Natural Tx of IBD Flashcards Preview

Gastroenterology > Natural Tx of IBD > Flashcards

Flashcards in Natural Tx of IBD Deck (47)
Loading flashcards...
1

what are the 4 forms of IBD?

Crohn's
indeterminate colitis
UC
microscopic colitis

2

where does Crohn's mostly affect the GI?

SI, ileocecal valve and surrounding area, splenic flexure of colon, just before sigmoid colon

3

what can be a tell-tale appearance for Crohn's?

cobblestoning appearance of bowel wall

4

what will the bowel wall look like in UC?

pseudopolyps, ulceration, loss of haustra

5

microscopically what will Crohn's look like?

crypts are non-existing
lamina propria is extremely thickened

6

microscopically what will UC look like?

severe crypt distortion and less organized

7

besides the distal ileum and the R colon, where else can Crohn's appear? what percentages are associated with each spot?

besides the R colon and distal ileum (MC spots) Crohn's can appear gastroduodenally 5% of the time, in the SI alone 5% of the time and in the colon alone 20% of the time

8

what is progression (complication) that can occur with Crohn's?

stenosis or inflammation of the ileocecal valve both of which can lead to fistula formation of the SI directly with the colon
stenosis occurs 50% of the time, inflammation 30% of the time and fistula formation appears 20% of the time

9

what are some common sxs to see in the following organs/systems w/Crohn's?
eyes?
KD?
skin?
mouth?
liver?
biliary tract?
joints?
circulation?

eyes: episcleritis, uveitis
KDs: stones, hydronephrosis, fistulae, UTI
skin: erythema nodosum, pyroderma grangrenosum
mouth: stomatitis, apthous ulcers
liver: steatosis
biliary tract: gallstones, sclerosing cholangitis
joints: sponylitis, sarcoilitis, peripheral arthritis
circulation: phlebitis

10

4 step pathogenesis process of Crohn's
2 factors that can impact the progression/end of the possible first step?

1. causative agent (bacteria, virus, dietary)
2. immune response
3. inflammation
4. tissue injury

modifying factors: environmental, genetic
luminal factors: luminal bacteria, digestive enzymes, bile acids

11

what kind of an immune response is Crohn's? explain the immune cell cascade that happens

Th1 response
MOs activate T cells which generate a Th1 response

12

what demographic is most likely to be dx with Crohn's?

caucasian jews

13

what are some hostile factors that could lead to a pt developing Crohn's? what protective factors usually keep the GI healthy?

hostile: bacteria, bile acids, bacterial and dietary ags, digestive enzymes, Th1 lymphocytes
protective: impermeable mucosa, mucus, sIgA, PGE2, PGI2, UL-1ra, cortisol, IL-4, IL-10, TGF-b, VIP, somatostatin, glutamine, SCFA, Th2 lymphocytes

14

compare-contrast the depth to which Crohn's affects the GI tract vs UC

Crohn's: affects the mucosal and submucosal layers
UC: only affects the mucosal layer

15

in UC what happens to the normal intestinal crypts and what can form?

crypts get distorted and lost their goblets cells
abscesses can form

16

describe UC pathogenesis

microbial pathogens are introduced to the GI, there is an ineffective immune response
dietary ags or non-pathogenic microbes come into contact with the GI and we get an abn immune response
luminal ags are present which leads to an immune response to the luminal ag along with to the person's own epithelium= auto-immune

17

3 forms of UC? where does each affect in the GI? which has the greatest risk of colon CA

proctitis: rectum
left-sided colitis: descending colon through the rectum
pancolitis: ascending, transverse, descending colon through the rectum
greatest risk of colon CA in pts w/pancolitis, even if they go/are in remission

18

what is the main complication in UC?

toxic megacolon b/c of the loss of haustra and 'tubularization' of the LI

19

how do you dx UC?

endoscopy
can go all the way into the terminal ileum

20

antibiotics is more associated with which IBD dz? increases the risk in what population specifically? what abx is not associated with an IBD? which 2 are more strongly associated?

Crohn's
increases risk in children
penicillin was not associated with increased risk
metronidazole and fluoroquinolones are strongly associated with new-onset IBD

21

what OTC can be associated with IBD relapse?

NSAIDs, even just one time use

22

what lifestyle factor doubles the risk of Crohn's? effect on UC?

smoking doubles the risk of Crohn's, actually decreases risk of UC

23

what are 3 supplements that can help decrease the side effects of IBD meds and protect against complications?

folic acid
DHEA
withania somniferi (ashwagandha)

24

what CBC marker could you use to assess tissue levels of folic acid?

neutrophilic hypersegmentation index (earliest sign of folate deficiency)

25

what gene polymorphism could lead to folate deficiency?

MTHFR b/c it controls the synthesis of methylene tetrahydrofolate reductase and is responsible for taking inactive folate to active folate

26

folic acid deficiency can occur during what UC tx?

sulfasalazine

27

what dosage of what vitamin could decrease the risk of colorectal CA by 89%?

taking >1 mg of folic acid daily

28

what are some side effects of higher doses of prednisone

hyperglycemia
muscle wasting
osteoporosis
HTN
delayed healing
immune suppression

29

what could you supplement with so as to negate the side effects of long term cortisol use without affecting the cortisols efficacy?

DHEA

30

risk factors for osteoporosis?

disease activity (acute flare)
lifetime steroid dosage >10 g
active IBD
multiple bowel resection
age
low body mass index