IBD CIS

Question 1

Does diet affect the course of IBD?

Answer 1

No… at least for this class anyways

Question 2

Is there a cure for Crone’s

Answer 2

No

• it’s chronic and lifelong
• exacerbations and remissions

Question 3

what commonly happens to people with Crohn’s

Answer 3

Extensive terminal ileum resection

• parenteral Vitamin B12
• that is where B12 is absorbed
• Non-caseating granulomas
• there can be many different kinds of FISTULAS

Question 4

What other diseases have non caseating granuomas?

Answer 4

Sarcoid was the bolded one

• PBC
• histoplasmosis

Question 5

Ulcerative Colitis?

Answer 5

• idiopathic inflammatory condition
• involves mucosal surface of colon only
• diffuse friability and erosions with bleeding

Question 6

What would UC look like clinically?

Answer 6

bloody diarrhea with low abd cramping

• tenesmus
• starts at rectum and progresses continuously to cecum

Question 7

What is interesting about UC and smoking?

Answer 7

-more common in non-smokers

… or smokers that just quit

Question 8

What is associated with reduced risk of UC?

Answer 8

appendectomy before age 20

Question 9

What do lab studies look like with UC?

Answer 9

• P-ANCA
• ASCA
• HLA-B27

Question 10

What is UC associated with?

Answer 10

• Uveitis
• Pyoderma gangrenosum
• pleuritis
• erythema nodosum
• ankylosing spondylitis
• spondyarthropathies
• PSC
• HLA-B27

Question 11

What are some indications for surgery in UC?

Answer 11

• severe hemorrhage
• perforation
• carcinoma
• fulminant colitis
• Toxic megacolon
• Invisible flat dysplasia
• Non-endoscopically resectable dysplastic lesions
• refractory disease requiring long-term coticosteroids

Question 12

What is the cure for UC sometimes?

Answer 12

Surgery

Question 13

Ulcerative colitis as opposed to Crohn’s

Answer 13

• Mucosal
• Colon only
• continuous lesions
• bloody diarrhea
• crypt abscess on histology
• toxic megacolon (no fistulas or fissures)
• Ulcerated pseudopolyps
• smoking protective*

Question 14

Crohns as opposed to UC?

Answer 14

• transmural
• anywhere along GI tract (most common is Terminal ileum)
• Skip lesions
• often without blood
• Non-caseating granuloma on histology
• Strictures (string sign), obstruction, abscesses, fistulas, and fissures
• apthous ulcers intervening with normal mucosa, linear fissure, “Cobble-stoning”, thickened bowel wall, “creeping fat”
• Smoking worsens the disease

Question 15

What lab thing does Crohn’s have?

Answer 15

ASCA

Question 16

What lab thing does UC have?

Answer 16

pANCA

Question 17

Which one is seen with a perianal fistula?

Answer 17

Crohn’s disease

Question 18

what are some IBD extraintestinal manifestions?

Answer 18

• pyoderma gangrenosum
• oral apthous ulcer
• iritis
• anterior uveitis
• toxic megacolon
• ankylosing spondylitis aka bambook spine
• eyrethema nodosum

Question 19

What are the treatment options for IBD?

Answer 19

• 5-ASA derivatives
• Corticosteroids
• Immuno-modulating agents
• Biologic agents

Question 20

adverse effect of 5-ASA ?

Answer 20

Acute interstital nephritis

Question 21

adverse effect of Corticosteroids?

Answer 21

Acute: mood changes, insomnia, dyspepsia, weight gain, edema…. mmon facies
-Long term: osteoporosis, osteonecrosis of the gemoral head, myopathy, cataracts, susceptibily to infection

Question 22

What do we need to do if we give someone corticosteroids?

Answer 22

give them calcium and vitamin D supplements

-Monitor bone densitometry