Wk 10 IBD lewis

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33 Terms

1
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What is Crohn’s disease most common in?

Women (teenagers)

2
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What is ulcerative colitis most common in?

Men (20 year olds)

3
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What is the etiology of IBD?

Inflammation d/t infectious (pro-inflammatory bacteria, diet), genetic (1st degree relatives, monozygotic twins), environment (microflora of GI tract), immunologic (cytokines, TNF-a), psychologic (stress, anxiety, depression), too hygienic of environment , diets in fruits and vegetables

4
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How does smoking affect IBD?

Protective in UC, harmful in CD

5
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What meds can cause IBD?

NSAIDs, antibiotics, oral contraceptives, isotretinoin

6
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What is common in Crohn’s but rare in UC?

Fever, malaise, tenderness, abdominal mass, internal fistulas, linear ulcers, illeal involvement, strictures, cobblestone appearance, discontinuous/ patchy pattern, usually affects small intestine, affects all layers of bowel wall

7
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What is more common in UC than Crohn’s?

Rectal bleeding, rectal involvement, continuous distribution, usually affects colon, only affects inner layer of bowel

8
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What are complications of UC?

Hemorrhoids, fissures, perirectal abscess, toxic megacolon, colonic hemorrhage, colonic stricture, colorectal cancer (risks: young age of onset, severe inflammation, family hx, primary sclerosis cholangitis)

9
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Which IBD has a higher risk of colorectal cancer?

Ulcerative colitis

10
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What are complications of CD?

Small bowel stricture, access, fistula formations (connect parts of GI tract together), nutritional deficiencies (vitamin B12, A-D, folate, iron)

11
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What are extra intestinal manifestations of IBD?

Hepatobillary complications (liver/ gallbladder problems not related to disease severity), ocular complications, dermatologic complications, arthritis, anemia, VTE, osteoporosis

12
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What are lab tests for IBD?

low Hg/HCT, high WBC, ESR, CRP

13
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What is Pancolitis?

Entirety of colon

14
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What is proctosignoiditis?

Rectum and sigmoid colon

15
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What is proctitis?

Confined to rectal area

16
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What is extensive UC?

Extends proximal to splenic flexure

17
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What is distal UC?

Limited to areas distal to splenic flexure (left-sided)

18
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What is ilocoloitis CD?

Most common form of CD, affects terminal ileum

19
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What are poor prognostic factors of UC?

Age <40 at diagnosis, extensive colitis, severe endoscopic disease, hospitalization for colitis, elevated CRP, low serum albumin

20
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What are poor prognostic factors for CD?

Age <40 at diagnosis, smoking, extra-intestinal manifestations, perianal disease, stenotic/penetrating behavior, need for systemic corticosteroids, severe lesions, elevated CRP

21
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What are goals of therapy?

No rectal bleeding, abdominal pain, higher quality of life, prevent complications. Low fecal calprotein, CRP, ESR, better imaging

22
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What are non pharm management of Crohn’s?

Try special diet, avoid: sugary/ carbonated drinks, avoid popcorn, fruit skins, veggies, nuts, seeds cookies. Drink water, eat small meals, keep food diary

23
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What drugs are used to treat IBD?

Aminosalicylates, corticosteroids, immunosuppresive agents/ immunomodulators, antimicrobials (metronidazole, ciprofloxacin)

24
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What are TNF-a inhibitors?

Infliximab (Remicade), Adalimumab (Humira), Golimumab (Simponi), Certolizumab (Cimzia)

25
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What are sphingosine 1-phospate modulators?

Ozanimod (Zeposia), Etrasimod (Velsipty)

26
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What are interleukin inhibitors?

Ustekinumab (Sterlara), Risankizumab (Skyrizi), Mirikizumab (Omvoh), Guselkumab (Tremfya)

27
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What are integrin receptor antagonist?

Vedolizumab (Entyvio), Natalizumab (Tysabri)

28
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What are JAK inhibitors?

Tofacitinib (Xejanz), updacitinib (Rinvoq)

29
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What should be started in IBD? (Top-down approach)

Biologics

30
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When is surgery implicated in UC?

Maxed out on medicine management, have chance of cancer. Protolectomy/ colectomy can cure UC

31
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When is surgery implicated in CD?

Pts with complications, fistulas, strictures. Resections of small intestine may cause (malabsorption, high rate of recurrence).

32
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What is given after surgically induced remission of CD if low risk of recurrence?

3 month course of metronidazole & ileocolonoscopy after 6-12 months

33
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What is given after surgically induced remission of CD if high risk of recurrence?

Anti-TNF or AZA/6MP & 3 months of metronidazole ileocolonsocpy after 6-12 months