13-1: 2/2 - Inflammatory Bowel Disease

Front 1

Key features of microscopic colitis.

Back 1

Chronic diarrhea, mucosa looks normal. need biopsy.

Front 2

Crohn's Disease vs Ulcerative Colitis:
Inflammatory patterns
Granuomas
Location of inflammation

Back 2

Crohn's: patchy (SKIP LESIONS), transmural; affects any part of GI tract
Noncaseating granuloma

Ulcerative: DIFFUSE mucosal; limited to colon; affects rectum but can expand to rest of colon
Non-granulomatous

Front 3

Crohn's Disease vs Ulcerative Colitis:
Peak age of presentation
Effect of smoking
Effect of appendectomy

Back 3

Crohn's:
First peak--teens/20's
Second peak: 7th-8th decade
Smoking is a RISK FACTOR
Appy may be a RF

Ulcerative colitis:
Teens and 20's: first peak
7th-8th decade: second peak
Smoking is PROTECTIVE
Appy is PROTECTIVE

Front 4

Crohn's Disease vs Ulcerative Colitis:
Monozygotic Concordance
Dizygotic Concordance

Back 4

Crohn's:
Monozygotic concordance: 44-50%
Dizygotic: 8%

Ulcerative Colitis:
Monozygotic: 5-14%
Dizygotic: 0%

Front 5

Nod2:
AKA
Function
Associated Disease

Back 5

Nod2 = CARD15

Protein that recognizes bacterial Ag's and releases NF-kappa B

Associated w/Crohn's

Front 6

The gut is normally in a state of ______.

How does this relate to IBD?

Back 6

Note: NOD2-->Defensins (natural Abx)

Normally gut is mildly inflamed; most of us able to down-regulate it. Those who can't advance to IBD.

Front 7

This cytokine is linked to both Crohn's and IBD.

Effects of cytokine?

Back 7

IL-23 (linked to Crohn's and IBD)
Drives innate and T cell-mediated inflammn

Front 8

These cytokines suppress immune responses.

Back 8

TGF-beta
IL-10

Front 9

Crohn's Disease vs Ulcerative COlitis:
Presentation
Extracolonic Involvement

Back 9

Crohn's: Diarrhea, n/v, wt loss, fever, FISTULA

Extratest involvement: erythema nodosum, arthritis, uveitis

UC:
Rectal bleeding!
Tenesmus (push to poop but can't go)/cramping
Diarrhea
Extracolonic:
Arthritis, erythema nodosum, uveitis

Front 10

How does IBD differ from IBS?

Back 10

IBD has anemia, high PLT, high sed rate, low albumin

IBD has weight loss, fever, perianal dz, bloody stools, tenesmus (strain to poop and nothing comes out), fecal WBC, occult blood

IBS has none of these things!

Front 11

Acute Infection vs IBD:
Duration of Symptoms
Onset of Symptoms
PLT
HCT
Biopsy Results

Back 11

Acute Infection:
Syx <2 weeks, abrupt onset, nl PLT, nl HCT, nphils on bx

IBD:
Syx >4 weeks, insidious onset; PLT >450K; low HCT, bx shows abnml crypt architecture, lymphoid aggregates, basal plasmacytosis

Front 12

Pseudopolyps are indicative of ________.

Back 12

Chronic ulcerative colitis

Front 13

Ulcerative colitis:
Current surgical option

Back 13

Ileo-anal anastomosis with reservoir (attach ileum to rectum after colectomy)

Front 14

Fistulas are a complication of _______.

Back 14

Crohn's disease

Can happen anywhere (air in urine = fistula to bladder)

Front 15

What is the most common extraintestinal symptom of IBD?

Back 15

Peripheral arhritis

Note: it is monoarticular, asymmetrical and favors large joints over small joints (no synovial destruction!)

Front 16

What are the systemic complicaitons of small bowel inflammation?

Back 16

Bile-salt wasting or depletion, Gall stones

Bile-salt depletion-->malabsorption, bacterial overgrowth

Kidney stones, fistulae, amyloidosis

Front 17

All IBD patients should have testing for ______.

Why? How does this differ for CD and UC?

Back 17

All IBD pts should have vit D testins bc osteoporosis occurs in 20-30% of IBD pts.

All CD pts should get bone scan (DEXA); UC if using steroids/RF.

Ca2+/Vit D prophylaxis, bisphosphonates too!

Front 18

How is IBD presentation different in children?

Back 18

Fall off growth curve (avoid steroids)

Front 19

Risk factors for ischemic colitis.

Back 19

Smoking, birth control, age

Front 20

Sulfasalazine:
MOA
Indication

Back 20

Pro-Drug: Sulfapyridine + 4-ASA
cleaved by gut bacteria-->reduces inflammation in pts w/UC

Front 21

Sulfasalazine:
Sulfa vs 5-ASA AE's
Combined AE's

Back 21

Sulfa:
Male infertility
Hemolytic anemia
Agranulocytosis

5-ASA: Nephritis

Both:
Alveolitis
Pancreatitis

Front 22

Steroids:
Use in UC

Back 22

Excellent for induction medication in UC and CD

Do not work for maintenance

LOTS OF SIDE EFFECTS

Front 23

This drug has 90% first pass metabolism by the liver.

Why is this a good thing?

Back 23

Budesonide

only 10% makes it to systemic circuln; since this is a steroid drug, this will limit its side effects!

Front 24

Azathioprine/6-Mercaptopurine:
MOA
AEs

Back 24

Inhibits purine synthesis
Inhibits T-helper activity

AEs:
Hypersens rxns (fever, rash, pancreatitis, hepatitis)
BM suppression
Opportunistic Infections

NO STEROID-LIKE COMPLICATIONS

Front 25

Infliximab:
AEs

Back 25

Infusion rxns
TB (!!), fungal infections
HBV reactivation

Front 26

IBD patients:
Vaccine recommendations

Back 26

Annual influenza
Pneumoccocal vaccine if immunosuppressed (steroids etc)
HBV/HAV if not immune
HPV in women
Varicella

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