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What are some reasons that people develop inflammatory bowel disease?
genetics
bacteria, viruses and dietary antigens
immune dysregulation/autoimmunity
chronic infection
IBD is the same thing as IBS-D.
a. True, no difference
b. False
False
What are some exacerbating factors of UC?
salmonella or campylobacter infection
smoking cessation
NSAIDs
diet?
What are some exacerbating factors of CD?
URI or c. diff infection
cigarette smoking
NSAIDs
stress
True or False: Once someone has IBD, it never goes away.
True
What are some symptoms of both UC and CD?
chronic
relapsing-remitting
abdominal pain
diarrhea
What are some symptoms of UC?
hematochezia
rectal urgency
tenesmus
What are some symptoms of CD?
chronic or nocturnal diarrhea
weight loss
low-grade fever
fatigue
A patient with UC presents with normal ESR, no systemic toxicity, and passes less than 4 stools a day. What severity is their UC?
a. mild
b. moderate
c. severe
mild
A patient with UC presents with minimal evidence of systemic toxicity and passes about 4-6 stools a day. What severity is their UC?
a. mild
b. moderate
c. severe
moderate
A patient with UC presents with a high ESR (> 30), fever, tachycardia, anemia and passes more than 6 bloody stools a day. What severity is their UC?
a. mild
b. moderate
c. severe
severe
What are some extra-intestinal manifestations of IBD?
reactive arthritis
ankylosing spondylitis
uveitis
pyoderma gangrenosum
primary biliary cirrhosis
What specific laboratory finding is a telltale indicator of UC and CD?
a. Anemia, Thrombocytopenia
b. Elevated fecal leukocytes
c. Elevated fecal calprotectin (> 100)
d. Low fecal calprotectin (< 30)
Elevated fecal calprotectin (> 100)
Imaging of a patient with ulcerative colitis would show...
continuous, diffuse inflammation in the colon and rectum
granular, friable, erythematous
ulceration
Imaging of a patient with Crohn's disease would show...
segmental, patchy cobblestoning
discontinuous, ulceration throughout the entire GI tract
fistulas, fissures, and strictures
What kind of inflammation is specific to UC?
a. mucosal inflammation
b. transmural inflammation
mucosal inflammation
What kind of inflammation is specific to CD?
a. mucosal inflammation
b. transmural inflammation
transmural inflammation
Crypt abscesses and a loss of haustra is specific to which type of IBD?
a. UC
b. CD
UC
Fat wrapping and a thickening of the intestinal wall is specific to which type of IBD?
a. UC
b. CD
CD
What therapy can you NOT use for CD?
a. antibiotics
b. topical agents
c. sulfasalazine
d. systemic corticosteroids
topical agents
What therapy can you NOT use for UC?
a. antibiotics
b. topical agents
c. IV steroids
d. oral 5-ASA
antibiotics
Mesalamine and sulfasalazine are both examples of what drug class?
aminosalicylates
Budesonide and hydrocortisone are both examples of what drug class?
topical corticosteroids
Prednisone, methylprednisolone, and prednisolone are all examples of what drug class?
systemic corticosteroids
AZA, 6-MP, and MTX are all examples of which drug class?
immunosuppressants
Adalimumab, Certolizumab pegol, Infliximab and Golimumab are all examples of which drug class?
anti-TNF agents
Tofacitinib (Xeljanz) is part of what drug class?
JAK inhibitor
Metronidazole and ciprofloxacin are both examples of what drug class?
antibiotics
What drug do you use to treat an active, mild distal case of UC?
topical 5-ASA
What drug do you use to treat an active, mild extensive case of UC?
oral 5-ASA
If a patient with mild UC does not respond to 5-ASA, what should be used next?
Budesonide MMX
What drugs do you use to treat an active, moderate to severe case of UC?
Budesonide MMX
Anti-TNF agents
Which anti-TNF agent should be used with thiopurine?
a. Adalimumab
b. Certolizumab pegol
c. Infliximab
d. Golimumab
Infliximab
What drug should be employed if a patient with moderate to severe UC fails anti-TNF therapy?
Vedolizumab
When does a patient with UC require urgent hospitalization?
6+ stools per day and either tachycardia, fever, increased ESR, or GI bleed
What is the first line therapy for acute severe UC (ASUC)?
IV steroids like methylprednisolone and hydrocortisone
What drug should be avoided for UC maintenance?
a. Budesonide MMX
b. MTX
c. Aminosalicylates
d. Topical agents
MTX
How often should UC patients get a colonoscopy?
a. Every 5-10 years, within 8 years of diagnosis
b. Every 6 months, within 8 years of diagnosis
c. Every 1-3 years, within 8 years of diagnosis
d. Every 2-3 months, within 8 years of diagnosis
Every 1-3 years, within 8 years of diagnosis
The risk of developing colon cancer with CD is 18x higher than with UC.
a. True
b. False, same amount of risk
False, same amount of risk
The risk of developing adenocarcinoma with CD is 18x higher than with UC.
a. True
b. False, same amount of risk
True
How soon should you see improvements in CD patients following therapy?
2-4 weeks, maximum effects in 12-16 weeks of therapy
Which agents should be avoided while treating CD?
a. oral mesalamine
b. topical 5-ASA agents
c. flagyl
d. cipro
e. all of the above
all of the above
What agent is used first line to treat mild-moderate CD?
sulfasalazine
What agent is used first line to treat moderate-severe CD?
systemic corticosteroids (with rapid taper)
What line of therapy is anti-TNF for treating moderate-severe CD?
a. first line
b. second line
c. third line
d. last line
second line
What line of therapy is anti-integrin therapy for treating moderate-severe CD?
a. first line
b. second line
c. third line
d. last line
third line
What agents are used to treat severe CD?
parenteral corticosteroids
anti-TNF agents
Due to the frequent use of steroids in IBD therapy, what steps can be taken to prevent osteoporosis?
smoking cessation
limit alcohol intake
increase activity
increase calcium and vitamin D intake
What is some non-pharmacological treatment options for IBD?
psychotherapy
low-impact exercise
What should be monitored during aminosalicylate use?
CBC and LFTs at baseline, Q2weeks x 3 month
What should be monitored during corticosteroid use?
yearly eye exams
