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MS2 Exam 2 > IBD: Chrohn's > Flashcards

IBD: Chrohn's Flashcards

1
Q

IBD Definition

A

term encompassing a number of chronic inflammatory disorders leading to damage of the GI tract

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2
Q

IBD includes…

A
  • Ulcerative colitis

- Chrohn’s Diz

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3
Q

IBD is…

A
  • autoimmune dz
  • chronic inflammation with remissions and exacerbations
  • inflammation and consequences are different for CD and UC
  • Serious digestive problems
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4
Q

Etiology of IBD

A
  • unknown
  • infectious agents
  • altered immune responses
  • autoimmunity
  • lifestyle (smoking)
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5
Q

Musculoskeletal Manifestations of IBD

A
  • peripheral arthritis
  • sacroilitis
  • ankylosing spondylitis
  • osteoporosis
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6
Q

Dermatologic Manifestations of IBD

A
  • erythema nodosum
  • pyoderma gangrensoum
  • aphthous stomatitis
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7
Q

Hepatobiliary Disease

A

primary sclerosing cholangitis

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8
Q

Ocular Manifestations of IBD

A
  • uveitis
  • scleritis
  • episcleritis
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9
Q

Vascular Manifestations of IBD

A

Thromboemoblic events

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10
Q

Renal Manifestations of IBD

A

Nephrolithiasis

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11
Q

Therapies used by interdisciplinary Team

A
  • diagnostic tests
  • pharmacologic therapy
  • complementary and alternative therapy
  • surgery, including ostomies
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12
Q

Risk factors for IBD

A
  • more frequent in US and northern europe
  • american jews of european descent 4-5x more likely to develop IBD
  • AA and white more than hispanics or asians
  • smoking increased risk of CD
  • use of NSAIDs and antibiotics
  • peaks at 15-30 yrs of age
  • second peak in the 50s
  • equally in men and women
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13
Q

Crohns Disease Manifestations

A

-cobblestone appearance of bowel wall with patchy distribution from mouth to anus

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14
Q

Symptoms of CD

A
  • fevers, night sweats and weight loss (nutrition deficit)
  • abdominal pain
  • N/V/D (or constipation)
  • rectal bleeding
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15
Q

Clinical Manifestations Intestinal Complications

A
  • intestinal obstruction
  • abscesses
  • fistulas
  • perforation
  • massive hemorrhage
  • colon cancer
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16
Q

Physical Examination in CD

A
  • weight loss/pallor
  • clubbing of fingers
  • abdominal distension
  • tenderness in the area of involvement
  • abnormal bowel sounds
  • presence of an inflammatory mass are common
  • perianal abscess, fistula, skin tags, or anal stricture
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17
Q

Lab Studies

A
  • Anemia
  • Luekocytosis
  • Thrombocytosis
  • Elevated ESR and C-reactive protein levels
  • Decreased serum albumin levels
  • Prometheus
  • Urinalysis commonly demonstrates calcium oxalate crystals
  • stool analysis for fecal leukocytes
  • serologic markers with high specificity for CD
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18
Q

Anemia

A

-deficiencies of iron, vitamin B12, folic acid

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19
Q

Imaging Studies

A
  • plain abdominal xray
  • barium studies
  • U/S abdomen and Pelvis
  • CT abdomen and pelvis
  • MRI
  • Sigmoidoscopy
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20
Q

Mild-Moderate CD

A
  • ambulatory patients
  • patients who are able to tolerate oral meds
  • patients without manifestations
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21
Q

Moderate-Severe CD

A
  • patients who have failed to respond to tx for mild-moderate disease
  • patients with more prominent symptom of fever, wt loss, abdominal pain or tenderness, intermittent N/V, significant anemia
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22
Q

Severe CD

A
  • patients with persistent symptoms despite the introduction of steroids as out patient
  • individuals presenting with high fever, persistent vomiting, evidence of intestinal obstruction, rebound tenderness, cachexia, or evidence of abscess
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23
Q

CD in Remission

A
  • patients who are asymptomatic or without inflammatory
  • patients who have responded to acute medical intervention or have undergone surgical resection without gross evidence of residual disease
  • patients requiring steroids to maintain well-being are considered to be “steroid-dependent” and are usually not considered to be “in remission”
24
Q

Current Goals for CD Therapy

A

Top-Down:

  • induce clinical remission
  • maintain clinical remission
  • improve quality of life

plus:

  • heal mucosa
  • decreases hospitalization/surgery/overall costs
  • minimize disease-related and therapy-related complications
25
Q

Tx for Mild-Moderate CD

A

Mild: antibiotics and aminosalicylates

Moderate: immunomodulators and corticosteroids

26
Q

First Line of Therapy

A

Aminosalicylates (4-ASA compounds)

Drugs used:

-decrease GI inflammation

-effective in achieving and maintaining
remission

  • for mild to moderate episodes
  • causes fewer adverse effects than sulfasalazine
  • inexpensive and effective for many patients that tolerate it
  • oral delayed-release
27
Q

Pentasa/Apriso

A

-release 5 ASA directly to small intestine/colon or to the ileum

28
Q

Olsalazine(Dipenteum) or Balsalazide(Colazal)

A

to colon only

29
Q

Antibiotics

A
  • used with flare ups

- used when abscesses form

30
Q

Metronidazole

A

Flagyl

Antibiotic

31
Q

Ciprofloxacin

A

Cipro

Antibiotic

32
Q

Rifaximin

A

Xifaxan

Antibiotic

33
Q

Immunomodulators

A
  • suppress immune response
  • most useful in those who do not respond to aminosalicylates, antibiotics, or corticosteroids

-require regular CBC monitoring

34
Q

Azathoprine (Imurna, Azasan)

A

Immunomodulators

35
Q

6-mercaptopurine (6-MP, Purinethol)

A

Immunomodulators

36
Q

Cyclosporine A (Sandimmune, Neoral)

A

Immunomodulators

37
Q

Tacrolimus (Prograf)

A

Immunomodulators

38
Q

Methotrexate

A

Immunomodulators

39
Q

Corticosteroids

A
  • decrease inflammation
  • used to achieve remission
  • helpful for acute flare ups
40
Q

Prednisone

A

Deltasone

Corticosteroids

41
Q

Methylprenisolone

A

Medrol, Solu-Medrol

Corticosteroids

42
Q

Hydrocortisone

A

Corticosteroids

43
Q

Buedesonide

A

Entocort or UCERIS

Corticosteroids

44
Q

Tx for Moderate-Severe CD

A
  • Cortcosteroids
  • Biologic Therapies
  • Surgery
45
Q

Biologic Therapies

A

block a small inflammatory protein called tumor necrosis factor alpha that promotes inflammation in IBD

  • induces and maintains remission
  • newest IBD drugs
46
Q

Infliximab

A

Remicade

-only approved for UC

47
Q

Natalizumab

A

Tysabri

-only approved for Chrohn’s

48
Q

Adalimumab

A

Humira

-biologic approved for both UC and Crohn’s

49
Q

Certolizumab pegol

A

Cimzia

-only approved for Chrohn’s

50
Q

Nursing considerations for IBD

A
  • nonadherence
  • lack of knowledge
  • concerns about side effects
  • lack of trust in meds
  • diminished sense of priority for meds
  • burden of taking the meds
  • tx cost
51
Q

Complementary and Alternative Therapy

A
  • Encourage patients to discuss all potential therapies with the primary care provider
  • may interact with prescribed meds
  • includes herbals and OTCs
52
Q

Types of Alternative and Complementary Tx

A
  • antidiarrheal
  • probiotics
  • vitamin b12
  • zinc
  • iron
  • folate acid
  • calcium
  • potassium
53
Q

Tx for Severe CD

A
  • Hospitalization
  • High recurrence rate
  • surgery
  • Parenteral broad spectrum antibiotics
  • nutritional support (elemental or TPN)
54
Q

Parenteral broad spectrum antibiotics

A
  • high fever
  • toxic appearance
  • inflammatory mass
55
Q

Nutritional Support

A
  • TPN in addition to steroids plays no specific role
  • indications: patients unable to maintain nutritional requirements after 5-7 days
  • preop management
  • pediatric
56
Q

Proven efficacy for perianal fistulas in CD

A

infliximab

57
Q

Possible efficacy for perianal fistulas in CD

A
  • antibiotics
  • AZT/6-MP
  • Cyclosporine

MS2 Exam 2 (9 decks)

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