2.2 Cs Exam 2: Ibd

Front 1

what are the three etiologic theories for IBD?

Back 1

genetic susceptibility + environmental triggers + immune dysregulation

Front 2

what affect does smoking have on Ulcerative Colitis? Crohns?

Back 2

UC- decreased incidence & severity in smokers
Crohns- increased incidence in severity in smokers.

Front 3

Crohn's involves the entire alimentary tract.

what is the MC site for crohn's disease?

Back 3

terminal ileum

1/3 involve SI only, 1/5 colon only

Front 4

Transmural inflammation & skip lesions are associated w/ which dz?

Back 4

Crohn's ONLY

Front 5

nonbloody diarrhea, loud borborygmi & aphthous ulcers are associated with?

Back 5

Crohns

Front 6

Cobblestoning & string sign are associated w/ what disease?

Back 6

Crohn's

Front 7

when is doing a scope in a crohn's pt CI?

Back 7

during acute flairs bc it will perforate

Front 8

what are the long term complications of crohns?

Back 8

-extensive ileal mucosal dz leading to malabsorption & weight loss
-fistulas (d/t transmural inflammation/ abscess

--> colonic-peritoneal fistula)
-obstruction
-Ca oxalate stones (d/t fat malabsorption)
-colon carcinoma IF COLON INVOLVED*

Front 9

what are the extraintestinal manifestations associated w/ Crohn's?

Back 9

- peripheral arthritis (asymm, seroneg, nondeforming)- 20%
- central arthritis ( sacroileitis and/ or ankylosing spondylitis)- 10%
- hepatobiliary tract dz (cirrhosis)
- pyoderma gangrenosum (5%)& erythema nodosum (10%)
- iritis & episcleritis
- anemia, thromboembolic dz & amyloidosis.

Front 10

which extraintestinal manifestation directly mirrors colon involvement?

Back 10

Peripheral arthritis

Front 11

what are the 4 main indications for surgery for Crohn's pts?

Back 11

Disease intractable to medical tx & include;

1. intra-abdominal abscess
2. symptomatic refractory fistulas
3. intestinal obstruction
4. massive bleeding

Front 12

what is the clinical recurrence pot surgery in a Crohn's pt at 1 year? 10 years?

Back 12

1 year- 20%
10 years- 80%

= HIGH REOCCURANCE

Front 13

what area does Ulcerative Colitis (UC) generally affect?

Back 13

colon (50% rectum only) only w/ diffuse friability & erosions leading to chronic bleeding

*correlation btwn extent of colon involved & severity**

Front 14

what are the 3 major types of UC?

Back 14

proctitis-- rectum involved only (50%)
left sided colitis - descendning colon (30%)
entire colon- pancolitis (20%)

Front 15

in which populations is UC more common?

Back 15

nonsmokers & those who quit smoking during the disease.

Front 16

what surgical procedure is associated w/ a decreased occurrence of UC?

Back 16

appendectomy b4 age 20.

Front 17

what is the hallmark of UC?

what is a common repercussion of this hallmark?

Back 17

bloody diarrhea;

anemia

Front 18

what type of inflammation would you see on endoscopy of a pt w/ UC?

Back 18

edematous mucous that is friable & generalized continuous erosions.

Disease confined to mucosa only w/ rectum always involved.

Lesions are NOT TRANSMURAL.*

Front 19

what can a plain film show in a pt w/ UC?

what can a Barium enema show in the same pt?

Back 19

plain film- toxic megacolon

BE- loss of haustral folds

Front 20

what is the most worrisome long term complication associated w/ UC?

what might decrease this risk?

what are other long term complications?

Back 20

increase in colon carcinoma in pts w/ dz proximal to the sigmoid colon. 1% / year increased risk starting at 10 years after dx

- folic acid decreases risk

- other LT complications: colon obstruction w/ toxic megacolon & perforation. Anemia & dehydration.

Front 21

how do the extraintestinal manifestations of UC differ from Crohn's?

Back 21

they don't (as far as kalekas is concerned)

Front 22

t/f

In both UC & Crohn's, post surgery there is a recurrence at the surgical anastomosis

Back 22

FALSE

in crohn's there is a recurrence at the surgical site (80%- 10 years)

in UC, there is no recurrence.

Front 23

How do you cure UC?

Back 23

Total colectomy

* indicated in pts w/ toxic megacolon, obstruction, carcinoma, severe hemorrhage, or perforation***

Front 24

how do you tx UC & Crohns?

Back 24

UC & Crohns-

acute flares:

corticosteroids + Abx

prevention:

5-aminosalicylic acid derivatives, immunomodulating agents

+ nicotine patch (UC)
+ infliximab, probiotics (crohns)