IBD, Celiac, Lactose Intolerance Flashcards Preview

Clin Med III Exam I > IBD, Celiac, Lactose Intolerance > Flashcards

Flashcards in IBD, Celiac, Lactose Intolerance Deck (63)
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1
Q

Etiology of IBD

A

dysregulated mucosal immune response to host gut flora in genetically susceptible individuals

2
Q

Two major types of IBD

A

Ulcerative colitis

Crohns disease

3
Q

What parts of the GI tract does UC affect?

A

mucosa/submucosa of the colon and rectum (diffuse lesions)

4
Q

What parts of the GI tract does Crohns disease affect?

A

the entire GI tract, transmurally (skip lesions)

5
Q

Damage to what can contribute to IBD

A

epithelial mucin proteins and tight junctions

6
Q

The breakdown of homeostatic balance between what two things can contribute to IBD (2 groups)

A

host mucosal immunity and enteric microflora

regulatory and effector T cells

7
Q

Polymorphisms is what things are a factor in IBD

A

toll like receptors

8
Q

IBD is common in what geographic location

A

western world and industrialized countries

9
Q

Which type if IBD is most common

A

UC

10
Q

Incidence of UC

A

bimodal distribution

15-30 years and 50-70 years

11
Q

What things put you at a higher risk for developing UC?

A
  • being Jewish
  • hx of GI infections
  • weak association with OCP and NSAID use
12
Q

What factors can lower your risk of getting UC or make the disease milder?

A

smoking

13
Q

What are the most common presenting sx with UC?

A
  • rectal bleeding
  • bloody diarrhea
  • abdominal pain
14
Q

What elements classify UC as mild to moderate?

A
  • <4 bloody BMs a day
  • urgency and tenesmus
  • LLQ cramping relieved by a BM
  • possible fever, anemia, hypoalbunemia
15
Q

What classifies UC as severe?

A
  • > 6 bloody BM a day
  • severe anemia, hypovolemia, hypoalbunemia with nutritional deficit
  • abd pain
16
Q

What is fulminant colitis?

A

subset of severe disease whichc is rapidly worsening sx’s with toxicity (pt present septic)

17
Q

What is the clinical course of UC?

A

periods of remission and relapse

18
Q

Common extraintestional manifestations of UC

A
  • apthous ulcers
  • iritis/uveitis/episcleritis
  • erythema nodosum
  • seronegative arthritis, ankylosing spondylitis, sacroilitis
  • primary sclerosing cholanitis
19
Q

Which extraintestional manifestations improve after a colectomy

A
  • arthritis
  • ankylosing spondylitis
  • erythema nodosum
  • pyoderma gangrenosum
20
Q

Which extraintestional manifestations do not improve after a colectomy

A

primary sclerosing cholangitis

21
Q

What needs to be ruled out before a diagnosis of UC can be made

A

infectious and non infectious causes of diarrhea

  • infectious colitis
  • radiation proctitis
  • ischemic colitis
  • CMV colitis
  • STI proctitis
22
Q

What labs are used to diagnose UC

A

ESR, CRP, H/H, albumin

23
Q

What does a colonoscopy show in a patient with UC

A
  • diffuse disease proximal to the dentate line
  • friability of mucosa
  • erythema, erosions, ulcerations, spontaneous bleeding
24
Q

Histologic features of UC

A
  • crypt abscess
  • infiltration of lamina propia with plasma cells, eosinophils, lymphocytes
  • lymphoid aggregates
  • mucin depletion
25
Q

Medical treatment for mild disease

A

aminosalicylates (5-ASA)

mesalazine or sulfasalazine

26
Q

Medical treatment with failure of 5-ASA

A

budesonide (preferred)

prednisone

27
Q

Medical treatment of serve disease

A

hospitalization and IV methylprenisolone with IVF

28
Q

Medical treatment of severe disease with steroid resistance

A

TNF- alpha blocker

VGEF blocker

29
Q

What is the last resort treatment for severe disease

A

cyclosporine

30
Q

Maintenance therapy for UC

A

5-ASA (if responsive)
steroids
immunosuppresants

OR
continue with infliamab if induction therapy successful

31
Q

Surgical therapy for UC

A

colectomy

32
Q

When is a colectomy considered emergent? urgent? elective?

A

emergent: life threatening complications related to fulminant colitis or toxic megacolon that is unresponsive to medical treatment
urgent: severe disease admitted to hospital and not responding to medical treatment
elective: refractory disease, colorectal dysplasia or adenocarcinoma found on screening, long term disease (7-10 years)

33
Q

When to pts begin to be screened for colorectal cancer w/ UC

A

8 years after diagnosis of disease

34
Q

In patients with UC, when do you do a follow up colonoscopy if proctitis/proctosigmoiditis is found on initial screen? left-sided colitis/pancolitis? if patient hasPSC?

A

proctitis: follow specific age guidelines
left-sided colitis: every 1-2 years
UC w/ PSC: anually from time of diagnosis of PSC

35
Q

In Crohns disease inflammation causes what in the GI tract

A

strictures, fistulas, ulcerations, abcesses

36
Q

Extraintestinal manifestations of Crohns disease

A
  • arthralgia
  • iritis/uveitis
  • pyoderma gangrenosum or erythema nodosum
37
Q

Factors attributing to Crohns disease

A
  • family history
  • smoking
  • sedentary lifestyle
  • exposure to air pollution
  • post infectious gastroenteritis
38
Q

Presentation of Crohns disease

A
  • RLQ intermittent abdominal pain
  • diarrhea (watery/nonbloody)
  • weithloss, anorexia
  • weakness
39
Q

Complications of Crohns disease

A
  • abcess
  • obstruction
  • fistula
  • perianal disease
  • carcinoma
  • malabsorption
40
Q

Gold standard for diagnosis of Crohns

A

colonoscopy and mucosal biopsy

41
Q

Labs for diagnosis of Crohns

A

CRP/ESR, fecal calprotectin, H/H, albumin, WBC

42
Q

Treamtent of mild Crohns

A

colon and small bowel disease= mesalamine

43
Q

Treatment of moderate to severe Crohns

A

Budesonide (short term)
immunosuppresants
TNF-alpha blockers (unable to taper from steroid)
anti-integrins (last line, not responsive to anything else)

44
Q

Treatment of fistula disease in Crohns

A

ABX (flagyl and metronidazole)
immunosuppressants/ TNF-alpha
surgery

45
Q

Is surgery curative in Crohns diseae

A

NO

46
Q

When us surgery indicated in Crohns disease

A
  • abscess
  • intractable fistula
  • toxic megacolon
  • strictures with obstruction
  • perforation
  • cancer
47
Q

When do you admit someone with Crohns to the hospital

A
  • bowel obstruction
  • intra abdominla or perirectal abscess
  • sevre sx
  • serious infections in immunocompromised population
48
Q

What screenings should be done for pts with Crohns

A
  • TB
  • hepatits
  • CMV
  • HIV
  • C diff
  • colonscopy
49
Q

What is celiac sprue disease

A

immunologic/inflammatory response to ingested gluten

50
Q

What part of the GI tract does celiac sprue affect

A

mucosa of proximal small bowel

51
Q

GI presentation of celiac

A

presenation

  • diarrhea
  • borborygmus
  • weightloss
  • weakness
  • abd pain
52
Q

Extraintestional sx of celiac

A
  • anemia
  • dermatitis herpetiformis
  • hormonal disorders
  • osteopenia and osteoperosis
53
Q

Do older or younger people present with more GI sx at time of diagnosis

A

younger

54
Q

Lab testing for celiac. What will it show?

A

CBC- anemia
CMP- malnutrition, electrolyte abnormality
Coags- PT prolonged (vit K def)
Stool- fat malabsorption

55
Q

Serologic testing for celiac

A

IgA TTG
IgA level
if less than 2 do IgA TTG and IgG

56
Q

Gold standard for dx of celiac

A

endoscopy and mucosal biopsy of proximal and distal duodenum

57
Q

What will an endoscopy show in a pt with celiac

A
  • atrophy or scalloping of duodenal folds
  • absent villi or atrophic villi
  • hypertrophy of crypts
58
Q

Treatment of celiac

A

REMOVE ALL GLUTEN

-steroid if accidental ingestion of gluten

59
Q

What causes lactose intolerance

A

inability to digest lactose, not enough lactose

60
Q

Lactose intolerance can develop secondarily to what other diseases

A
  • celiac
  • crohns
  • giardia
  • viral gastrointeritis
  • malnutrition
  • short bowel syndrome
61
Q

Clinical presentation of lactose intolerance

A
  • abd bloating/cramping
  • flatulence
  • diarrhea
  • nausea
  • borborygmi
62
Q

Labs for lactose intolerance

A

hydrogen breath test

63
Q

Treatment for lactose intolerance

A
  • remove lactose
  • lactase enzyme replacement
  • spread lactose intake throughout the day