Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med III Exam 1 > IBD & Celiac's > Flashcards

IBD & Celiac's Flashcards

(79 cards)

Start Studying
1
Q

IBD consists of

A 
Chrohn Disease (CD)
Ulcerative Colitis (UC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for IBD

A 
15-35 YO (bimodal w/ second peak 50-80)
Men- UC
Women: CD
Caucasian and Jewish
1st degree relative w/ IBD
Smoking (increases CD; decreases UC)
potential association w/ "western" diet
imbalance in gut microbiome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Crohns disease overview

A

GI tract from mouth to anus
patchy/skip lesions
Transmural inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ulcerative Colitis

A

limited to colon, involves rectum
extends proximally w/ continuous, circumferential involvement
mucosal layer inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Severity of CD involvement

A

entire GI from mouth to anus w/ SKIP lesions
- mouth (apthous ulcers) or gastroduodenal area
- ileum –> ileitis (most common) **
- terminal ileum (TI) & proximal ascending colon –> ileocolitis
- colon –> colitis “chrohn colitis”
perianal disease (abscess, fistula)

transmural – entire thickness of mucosa
PENETRATING DISEASE- ulcer, stricture, fistula, abscess

FISTULA (Tunnel) between two epithelial lined organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

skip lesion

A

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mucosal inflammation

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

transmural inflammation

A

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Types of fistulas

A

enteroenteric
enterovesical
enterovaginal
enterocutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Presentation of CD

A

depends on severity:
mild - inflammation
moderation- inflammation, strictures
severe - inflammation, strictures, fistula

insidious onset, usually intermittent - alternate bw exacerbations and relative remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hx and PE for CD

A

+/- fever, chills, fatigue, weight loss
+/- n/v, diarrhea (nocturnal), fecal urgency, tenesmus, rectal bleeding, perianal pain, fissure, abscess, IDA, B12 deficiency (TI involvement)

ABDOMINAL PAIN: RLQ pain/tenderness; tender, palpable RLQ mass (if abscess)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Extra-intestinal manifestations of CD

A 
oral apthous ulcers
episcleritis, iritis, uveitis
erythema nodosum
pyoderma grangrenosum
ARTHRALGIAS **
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dx of CD

A

CBC, CMP, ESR/CRP (+/- IBD specific antibodies)

Stool study: culture, c.diff, O&P, fecal calprotectin or lactoferin

Scope: colonoscopy w/ TI intubation; +/- IBD **

Imaging:
+/- CT, MR enterography, UGI w/ SBFT, capsule endoscopy (not in intestinal stricture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Contra of capsule endoscopy

A

patients w/ suspected intestinal stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnostic findings in CD

A 
skip lesions
ulcerations, cobblestoning
possible fistulas
rectal sparing in most pts
bx = GRANULOMAS (30% PTS) and chronic inflammation

CT/MR enterograph - inflammation, stricture, abscess, fistula

UGI w/ SBFT - “string sign”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

fecal calprotectin

A

shows inflammation in bowed (IBD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complications of colon cancer

A

Colon CA
strictures, abdominal and perianal fistulas, abscess - SMALL BOWEL OBSTRUCTION/PERFORATION
malabsorption* (Fe, B12)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How often should CD get colonoscopy

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

UC severity/extent

A

colon only; continuous, circumferential; mucosal surface only – friability, erosions, bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Presentation of UC

A

mild: <4 stools/day, no systemic
mod: >4 stools daily, anemia, low grade fever
severe: >6 stools, systemic toxicity

insidious, intermittent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hx and PE for UC

A

• +/- Fever, chills, fatigue, weight loss
• +/- Nausea/vomiting
• Abdominal pain***
- Periumbilical/LLQ pain
• Bloody diarrhea
• Fecal urgency, tenesmus, rectal bleeding • Constipation (if proctitis)
• +/- iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Extra-intestinal manifestations of UC

A
  • Episcleritis, iritis, uveitis
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Sclerosing cholangitis – (Alk phos) **
  • Arthralgias*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Labs for UC

A

CBC, CMP, ESR, +/- IBD antibodies
Stool studies: fecal calprotectin or lactoferrin

Scope* - Flex Sigmoidoscopy or Colonoscopy

Imaging: CT A/P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnostic findings for UC

A

• Inflammation begins distally, spreads proximally
• Continuous circumferential pattern, no skip lesions
• Loss of vascular markings
• Superficial inflammation: erythematous,
exudate, friability/erosions
• Strictures rare
• Biopsy shows – crypt abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Complications
Colon CA Hemorrhage Toxic Megacolon**** - chronic dilation >6 cm w/ signs of toxicity
26
Goal of IBD management
obtain and remain remission; healing mucosa
27
Medical therapies used
Salicylates (5-ASA) corticosteroids immunomodulators (6MP, Azathiopurine, Methotrexate) Biologics (anti-TNFs) Antibiotics (CD)*** - due to perianal disease (abscess/fistulas) surgery
28
Step-up therapy
low risk patients w/ mild disease
29
Step-down
high-risk pts w/ moderate to severe disease
30
5-ASA MOA
anti-inflammatory effects
31
Indications for ASA
mild/mod UC (primarily) and CD (less efficacy)
32
Options for 5-ASA
Sulfasalazine (must take folic acid) Mesalamine (generic name for): - PO: Asacol, Apriso, Lialda, Pentasa -- small bowel and colon - Topical: Canasa suppository; Rowasa enema (left colon)
33
SE of 5-ASA
nausea diarrhea* kidney injury* pancreatitis
34
MOA of cortciosteroids
anti-inflammatory | suppress immune system
35
Indications of corticosteroids
FLARES in UC & CD - short term use - exit strategy to avoid dependence - requires slow taper
36
Options for Corticosteroids
Oral Prednisone (caution systemic side effects) • Oral Budesonide (modified steroid provides targeted therapy with less systemic side effects) - Entocort – (CD), ileocecal disease - Uceris (UC) • Hydrocortisone suppositories, enemas, foams – distal colonic disease
37
SE of Oral Prednisone
* Mood changes * Insomnia * Weight gain * Worsening of Diabetes • Increased infection risk • Osteoporosis * Cataracts * Psychosis * Adrenal insufficiency
38
Recommendations for oral prednisone
DEXA scan in those with lifetime use of steroids >3 months Ca and Vit D supplementation
39
MOA of immunomodulators
modifies immune system activity; decreases inflammatory response
40
Indication of immunomodulators
moderate to severe UC & CD**; steroid sparing agent; can be used in combination with biologics to prevent immunogenicity
41
Options for immunomodulators
• 6- Mercaptopurine (6MP), Imuran (Azathioprine) - Optimal response takes 3-6 months - Genetic testing* necessary to determine patient metabolism of drug - Be aware of systemic risks • Methotrexate - Requires folate supplementation - Tetratogenic
42
SE of 6MP, Azathioprine
* Bone marrow suppression • Secondary infection * Pancreatitis * Hepatotoxicity * Non-Hodgkin lymphoma * HPV-related cervical dysplasia • Non-melanoma skin cance
43
Recommendations fo 6MP, Azatioprine
CBC, LFT annual derm exams up to date on cervical CA screening
44
MOA of Anti-TNFs
Modulates immune response; prevents intestinal inflammation, improves mucosal healing
45
Indications of Anti-TNFs
Moderate to severe IBD; steroid sparing | • May be given as monotherapy or in combination with thiopurines
46
Options for anti-TNFs
* Infliximab (Remicade) - (UC &CD) *Risk of infusion reaction* * Adalimumab (Humira) – (UC & CD) * Golimumab (Simponi) – (UC) * Certolizumab (Cimzia) – (CD)
47
Cons of Anti-TNFs
Effective, but can be associated with decreased or lost response Clinicians utilize “Therapeutic drug monitoring” to help guide decision making -- are there antibodies? change dosage? be aware of systemic risks
48
SE of Anti-TNFs
``` • Secondary infections • Risk of reactivation of TB and HBV • Malignancies • Non-melanoma skin cancer • Non-Hodgkin lymphoma ```
49
Contraindications of Anti-TNFs
* Active infection * History of CHF * MS/optic neuritis
50
Condierations prior to anti-TNF therapy
TB, HBV testing
51
monitoring in Anti-TNFs
CBC, CMP | annual derm exams
52
Biologics MOA
Modulates immune response; prevents intestinal inflammation
53
inidcations for biologics
Considered in patients with inadequate or loss response to | conventional therapies
54
Options for biologics
* Vedolizumab (Entyvio) - (UC & CD) * Natalizumab (Tysabri) - (CD) * Rarely used given gut selectivity and safety profile of Vedolizumab * Ustekinumab (Stelara) - (CD) * No demonstrated increase in severe infections or malignancy
55
Abx indication
acute disease for CD - perianal disease * - fistulas, abscess
56
Abx choices
Cipro | Flagyl
57
Cipro SE
tendinitis (rupture) photosensitivity prolonged QT (arrhythmia)
58
Flagyl SE
peripheral neuropathy metallic taste disulfiram rxn (avoid ETCH and 3 days after tx)
59
Red flags for IBD
``` • Severe bleeding • Significant anemia • Severe abdominal pain • Peritoneal signs • Inability to tolerate PO • Signs of dehydration • Increased creatinine, tachycardia, hypotension - Signs of obstruction ```
60
Indications for surgery
severe hemorrhage perforation dysplasia/cancer medical refractory disease
61
Risk factors assoicated w/ aggressive disease (benefit from early step-down tx)
high risk anatomic locations (extensive disease, perianal) penetrating/fistualizing disease steroid resistance/dependence severe disease activity (malabsorption as evidenced by weight loss, nutrient deficiency, hypoalbuminemia) young age
62
Change in BM and diarrea in IBD
check stool study (for infection) NSAIDS exacerbate disease ensure f/u compliance w/ GI identify those w/ increased infection risk- steroids, immunomodulators, biologics
63
Exacerbate IBD
NSAIDS
64
Health Maintenance for IBD
* Immunizations * Cancer screening (Colon, Skin, Cervical) * Osteoporosis screening with DEXA * Anxiety/Depression Screening * Smoking cessation * Routine laboratory monitoring (CBC/CMP)
65
Epidemiology of celiac disease
whites of northern european ancestry originally in infants, but now more frequently in 10-40 YO
66
What is celiac's disease
Immune-mediated disease triggered by the ingestion of gluten (wheat, rye, barley) in genetically susceptible individuals
67
Triggers in gluten for celiacs
wheat rye barley
68
Response of small intestine to gluten
- mucosal inflammation, crypt hyperplasia & abnormal villous architecture - villous atrophy of small intestines --> loss of absorptive surface capcity and small bowel malabsorption
69
Associated w/ celiacs
genetic- HLA DQ2, HLA DQ8 autoimmune disease (DM, thyroid disease) Down syndrome
70
Presentation of celiac
"classic" malabsorptive sx: diarrhea, steatorrhea, flatulence/bloating, weight loss "atypical" GI sx: ab pain, constipation, dyspepsia Silent: extra-intestinal manifestations
71
Extra-intestinal manifestations in celiac disease
* Nutrient deficiencies (Iron, B vitamins)* * Osteopenia/Osteoporosis (Vitamin D & Calcium deficiencies) * Transaminase elevation * Dermatitis Herpetiformis*** * Neuropsychiatric symptoms * In kids, may see FTT * Reproductive disorders (infertility, miscarriages)
72
Dermatitis herpetiformis
burning and itching lesions erythematous and papular, pustular or vesicles pathognomonic of celiac
73
Dx of Celiacs
Serology AND Bx of small intestines while on gluten diet (+) serologic antibody testing: IgA tissue transglutaminase (tTG Ab)***, IgA endomysial (EMA Ab titer), Deamidated GLiadin Peptide (DGP- IgA levels must be normal for test to be valid) EGD w/ duodenal bx = GOLD STANDARD - intraepithelial lymphocytes - crypt hyperplasia - villous atrophy
74
gold standar dx for celiac
villous atrophy on EGD bx
75
Primary antibody in celiacs
IgA tissue transglutaminage (tTG Ab)
76
Management of Celiac
gluten free diet - fresh fish, meat, poultry, milk, fruits/veggies
77
Supplements in celiac
``` Folate Iron Zinc Calcium B12 D ```
78
Overall managment of celiac
``` Consult w/ dietitian Educate about disease Lifelong gluten-free diet I- identify/tx nutrtional deficiencies Access advocacy groups/resources Continuous long-term f/u ```
79
Complications of celiac
malabsorption: Fe, B vitamin, Osteoporosis (Ca, vit D) - get DEXA at diagnosis Slight increase of malignancy - non-hodgkin lymphoma - GI malignancies

Clin Med III Exam 1 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions