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clin med iii > IBD > Flashcards

IBD Flashcards

1
Q

Pathophysiology of IBD

A

immunologic

genetic

environmental

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2
Q

IBD age group affected

A

15-35 y/o

bimodal second peak at 50-80

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3
Q

men are more likely to get UC or CD

A

UC

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4
Q

female are more likely to get UC or CD

A

CD

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5
Q

smoking increases or decreases risk of CD

smoking increases or decreases risk of UC

A

increases

decreases

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6
Q

with IBD, what impacts clinical presentation, dx eval, mgmt, and complications

A

extent and severity of involvement

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7
Q

mouth to anus

patchy/skip lesions

transmural inflammation

A

crohn’s disease

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8
Q

limited to colon, involves rectum

extends proximally with continuous circumferential involvement

mucosal layer inflammation

A

UC

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9
Q

most common form of crohn’s disease

A

ileitis (affects ileum)

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10
Q

if crohns impacts the colon, what is it called

A

Crohn colitis

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11
Q

is perianal disease possible in crohn’s disease

A

yes - abscess, fistula

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12
Q

which is a penetrating disease - ulcers, strictures, fistulas, abscesses?

A

CD

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13
Q

clinical presentation of MILD crohns

A

inflammation

insidious onset, intermittent usually (alternates between exacerbations and relative remission)

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14
Q

clinical presentation of MODERATE crohns

A

inflammation + strictures

insidious onset, intermittent usually (alternates between exacerbations and relative remission)

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15
Q

clinical presentation of SEVERE crohns

A

inflammation + strictures + fistula

insidious onset, intermittent usually (alternates between exacerbations and relative remission)

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16
Q

abdominal pain in RLQ pain and tenderness

tender, palpable RLQ mass if abscess

what dx?

A

Crohn’s

RLQ - due to terminal ileal involvement

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17
Q

if terminal ileal involvement with CD, what vit def will you see

A

b12

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18
Q

most common extra-intestinal manifestation of crohn’s disease

A

arthralgias

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19
Q

other extra-intestinal manifestations of crohn’s

A

oral aphthous ulcers

episcleritis, iritis, uveitis

ecythema nodosum

pyoderma gangrenosum

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20
Q

dx of CD

A

colonoscopy with TI intubation

+/- EGD

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21
Q

imaging of CD (if needed)

A

+/- CT or MR enterography

+/- UGI with SBFT

+/- capsule endoscopy

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22
Q

when do you not use capsule endoscopy with crohn’s

A

suspected intestinal stricture

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23
Q

What do you find on colonoscopy for Crohns

A

skip lesions

ulcerations

cobblestoning

granulomas

rectal SPARING in most pts

MAYBE fistulas

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24
Q

3 complications of crohn’s disease

A

colon cancer

intestinal strictures, abdominal and perianal fistulas, abscess which can lead to small bowel obstruction and perforation

malabsorption

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25
Q

when is a colonoscopy recommended with crohns

A

every 1-2 years beginning 8 years after disease/symptom onset

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26
Q

with crohn’s disease what can intestinal strictures, abdominal and perianal fistulas and abscess lead to

A

small bowel obstruction and perforation

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27
Q

UC affects what part of the GI tract

A

colon ONLY

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28
Q

continuous, circumferential pattern - CD or UC

A

UC

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29
Q

mucosal surface of colon only that causes friability, erosions, and bleeding - UC or CD

A

UC

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30
Q

mild UC clinical presentation disease course

A

less than 4 stools daily, no systemic toxicity

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31
Q

moderate UC clinical presentation disease course

A

more than 4 stools/day, anemia, low grade fever

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32
Q

severe UC clinical presentation disease course

A

more than 6 stools daily, systemic toxicity

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33
Q

onset of UC

A

insidious with intermittent exacerbations and remission

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34
Q

UC or CD:

periumbilical/LLQ pain

bloody diarrhea

fecal urgency, tenesmus, rectal bleeding

constipation (if proctitis)

A

UC

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35
Q

extra-intestinal manifestations of UC

A

episcleritis, iritis, uveitis

erythema nodosum

pyoderma gagrenosum

sclerosing cholangitis

arthralgias

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36
Q

most common extra manifestational symptom of UC

A

arthralgias

37
Q

UC dx eval (one in red)

A

flex sigmoidoscopy

colonoscopy **preferred over flex to see extent of disease

38
Q

what will you see with flex sig or colonoscopy with UC

A

begins distally and spreads proximally

continuous circumferential pattern WITHOUT skip lesions

superficial inflammation: erythematous, exudate, friability/erosions

39
Q

what does a biopsy show from flex sig or colonoscopy for UC

A

crypt abscesses

40
Q

UC complications

A

colon cancer

hemorrhage

toxic megacolon

41
Q

colonoscopy recommended when with UC

A

every 1-2 years beginning 8 years after disease/symptom onset

42
Q

descrive toxic megacolon (complication of UC)

A

high mortality rate

rare

colonic dilation of greater than 6 cm with signs of toxicity

43
Q

CD and UC mgmt goals

A

achieve remission

maintain remission

improve quality of life

44
Q

antibiotics used in CD or UC

A

CD

45
Q

4 medical tx for both CD and UC

1 for CD

A

salicylates (5-ASA)

corticosteroids

immunomodulators

biologics

antibiotics (CD)

46
Q

when do you use step-up tx management for tx of IBD

A

low risk pts with mild disease

47
Q

when do you use step-down tx to tx IBD

A

high risk pts with moderate to severe disease

48
Q

side effects of 5-ASA

A

diarrhea

kidney injury

pancreatitis

49
Q

anti-inflammatory meds for IBD. what class

A

5-ASA

50
Q

anti-inflammatory meds with immune system suppression - what class

A

corticosteroids

51
Q

when do you do corticosteroids in IBD

A

flares in UC and CD

52
Q

what three things should you remember about corticosteroids

A

SLOW TAPER

have an exit strategy to avoid steroid dependence

short-term use ONLY

53
Q

what should you be cautious of with oral prednisone

A

systemic side effects

54
Q

when do you recommend DEXA scan with oral prednisone

A

if pt with IBD has had a lifetime use of steroids for 3+ mos

55
Q

what should be given with oral prednisone

A

calcium and vit D

56
Q

modifies immune system activity and decreases inflammatory response

what med class

A

immunomodulators

57
Q

what should you consider with 6MP and Azathioprine (imuran)

A

optimal response takes 3-6 months so may need to bridge them with another med

be aware of systemic risks

58
Q

what should you be aware of with methotrexate

A

folate supplementation

tetraogenic (M and F need to be off meds for 6 mos before conceiving)

59
Q

three immunomodulators

A

methotrexate

6-MP

imuran

60
Q

with immunomodulators what needs to be monitored

A

CBC and liver tests

61
Q

biologics AKA

A

Anti-TNF

62
Q

when do you use biologics

A

moderate to severe IBD

modulates immune response, prevents inflammation, improves mucosal healing

63
Q

what is something a provider should be aware of when tx with biologics

A

decreased or lost response to med

64
Q

what should you consider before anti-TNFs are given

A

PPD test

CXR for TB

Hep B assessment + vaccine if needed

65
Q

clinical monitoring of TNFs

A

regular CBC + CMP

annual dermatologic exams

66
Q

when do you give antibiotics and why

A

CD for perianal disease, fistulas, abscesses!!!

67
Q

what two antibiotics can you give with CD

A

cipro and metro

68
Q

cipro adverse effects

A

tendinitis

photosensitivity

prolongation of QT interval - arrhythmia

69
Q

metro adverse effects

A

periph neuropathy

metallic taste

disulfram rx

70
Q

IBD red flags

A

severe bleeding - sig anemia

severe abdominal pain - peritoneal signs (guarding, rigidity, rebound tenderness)

inability to tolerate PO

signs of dehydation - increased creatinine, tachy, hypotension

signs of obstruction

71
Q

IBD indications for surgery

A

severe hemorrhage

perforation

dysplasia/cancer

refractory disease not responding to medicine

72
Q

risk factors assoc with aggressive IBD

A

high risk anatomic locations like perianal region, extensive disease

penetrating/fistualizing disease

steroid resistance/dependence

severe disease activity - maplabsorption as evid by weight loss, nutrient def, hypoalbuminemia)

young age

73
Q

IBD primary care considerations: what should you always check if someone has a change in baseline stool habits

A

stool samples - want to make sure it is not bacterial/viral/etc

74
Q

IBD: what can exacerbate disease

A

NSAIDS

75
Q

health maintenance things primary care should be aware of

A

immunizations

cancer screenings

DEXA

anxiety/depression

smoking cessation

routine lab monitoring of CBC and CMP

76
Q

celiac age presentation

A

10-40 y/o

77
Q

gluten toxicity to small intestines results in what

A

mucosal inflammation –> crypt hyperplasia –> abnormal villous architecture

villous atrophy which results in loss of absorptive surface capacity and small bowel malabsorption

78
Q

3 assoc with celiac disease

A

genetics: HLA DQ2, HLA DQ8
autoimmune: thyroid, DM

downs

79
Q

classic celiacs

A

diarrhea, steatorrhea, flatulence/bloating, weight loss

80
Q

atypical celiac

A

pain, constipation, dyspepsia

81
Q

silent celiac

A

extra intestinal manifestations (like anemia)

82
Q

derm symptom found in celiac disease

A

dermatitis herpetiformis - chronic inflammatory disease that produces lesions that burn and itch. erythematous and slightly papular or pustular; sometimes vesicles

83
Q

3 ways to establish celiac dx

A

serologic testing

clinical suspicion

endoscopic findings

84
Q

what must be done on a gluten containing diet for accurate dx of celiac

A

serology and biopsy of small intestine

will find positive serologic antibody testing = igA tissue transglutaminase

85
Q

what antibody is primarily assoc with celiac disease

A

IgA tissue transglutaminase tTG Ab

86
Q

Gold standard for dx of celiac disease

A

EGD with duodenal biopsy

find villous atrophy

87
Q

CELIAC: mgmt acronym

A

Consultation with dietitian

Education about disease

Lifelong adherence

Identification and tx of nutritional def

Access to advocacy group/resources

Continuous follow-up

88
Q

complications with celiac disease

A

malabsoprtion - Fe, B vit, osteoporosis

malignancy - non-Hodgkin, GI malig

clin med iii (6 decks)

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