Inflammatory Bowel Disease

Question 1

What is inflammatory bowel disease?

Answer 1

A dysregulated, inappropriate response of the intestinal immune system, to an otherwise innocuous luminal antigens, in a genetically susceptible host

Question 2

What are the three types of crohn’s disease?

Answer 2

ileitis
colitis
ileocolitis

Question 3

UC or CD: diffuse mucosal inflammation limited to the colon

Answer 3

UC

Question 4

UC or CD: affects rectum

Answer 4

UC

Question 5

UC or CD: patchy, transmural inflammation

Answer 5

CD

Question 6

UC or CD: may affect any part of the GI tract

Answer 6

CD

Question 7

UC or CD: may involve all or part of the colon, but no further

Answer 7

UC

Question 8

Who usually has UC?

Answer 8

Young people 20-30s

Question 9

What is the effect of smoking on UC? CD?

Answer 9

Lowers UC, increases CD

Question 10

What is the effect of an appy on UC? CD?

Answer 10

Lowers CD, no effect on CD

Question 11

What is the effect of high sanitation in childhood on UC? CD?

Answer 11

No effect on UC

Increases CD

Question 12

What is the effect of high carb intake on UC? CD?

Answer 12

UC no effect

Increases CD

Question 13

What is the effect of perinatal infection on UC? CD?

Answer 13

UC = ?
CD = increases

Question 14

What is the dysbiosis theory of IBD?

Answer 14

Decrease protective bacteria, increased aggressive bacteria

Question 15

What are the effect of dysregulated immune response on IBD?

Answer 15

Loss of tolerance

Defective apoptosis

Question 16

What is the cytokine that causes Th0 cells to turn into Th1 cells?

Answer 16

IL-12

Question 17

What is the cytokine that causes Th0 cells to turn into Th3 cells?

Answer 17

IL-10

Question 18

What is the role of Th1 cells in IBD?

Answer 18

cell mediated granulomas

Question 19

What is the role of TH2 cells in IBD?

Answer 19

Hypersensitivity

Question 20

Which has a higher genetic influence: CD or UC?

Answer 20

CD

Question 21

What is the gene that transmits IBD susceptibility?

Answer 21

Polygenic

Question 22

What are the three factors that lead to the development of IBD?

Answer 22

Luminal antigen
Genetic susceptibility
Environmental triggers

Question 23

What is the usual presentation of UC?

Answer 23

Bloody diarrhea
Rectal discomfort
Fecal urgency
Abd cramping

Question 24

Is UC transmural?

Answer 24

no

Question 25

What is proctitis? Proctosigmoiditis? | Pancolitis?

Answer 25

UC at the various flexures

Question 26

What are the four presentations of CD?

Answer 26

Inflammation Obstructuion Fistualization Microperforation

Question 27

What is the most common site of CD?

Answer 27

ileum and cecum

Question 28

Which has perianal diseases: CD or UC?

Answer 28

CD

Question 29

Obstruction usually occurs in CD or UC? Why?

Answer 29

CD d/t fibrosis of the wall

Question 30

What are the signs of a retroperitoneal fistualization with CD?

Answer 30

Psoas abscess sign

Question 31

Skips lesions = ?

Answer 31

CD

Question 32

Cobblestoning appearance =?

Answer 32

CD

Question 33

Granulomas is found in CD or UC?

Answer 33

CD

Question 34

True or false: the rectum is usually spared in CD

Answer 34

True, but it can involve

Question 35

What are the mouth symptoms of IBD?

Answer 35

APthous stomatitis

Question 36

What are the eye symptoms of IBD?

Answer 36

Episcleritis and uveitis

Question 37

What are the joint symptoms of IBD?

Answer 37

Arthritis

Question 38

What affects the risk of osteopenia with IBD?

Answer 38

``` cytokines IBD meds (corticosteroids) ```

Question 39

WHich joints are usually affected in IBD?

Answer 39

Wrist, knee, ankle

Question 40

What are the skin manifestations of IBD?

Answer 40

P. Gangrenosum vascular complications E. Nodosum

Question 41

What are the goals of IBD treatment?

Answer 41

Obtain remission | Avoid long term toxicity

Question 42

What are the drugs used to obtains remission induction in UC?

Answer 42

aminosalicylates Corticosteroids 6MP

Question 43

What are the drugs that are used to maintain remission in UC?

Answer 43

6MP | Aminosalicylates

Question 44

What are the drugs used to obtains remission induction in CD?

Answer 44

Aminosalicylates Abx Corticosteroids

Question 45

What are the drugs that are used to maintain remission in CD?

Answer 45

Abx Immunomodulators Aminosalicylates

Question 46

What are the indications for metronidazole use in IBD?

Answer 46

Active DC | Perianal disease

Question 47

What are topical corticosteroids indicated for IBS? Systemic?

Answer 47

Proctitis and left-sided colitis moderate to severe CD

Question 48

What is the MOA of azathioprine?

Answer 48

Purine analogue (HGPRT)

Question 49

What is the MOA of 6 mercaptopurine

Answer 49

Purine analogue (HGPRT)

Question 50

What are the adverse effects of 6MP?

Answer 50

Fever, rash Pancreatitis Hepatitis

Question 51

What is the MOA of methotrexate?

Answer 51

inhibits dihydrofolate reductase

Question 52

What are the antibody drugs used in IBD? What is this particularly useful for?

Answer 52

Infliximab Fistulas

Question 53

What are the indications for surgery in UC? (4)

Answer 53

- Exsanguinating hemorrhage - Perforation - CA - Unresponsive acute disease

Question 54

What is the most common surgery for UC?

Answer 54

Ileal pouch-anal anastomosis

Question 55

What are the indications for surgery in CD?

Answer 55

- Free perforatio - Massive hemorrhage - CA - Chronic obstructions

Question 56

What is strictureplasty?

Answer 56

Maintain the bowel, but push it together and sew it up vertically (see slide) This saves intestines

Question 57

What is the antibody that is effective for CD?

Answer 57

anti-TNF