IBD

Question 1

def. IBD

Answer 1

chronic inflamm of the intestinal tract, variable systemic involvement

Question 2

location of 2

Answer 2

UC - colon and rectum

CD - any portion

Question 3

peak ages

Answer 3

bimodal - 20-30 and 60s

Question 4

epi

Answer 4

more UC

Question 5

Sx of CD

Answer 5

• abdo pain
• diarrhea
• mass in RLQ
• obstrcution
• weight loss
• fever
• stricture
• fistula and anal involvment

Question 6

4 most common extraintestinal

Answer 6

1. eye - episcleritis
2. skin - erethyma nodosum
3. mouth ulcers
4. MSK - arthiritis

Question 7

4 aspects to patho

Answer 7

1. genes - CD>UC : NOD2 gene
2. host immune system
3. luminal bact
4. env

Question 8

what is the immune response

Answer 8

inappropiate extreme immune response

Question 9

3 env factors

Answer 9

1. altered mucous
2. incr. permeability
3. impaired repair mech.

Question 10

what is actual path

Answer 10

normal>triggers>acute inflammation> not cleared> chronic inflammation

Question 11

what to ask on Hx

Answer 11

• travel
• AB use
• diet
• sex hx
• fam hx
• extra intestinal Sx

Question 12

labs

Answer 12

• CBC
• iron
• folate
• B12
• CRP
• ESR
• stool WBC

Question 13

imaging

Answer 13

US, CT MR, endo

Question 14

3 main goals and 2 additional of therapy

Answer 14

1. remission induction
2. remission maintenance
3. prevent treat compl.

a. mucoal healing
b. QOL

Question 15

5 classes of meds

Answer 15

1. 5-ASA
2. corticosteroids
3. immunosuppresants - methotrexate
4. ABs
5. imunobiologics - mab’s

Question 16

preps, uses, action, effect, formulation and SE of 5-ASA

Answer 16

preps - mesalamine
uses - UC, mild crohn ilitis
action - oxy free radical scavenger
effect - local only
formulation - oral, rectal
adverse effects - pancreatitis, nephritis

Question 17

preps, uses, action, effect, and SE of steroids

Answer 17

preps - prednisone, budesonide
uses - remission induction, no use for maintenance
action - inhib inflam. cytokines
adverse effects - cushins, ** avasc. necrosis

Question 18

action, use and SE of azathroprine

Answer 18

action - purine analog- DNA syn. inhib
use - remission and maintenance, healing of fistula
SE - bone marrow sup., pancreatitis, lymphoma,

Question 19

ction, use and SE of methotrexate

Answer 19

action - folic acid antag - no DNA, cort. sparing
use - remission and maintenance
SE - liver, leukopenia, N/V, diarrhea, hypersensitivity

Question 20

action, use and SE of cyclosporine

Answer 20

action - inhib of t -cell mediated responses
use - acute and refractory UC
SE - nephrotox, infections, hypertension

Question 21

action, use and SE of immunobiologics

Answer 21

action - antiTNF ABs
use - CD - active and perianal, UC severe
SE - delayed hypersenstivity and lotof others

Question 22

use of ABs (

Answer 22

metronidazole and cipro
- no use in UC
-

Question 23

what to do when refractory

Answer 23

Surgey

Question 24

2 indications for surg

Answer 24

1. failure of meds

2. disease complications - CA, perfs, stenosis

Question 25

what is surg CD mantra

Answer 25

- do not harm - can't cure - preserve function

Question 26

2 gen classes of IBD for a surg

Answer 26

1. fibrosteonitic - obstructive - pain, blaoating, | 2. perforative - fistula, abscess, free perf

Question 27

3 main types of surg

Answer 27

1. resection 2. strictureplasty 3. diversion alone - rare

Question 28

2 types of resection

Answer 28

1. restorative - +/- protected anastamosis | 2. non-restorative

Question 29

what is surg for obstructing terminial illeum CD

Answer 29

illeocolic resection with anastamosis

Question 30

**2 keys to a good anastamosis

Answer 30

1. tension-free | 2. well-vascularized

Question 31

what is role of the protecting stoma

Answer 31

lower leak rates

Question 32

complications of ileo-colic resection

Answer 32

- leak - bad - localized abscess - diffuse peritonitis

Question 33

how common is recurrence

Answer 33

very high over time - esp @ ileocolic jct

Question 34

surg for segmental colon, diffuse colon, anorectal colon

Answer 34

segmental - segmental resection diffuse - subtotal colectomy anorectal +/- colon - prectectomy

Question 35

3 CD mantra for anal CD

Answer 35

1. control Sx 2. preserve function 3. do no harm - don't injure sphinter

Question 36

gross appearnce of CD

Answer 36

stiff, thick walled bowel, linear ulcers

Question 37

patho of CD (5)

Answer 37

1. shallow aphthous ulcers from mouth to anus 2. full thickness inflammation 3. fissuring ulcers - epithelium enters 4. patchy lesions (skip) 5. granuloma

Question 38

4 common UC sx

Answer 38

1. abo pain 2. diarrhea, freq, small volume 3. rectal bleeds 4. mucous

Question 39

major complications of UC

Answer 39

toxic mega colon

Question 40

4 malignant aspects of toxic megacolon

Answer 40

1. duration - 8-10 years 2. extensive disease 3. comorbid liver disease 4. chronic indolent disease

Question 41

3 aspects to guide therapy

Answer 41

1. extent 2. severity 3. complications

Question 42

3 extents of disease

Answer 42

1. proctitis - rectum only 2. severity 3. complications

Question 43

5 aspects to consider for severty

Answer 43

1. # BM (>6) 2. rectal bleeds 3. fever. tachy 4. anemia 5. extraintestinal

Question 44

use of ASA for UC

Answer 44

remisson and maintenance

Question 45

use of ABs for UC

Answer 45

none

Question 46

use of steroids for UC

Answer 46

induction only

Question 47

use of innumonosuppression for UC

Answer 47

all remission and maintenance - except methotrexate, no maint

Question 48

use of anti-TNF

Answer 48

both

Question 49

what to do for severe attack of UC

Answer 49

try rescue therapy, and if fails > colectomy

Question 50

2 options for colectomy

Answer 50

1. permanent ileostomy | 2. modified pouch attached to the anus

Question 51

complications of colectomy

Answer 51

- bowel obst. - infection/leak - pouchitis - fistula - infert and SD

Question 52

classic histo of UC

Answer 52

- diffuse and continuous inflammation the entire length of region affected - flat broad based ulcers - usually limited to the mucosa - crypt abscesses

Question 53

what is prioblem in diagnosing IBD

Answer 53

- not always classical - can get illeal backwash in UC - can get patches in UC after treatment -

Question 54

DDX for both IBDs (6)

Answer 54

1. infection! - esp TB 2. iscemia 3. diverticular assoc. sigmoid 4. behcet's disease 5. NSAID 6. tumours

Question 55

what is issue with fulminant

Answer 55

can be severe and go deep which makes it hard to diff. between UC and CD - most act like UC - need to diff. because doing colectomy can be bad in CD

Question 56

4 dysplasia risk factors for UC

Answer 56

1. duration 2. early age of onset 3. extent 4. primary sclerosin cholangitis

Question 57

3 dysplasia risk factors for CD

Answer 57

1. duration 2. most in colon 3. 20-500x risk of smal bowel adenocarcinoma

Question 58

what to do with polyps and flat dysplastic lesions

Answer 58

polyp - remove endo | flat - consider colectomy