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GI Week 6 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What are the two branches of IBD?

A

ulcerative colitis and crohns disease

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2
Q

what part of the GI tract is always affected in UC?

A

rectum (extends proximally)

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3
Q

What are the two potential patterns one sees in crohns disease?

A

obstructive/fibrostenotic

pentrating/fistulizing

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4
Q

Which gender is affected by IBD more offten?

A

effected equallye

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5
Q

WHen is the peak incidence for IBD?

A

age 15-25

but there’s a bimodal distribution with a second less significant peak from age 60-70

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6
Q

What countries have more IBC?

A

Westernized countries like US, canada and Europe

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7
Q

What are the sypoms of UC?

A 
bloody mucoid diarrhea
tenesmus
fecal incontinence
abdominal pain
weight loss
arthralgias, uveitis and dkin ulcers
jaunduce if you get scelrosin cholangitis
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8
Q

What are the symptoms of CD?

A 
nonbloody diarrhea
abdominal pain
weight loss
perianal abscesses or fistulas
growth failure in kids
fever
nausea/vomiting
arthralgias, mouth ulcers, erythema nodosum
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9
Q

What layers of the wall are affected in UC?

A

only the mucosa

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10
Q

What percentage of epople with UC will udnergo colectomy over 30 years?

A

30%

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11
Q

What is the risk for colon cancer after 30 year of ulcerative colitis?

A

18% - nearly 1 in 5

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12
Q

What percentage of people with UC will have primary sclerosing cholangitis?

A

4%

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13
Q

UC typically starts in the rectum and then spreads proximally until it abruptly stops. What are the two exceptions to this rule?

A
  1. periappendiceal ulceration
  2. Backwash ileitis just past the ileocecal junction

probably because these areas have high levels of lymphocytes which mean they can inflame easily

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14
Q

What will happen to the crypts histologically in UC

A

you get mucosal inflammation with cryptitis and crypt abscesses

PMNs will fill the crypts and branching can occur if chronic

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15
Q

What layers of the wall are affected in CD?

A

all of them - transmural

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16
Q

What part of the GI tract is affected in CD?

A

can be anywhere - usually spares the rectum though

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17
Q

What is the most common location for CD?

A

termianl ileum (70%)

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18
Q

What are the complications associated with the transmural involvement in CD?

A

fistulae, abscess and strictures

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19
Q

Which is more likely to have bloody diarrhea - CD or UC?

A

UC

20
Q

What percentage of people will need surgery after 15 years of CD?

A

80%

and once you have a resection, you’ll likely need another eventually

21
Q

What’s the almost-pathonomonic histology tip off that it’s crohn disease?

A

non-caseating granuloma (but you often don’t see them)

22
Q

What serology will be positive in CD?

A

anti-saccharomyces cerevisiae

23
Q

What serology will be positive in UC?

A

pANCA

24
Q

What are the musculoskeletal manifestations of IBD?

A

arthritis, ankylosing spondylitis, osteoporosis, sacroilitis

25
Q

What are the skin and mouth manifestiosn of IBD?

A

erythema nodosum, pyoderma gagnrenosum, apthous ulcers, vitiligo, psoriasis, amyloidosis

26
Q

What are the ocular manifestations of IBD?

A

uveitis, iritis

27
Q

What are the hepatobiliary manifestations of IBD?

A 
primary sclerosing cholangitis
cholangiocarcinoma
heptatitic
pericholangitis
gallstones
28
Q

Which are the complications of IBD - both UC and CD?

A 
hemorrhage
hypercoagulability
amyloidosis
colon cancer
osteoporosis
29
Q

Which will will have higher risk for toxic megacolon?

A

UC

30
Q

Which will have the risk for primarily sclerosing cholangitis?

A

UC

31
Q

Which will have the risk of obstruction?

A

CD

32
Q

What are the four issues that can crop up in CD affecting the ileum or after ileal resection?

A
  1. bile salt diarrhea
  2. gallstones
  3. vitamin B12 deficiency
  4. oxylate stones (calcium binds to the malabsorbed fat instead of the oxylate)
33
Q

True or false: the colon cancer that arises in ulcerative colitis or crohn’s typically develops in the same fashion as other CRC?

A

false

other cRC usually starts as an adenomatous polyp or serrated polyp progresses thoruhg the adenoma-carcinoma sequence

in IBD you get fields of dysplasia from the chronic inflammation which then gives rise to a flat or depressed adenoma which can progress to carcinoma

34
Q

What are some characteristics of an IBD case that would suggest higher risk for CRC?

A
  1. disease proximal to splenic flexure
  2. over 8 years of disease ( young age at diagnosis)
  3. primary sclerosin cholangitis as complicaitons
  4. family hx of CRC
  5. pseudopolyp son colonoscopy (wouldn’t be able to pick out an adenomatous polyp if it was there)
35
Q

What drug is protective against CRC in IBD?

A

5-ASA

36
Q

What should the colonoscopy schedule be in IBD?

A

every 1-2 years after 7 years of disease

37
Q

True or false: surgery is essentially curative in UC?

A

true

38
Q

Describe the environemtnal influences that may affect IBD incidence?

A
  1. clean kid hypothesis
  2. more common in cold climates
  3. more common in industrialized areas
  4. smoking worsens CD, may be protective against UC
39
Q

True or false: treatment for IBD is considered more dangerous to a fetus than the disease itself, so we typically don’t treat pregnant women.

A

false 0 active disease increases risk to fetus and mother in pregnancy

continue all treatments with the exception of methotrexatee

40
Q

What are the general treatment expectations for IBD?

A
  1. induce clinical remission
  2. maintain clinical remission
  3. improve patient quality of life

if you can do those….

  1. heal mucosa (endoscopic remission)
  2. decrease hospitalization/surgery/cost
  3. minimized disease-related and therapy-related complication
41
Q

Describe the IBD therapeuti pyramid.

A

mild disease = start with 5-ASAs
moderate disease = steroids to induction and immunomodulators like methorexate, azathrioprine and 6-mercaptopurine. also infliximab
severe disease = surgery

42
Q

Can the steroids be used for maintenance therapy

A

no

43
Q

What are hte two 5-ASAs as know?

A

sulfasalazine

mesalamine

44
Q

What is infliximab an antibody against?

A

TNFalpha

45
Q

Why do you need to give a patient an immune modulator if they’re on infliximab?

A

to minimize the risk of them developing antibodies against the infliximab with subsequent loss of response

46
Q

What are the UC indications for surgery?

A

exsanguinating hemorrhage
unresponsive acute diasease
perforaiton
cancer or dysplasia (no question)

chronic intractability
steroid dependency
growth retardation
systemic complicatoins

47
Q

What are the CD indications for surgery?

A

free perforation
massive hemorrhage
cancer or dysplasia
chronic high grade obstruction

intractability
complex fistulae and abscesses
perianal complicaitons
grwoth retardation in kids

GI Week 6 (14 decks)

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