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clin med III, exam 1 > IBD > Flashcards

IBD Flashcards

1
Q

inflammatory bowel disease is most common in what patient population

A

Jews

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2
Q

smoking has what affect on risk of inflammatory bowel disease

A
  • smoking increases risk of crohns disease
  • smoking decreases risk of ulcerative colitis
    • pt diagnosed once they quit smoking
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3
Q

Crohns disease affects what portion of the GI tract

A
  • mouth to anus
  • transmural: affects all entire thickness of mucosa
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4
Q

what are possible complications of crohns disease

A
  • ulcer
  • stricture
  • fistula
  • abscess
  • colon cancer
  • obstruction, perforation
  • Nutritional deficiencies (Fe, B12)
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5
Q

most common site of involvement of Crohns disease is

A

distal ileum

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6
Q

What is a fistula

A

tunnel between two epithelial lined organs

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7
Q

Define the following fistulas

  • enteroenteric
  • enterovesicular
  • enterovaginal
  • enterocutaneous
A
  • enteroenteric: bowel to bowel
  • enterovesicular: bowel to bladder
  • enterovaginal: bowel to vagina
  • enterocutaneous: bowel to skin
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8
Q

differentiate between crohns ileitis, ileocolitis, and colitis

A
  • crohns ileitis: disease limited to ileum
  • crohns ileocolitis” disease of terminal ileum and adjacent proximal ascending colon
  • crohns colitis: disease of the colon
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9
Q

clinical presentation

  • highly variable
  • colickly RLQ pain
  • chronic, intermittent diarrhea
    • often noctural
  • rectal bleeding
A

Crohn’s disease

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10
Q

List the extra-intestinal manifestations of Crohn’s disease

A
  • aphthous ulcerations
  • arthralgias, arthritis (primarily large joints)***most common
  • erythema nodosum
  • episcleritis, iritis, uveitis
  • gallstones
  • sclerosing cholangitis
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11
Q

procedure of choice to evaluate suspected crohns disease

A

colonscopy

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12
Q

colonoscopy showing skip lesions and rectal sparing is characteristic of what form of IBD

A

Crohn’s disease

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13
Q

biopsy showing granulomas is diagnostic of what type of IBD

A
  • Crohn’s disease
    • seen in 30% of patients
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14
Q

small bowel follow-through: string sign is seen with what form of IBD

A

Crohn’s disease

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15
Q

list other diagnostic/lab tests (besides colonoscopy) used to assess IBD

A
  • CT scan with contrast
    • inflammation (thickened walls), abscesses, fistulas
  • ESR, CRP: elevated in active disease
  • IBD specific antibodies
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16
Q

long term inflammation caused by IBD increases risk of colon cancer, how often should pt be screened

A
  • colonoscopy ever 1-2 yrs
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17
Q

if patient has IBD, he/she should not take what pain medication

A
  • NSAIDs
    • can cause flare-ups
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18
Q

List tx options for crohns disease

A

step up therapy or top-down

  • salicylates (5-ASA)
  • antibiotics (fistulas, abscesses)
  • corticosteroids (flares)
  • immunosuppressants
  • TNF blockers- remicade
  • surgery
  • nutrition
    • ​**unique to crohns
19
Q

ulcerative colitis affects what portion of GI tract

A
  • colon only
    • almost always involves rectum
    • occurs distal -> proximal (continuous)
  • mucosal surface only
20
Q

proctitis

A

ulcerative colitis limited to rectum

21
Q

left sided colitis

A

ulcerative colitis that extends to but not beyong splenic flexure

22
Q

pancolitis

A

ulcerative colitis that extends to cecum

23
Q

clinical presentation

  • rectal bleeding
  • diarrhea, often bloody and includes mucous,
    • often nocturnal
  • crampy abd pain
  • tenesmus (feeling of constantly needing to pass stools)
A

ulcerative colitis

24
Q

List extra-intestinal manifestations of ulcerative colitis

A
  • arthralgias, arthritis (primarily large joints)***most common
  • erythema nodosum
  • episcleritis, iritis, uveitis
  • sclerosing cholangitis
25
How is ulcerative colitis diagnosed
* flex sig or colonoscopy * only colon affected * **continuous** area of involvement, **no skip lesions**
26
complications of ulcerative colitis
* colon cancer * hemorrhage * toxic megacolon: colonic dilation \> 6 cm with signs of toxicity
27
list tx options for ulcerative colitis
step up therapy 1. **salicylates** (5-ASA) \*\*first line 2. **corticosteroids (flares)** 3. immunosuppressants 4. TNF blockers- remicade 5. surgery
28
first line therapy for IBD
* salicylates (5-ASA)
29
if patient is taking the salicylate (5-ASA) **sulfasalazine**, he/she must take what
folic acid
30
side effects of salicylates (5-ASA)
* nephrotoxicity * GI upset
31
When patient with IBD is given corticosteroids, what do you need to know about taking them off
* not used for maintenance, only for flares * slow taper
32
What corticosteroid is commonly used for ileal/ rt sided colonic disease
* Budesonide * steroid-light-\> less systemic side effects
33
side effects of prednisone
* osteoporosis * insomnia * worsening of DM * weight gain * adrenal insufficiency * psychosis * increased infection risk
34
Which abx are commonly used in crohns tx
* ciprofloxin and flagyl (metronidazole) * used in acute disease
35
side effects of Flagyl (Metronidazole)
* peripheral neuropathy * metallic taste * disulfuram rxn (avoid alcohol)
36
side effects of ciprofloxin
* tendinitis (tendon rupture) * photosensitivity * prolongation of QT interval
37
red flags of IBD
* severe bleeding * severe abd pain -\> peritoneal signs * weight loss * signs of dehydration * signs of obstruction * failure to respond to medical therapy
38
What is celiac's disease
* immune disorder triggered by environmental exposure * gluten is toxic to small intestine * causes mucosal inflammation, crypt hyperplasia and villous atrophy
39
celiac disease is prevalent in what patient populations
* whites of northern european ancestry * relative with celiacs * autoimmune disease * DM I * thyroid disease * down's syndrome
40
clinical presentation * **diarrhea** with bulky, foul-smelling, floating stool due to steatorrhea, **bloating and flatulence** * **Fe deficiency anemia** * **osteopenia** * **dermatitis herpetiformis** * **B vitamin deficiencies** * elevated LFT
celiac's disease
41
dermatitis herpetiformis is pathonmeumonic for
celiac disease
42
how is celiac disease diagnosed
* must do testing while patient is **eating gluten** * **small bowel biopsy** via **EGD** is gold standard * find villous atrophy * blood testing: celiac disease panel
43
tx of celiac disease
* avoid gluten * supplement as needed
44
celiac disease complications
* malabsorption * Fe deficiency anemia * B vitamin deficiency * osteoporosis * slight increase in * non-hodgkins lymphoma * GI malignancies

clin med III, exam 1 (5 decks)

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