IBD basics

proctitis (uc): only affects the _

rectum

proctosigmoiditis (UC): affects the rectum and _ colon

sigmoid

left sided (UC) : inflamamtion begins in the _ and moves up to the _ flexure

rectum; splenic

right sided (UC): inflammation begins in the cecum and includes the

1. ascending _,

2. _ flexure, and

3. up to the right half of the transverse colon

1. colon

2. hepatic

pancolitis (uc): affects the entire _

colon

the inflammatory lesions in CD can be described as a ________appearance

cobblestone or patchy

risk factors for UC

stress, diet, _, antibiotics, smoking

nsaids

what is protective in UC

smoking

chrons colitis (CD)

only effects the _

colon

gastroduodenal CD

affects the _ and the first part of the _ intestine

stomach; small

ileitis CD

only affects the _

ileum

ileocolitis CD

affects the ileum and _

colon

jejunoileitis CD

affects upper half of _intestine

small

what are the imaging/stool options

1. stool sample
2.colonoscopy
3. upper endoscopy
4. sigmoidoscopy
5. capsule endoscopy

a stool sample is important to generally rule out _

c. diff

a recommeneded test for CD

upper endoscopy

it is recommended that patients aged _-_years be screened for colon cancer

45 to 75

subjective symptoms for UC

-abdominal cramping
-frequent _ _ with _ in stool
-eye pain, blurred vision
-raised, red tender nodules

bowel movements; blood

objective signs and labs

1. fever and _ - severe disease

2. increased _, increase _, fecal calprotecin

3. _ and hypoalbuminemia in severe disease
   
   OTHER:
   -weight loss
   -number of nocturnal bowel movement
   -arthritis
   -hemorrhoids, anal fissues, perirectal abscesses
   -decreased hemotocrit/hemoglobin

tachycardia; ESR; CRP, leukocytosis

classify mild UC

stools: <_ /day
blood in stools:intermittent
urgency: mild, occassional
hemoglobin: normal
ESR: <_
CRP: elevated
fecal calprotectin (FC): >150-200

4;30

classify moderate-severe UC

stools: >_/day
blood in stools: frequent
urgency: often
hemoglobin: <75% of normal
ESR: >30
CRP: Elevated
fecal calprotectin (FC): >150-200

6

classify fulminant UC

stools: >_
blood in stools: continuous
urgency: continuous
hemoglobin: transfuions required
ESR:>30
CRP: elevated
fecal calprotectin (FC): >150-200

10

classify remission UC

stools: _ stools
blood in stools: none
urgency: none
hemoglobin: normal
ESR:<_
CRP:normal
fecal calprotectin (FC): <150-200

formed; 30

what are UC treatment goals

1.. obtaining and maintaining _ free remission
2. restoration of _ bowel frequency
--decrease in the number of stools per day
3. controlling symptoms of bleeding and urgency
4. endoscopically healed muscosa
--lower amount of ulcers

steroid; normal

describe induction

-introducing a drug initially into the body to hopefully eliminate inflammation or decrease disease severity
-dosing is more aggressive in most cases

describe maintence

-relying on the drug to continue to help maintain remision
-dosing is not as aggressive in most cases

if we have c.diff what should be given

treatment with _ instead of metronidazole

vanco

MILD-MOD Proctitis tx

1. 5-_

2. _ suppository

3. _ suppository

1. ASA

2. tacrolimus

3. beclamethasone

MILD-MOD proctitis/left-sided colitis

1. 5-_

2. topical _ (suppository, enema, foam)

1. ASA

2. corticosteriods

MILD-MOD left-sided UC

1. 5-ASA _ (what formulation) + 5-ASA _ (what formulation)

2. _ MMX

1. enema +oral

2. budesonide

MILD-MOD Extensive colitis

1. 5- ASA (what fromulation)

oral

avoid what meds with fulminant

NSAIDs, opioid, and other anticholineric medications

who should not use 5-asa

people with sulfa allergies

how do aptients present with CD subjective

-_diarrhea(quantity either per day or week)
-abdominal pain
-fatigue

chronic

how do patients present with cD objective

-_ and _

others: fever, weight loss, stool testing (c. difficile, fecal calprotectin), anemia; check cbc

CRP/ESR

describe mild to moderate CD severity synopse

-ambulatory
-no evidence of _
-no evidence of systemic toxicity(high fever)
-<_ loss of body weight
-minimal abdominal tenderness, mass, or obstruction
-no severe endoscopic lesions

dehydration; 10%

describe moderate to severe CD severity synopsis

-ambulatory

-_ to respond to treatment for mild-moderate disease

-more prominent features of fever

->_ weight loss

-more features of abdominal pain or tenderness

-intermittmeent n/v or significant anemia

-moderate to severely active endoscopic lesions

failed; 10%

severe to fulmiannt CD severity

-_ symptoms

-evidence of systemic toxicity despire corticosteroid use or biologic treatment

-rebound treatment

-rebound tenderness

-intestinal obstruction

-presenting with high fevers

-persistent vomiting

-evidence of severe muscosal disease on endoscopy

persistent

CD treatment goals

-controlling _
-controlling _
-promote endoscopic muscosal healing
-prevent occurence of disease complications

inflammation; symptoms

when would we use antibiotics for chron's disease- when patients have _ that have to be removed

fistulas

corticosteroids

when should a UC patient taking prednisone see a response

2 weeks

corticosteroids

when should a UC patient doing induction therapy with budesonde MMX

4-6 weeks

corticosteriods

when should a CD patient see a response

4-7 weeks

infliximab

1. UC when should we see a response

2. CD when should we see a response

1. 2-8 weeks

2. 8-9 days

adalimumab

1. UC when should we see a response

2. CD when should we see a response

1. 8 weeks

2. 4 weeks

certolizumab pegol

1. CD when should we see a response

6 weeks

Golimumab

1. UC when should we see a response

6 weeks

Vedolizumab

1. UC when should we see a response

2. CD when should we see a response

1. 6 weeks

2. 10-14 weeks

Thiopurines

1. UC when should we see a response

2. CD when should we see a response

1. 1 month

2. 4-8 weeks

Methotrexate

1. UC when should we see a response

2. CD when should we see a response

1. 4 months

2. 12 weeks

cyclosporine

1. UC when should we see a response

2 days

what drugs are only for UC

mesalamine formulations
-golimumab
-tofacitinib
-ozanimod/etrasimod

what drugs are only use n chrons disease

-sulfasalazine
-certolizumab pegol
-natalizumab

this class of medications cannot be used with a tnf alpha inhibitor for either CD or UC

integrin inhibitors

this corticosteroid is preferred in chrons disease and ulcerative colitis

budesonide

this supplement is impaired when taking sulfasalzine and can lead to anemia

folic acid

this adverse effect of corticosteroids leads to increased blood sugar

hyperglycemia

consider this class of medications first for moderate to severe ulcerative colitis tat is unresponsive to aminosalicylates or corticosteroids

TNf alpha inhibitors

this medication formulation for ulcerative colitis is useful for patients presenting with left sided disease

enema

this tnf alpha inhibitor for UC is used for treatment navive patients and is typically used with an immunomodulator; it is also administered as an IV infusion

infliximab

this TNF alpha inhibitor is not FDA approved for ulcerative colitis

certolizumab pegol

this class of medications is typically used for moderate to severe chrons disease and is generally preferred over aSA

corticosteroids

this medication formulation for ulcerative colitis is useful for patients presenting with proctitis

suppository

this TNF alpha inhibitor is not FDA approved for chrons disease in the US

golimumab