (but more common in UC)?

Answer 33

Colorectal cancer

Question 34

What patients are screened for colorectal cancer with IBD?

Answer 34

all pt's with punctilios of 7 years or more than 12 years after L sided colitis (whichever comes first) eery 2-3 years until 20yr hx then annual

Question 35

When is Metranidazole given in the presence of Crohn's dz?

Answer 35

2nd step w/ failure to sulfasalazine

Question 36

So Metronidazole - second step tx in ________ | and 5-ASA is second step tx in ______

Answer 36

``` Metronidazole = Crohn's 5-ASA = 5ASA ```

Question 37

Should pt increase or decrease fiber during Crohn's flare?

Answer 37

decrease fiber

Question 38

Should pt increase or decrease fiber while not experiencing a Crohn's flare?

Answer 38

Increase fiber

Question 39

when do you admit a pt with Crohn's?

Answer 39

``` bleeding toxicity sever pain or too ill to obtain adequate nutrition orally bowel rest nasogastric feeding parenteral steroids surgical consult ```

Question 40

Define Rome Criteria for IBS

Answer 40

``` Abd pain/discofort relieved with BM and 2 or more of the following for at least 3 days/mo x 3mos: change in stool frequency Change in stool consistency Difficult stool passage Sense of incomplete evacuation Presence of mucus in the stool ```

Question 41

What age group is IBS more common in?

Answer 41

Young (under 45)

Question 42

Sx of IBS

Answer 42

``` altered bowel habits flatulence abd pain upper GI symptoms Symptoms are almost always during waking hours ```

Question 43

Characteristics of Abdominal pain in IBS?

Answer 43

``` location varies frequent episodic crampy ache intensity varies pain exacerbated by stress Pain relieved by BM ```

Question 44

What sx makes you think IBS and not UC?

Answer 44

If the pt is able to sleep through the night, no night-time awakenings they probably have IBS.

Question 45

What is the most common pattern of altered bowel habit in IBS?

Answer 45

Constipation alternating with diarrhea

Question 46

What percentage of pt's c/o upper GI problems with IBS?

Answer 46

25-50%

Question 47

What does the workup for IBS depend on?

Answer 47

onset of symptoms, severity and age of pt.

Question 48

diagnostics for IBS?

Answer 48

``` diagnosis of exclusion CBD flex sig stook for O&P older than 40 BE/colonscopy UGI dietary (lactose intollerance) UGI workup US gallbladder postprandial RUQ pain ```

Question 49

tx for IBS?

Answer 49

``` counseling/dietary stool bulking agents/high fiber diet antispasmodics (starting to fall out of fashion) antidiarrheals (temporary) antidepressants Antiflatulence GI motility enhancers ```