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GI > Ulcerative Colitis and Crohn's Disease > Flashcards

Ulcerative Colitis and Crohn's Disease Flashcards

1
Q

What is IBD?

A

chronic, idiopathic, relapsing inflammatory disorders

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2
Q

What is UC?

A

mucosal inflammatory condition of the GI tract limited to the rectum and colon

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3
Q

What is CD?

A

transmural inflammatory condition that can affect any part of the GI tract from mouth to anus

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4
Q

What age is UC typically diagnosed?

A

20-25

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5
Q

What age is CD typically diagnosed?

A

before 30

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6
Q

What is the etiology of IBD?

A

Infection
Foods (alcohol and red meat)
Smoking*
Genetic factors
Immunological

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7
Q

Smoking has actually shown to improve which IBD?

A

UC

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8
Q

1st degree relatives have how much of an increased risk of developing IBD?

A

13 fold

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9
Q

UC or CD has a bigger genetic role?

A

CD

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10
Q

What are the presenting symptoms of IBD?

A

Diarrhea
Abdominal pain/ cramping
Fever
Rectal bleeding
Weight loss

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11
Q

What is the mucosal appearance of UC?

A

Edema
Mucopus
Erosions
Continuous lesions

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12
Q

What is proctitis?

A

UC with only rectum involved

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13
Q

What is distal colitis?

A

extends from the rectum to the left splenic flexure

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14
Q

What is extensive colitis?

A

involves areas of the colon beyond the left splenic flexure

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15
Q

What is the mucosal appearance of CD?

A

ulcers
strictures (scarring)
fistulas
discontinuous and segmented lesions (cobblestone appearance)

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16
Q

Where can CD lesions occur? Where do they most commonly occur?

A

anywhere in the GI tract, mostly colon and ileum

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17
Q

What is mild UC?

A

< 4 stools/ day with or without blood
NO systemic disturbance

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18
Q

What is moderate UC?

A

4-6 stools/day with or without blood
Minimal systemic disturbance

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19
Q

What is severe UC?

A

7-10 stools/ day with blood
Systemic disturbance

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20
Q

What is systemic disturbance?

A

Fever
HR>90
anemia
abdominal tenderness
bowel wall edema
ESR>30mm/h

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21
Q

What is fulminant UC?

A

> 10 stools/ day continuous bleeding (may require transfusion)
marked systemic disturbance

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22
Q

What is mild-moderate CD?

A

ambulatory
tolerates PO
absence of fever, dehydration and abdominal tenderness
nonsignificant weight loss (<10%)

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23
Q

What is moderate-severe CD?

A

Failed treatment for mild-mod OR
fever, abdominal pain, N/V, dehydration, significant weight loss and anemia

24
Q

What is severe/fulimant CD?

A

Symptoms persist with corticosteroids OR
high fever, vomiting, reboound tenderness, cachexia, evidence of intestinal obstruction / abcess

25
Q

Which IBD has a higher risk of cancer?

A

UC

26
Q

The risk of cancer starts to increase how many years after IBD diagnosis?

A

8 years

27
Q

What are fistulas?

A

Abnormal communication between 2 organs or organ and exterior (intestines and bladder) usually areas of worst inflammation

28
Q

Which IBD are fistulas more common?

A

CD

29
Q

What is toxic megacolon?

A

severe inflammation, no peristalsis, emergency

30
Q

What drugs increase the risk of toxic megacolon?

A

anticholinergics
antispasmodics
opioids
other drugs that decrease peristalsis

31
Q

What agents are used for induction and maintenance of IBD?

A

Aminosalicylates
Budesonide
Remicade

32
Q

What agents are used only for IBD maintenance?

A

Thiopurines

33
Q

What agents are used only for IBD induction?

A

Corticosteroids

34
Q

What is a CI to Aminosalicylates?

A

Aspirin, salicylate allergy

35
Q

What Aminosalicylate should be avoided in patients with a sulfa allergy?

A

Sulfasalazine

36
Q

What are dose related ADEs with Sulfasalazine?

A

GI disturbance, headache, arthalgia

37
Q

What are ADEs that happen at any dose of Sulfasalazine?

A

rash, fever, hepatotoxicity, nephrotoxicity, bone marrow suppression, discoloration of skin, urine,and other secretions

38
Q

What needs to be monitored while taking Aminosalicylates?

A

LFTs, renal function (CrCl, SCr, BUN), CBC with differential

39
Q

What is the only Mesalamine dosage form that has effects on the small intestine and colon?

A

Pentasa ER capsules

40
Q

Mesalamine should be used with caution in patients with what?

A

renal or liver insufficiency

41
Q

Which Aminosalycilate does not require caution in patients with renal/ liver insufficiency?

A

Olsalazine

42
Q

What oral corticosteroids are used for IBD?

A

Prednisone
Budesonide

43
Q

What are contraindications to corticosteroid use?

A

Systemic fungal infections
LIVE vaccines

44
Q

What corticosteroids are used IV?

A

Hydrocortisone
Methylprednisolone

45
Q

What corticosteroids are used topically?

A

Hydrocortisone
Budesonide

46
Q

What is the only corticosteroid that can be used up to 3 months?

A

Budesonide

47
Q

What must be done if Budesonide is stopped after being used for >2 weeks?

A

Taper to avoid withdrawal

48
Q

Why can Budesonide be used for a longer period of time?

A

extensive first-pass metabolism; decreased systemic exposure

49
Q

What agents require genotype/ phenotype testing prior to initiation to properly dose and determine enzyme (TPMT) activity responsible for drug metabolism?

A

Thiopurines (Mercaptopurine and Azathioprine)

50
Q

What agents should be used with caution when taking thiopurines?

A

5-ASAs can inhibit TPMT, the enzyme responsible for thiopurine drug metabolism

51
Q

What ADEs are seen with thiopurines?

A

Bone marrow suppression
Anemia
Thrombocytopenia
Hepatotoxicity
Renal toxicity
Pancreatitis
N/V/D
rash

52
Q

When is cyclosporine used?

A

Severe UC flares not responding to IV corticosteroids

53
Q

What BBWs are seen with thiopurines?

A

chronic immunosuppression;
increased risk of malignancy and hematologic toxicities

54
Q

What BBWs are seen with Janus Kinase (JAK) inhibitors?

A

Serious bacterial, fungal, viral, and opportunistic infections
Higher rate of all-cause mortality including sudden CV death
Higher rate of MACE
Increased risk of thrombosis (PE, DVT, arterial thrombosis)
Increased risk of lymphomas/ other malignancies

55
Q

What can be given with TNF inhibitors to decrease infusion reactions?

A

APAP
diphenhydramine
corticosteroid

GI (23 decks)

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