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25 Cards in this Set
- Front
- Back
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Main highlights of Ulcerative Colitis
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1. Continuous inflammation
2. Colon ONLY 3. Superficial inflammation 4. Variable extent 5. Cancer risk 6. Extra intestinal manifestations |
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Main highlight of Crohn's Disease
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1. Patchy inflammation
2. Mouth to anus involvement 3. Full thickness inflammation 4. Fistulas and strictures 5. Cancer risk 6. Extra intestinal manifestations |
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What are some environmental triggers of IBD?
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1. abx (alters gut micro flora)
2. diet 3. stress 4. smoking (starting or stopping) 5. NSAIDs 6. Acute infx |
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***What is the overative mucosal immune system in IBD due to?
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-Failure to down regulate
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What 3 drugs stop cytokine secretion and activation of T cells?
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1. Adalimumab
2. Certolizumab 3. Infliximab |
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What 4 drugs stop the leukocyte migration from intravascular through endothelial cells
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1. Adalimumab
2. Certolizumab 3. Infliximab 4. NATALIZUMAB |
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What are 2 serum markers that you can look for that are not absolute for someone that can develop IBD?
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1. NOD2
2. CARD15 |
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What are 2 frequent presenting symptoms for IBD?
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1. Constant bowel movements throughout the day
2. Constant blood in stool is a good indication for dx (must r/o infx) |
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What are drug therapies for IBD?
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-abx and corticosteroids (but corticosteroids have many SEs when taking for long time)
-immunomodulators is where the field is heading |
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What are the locations of UC?
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1. Proctitis - rectum only
2. Proctosigmoiditis: + sigmoid 3. Left sided colitis: 2 + descending 4. Extensive colitis: beyond splenic flexure 5. Pancolitis: entire colon |
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***In UC what are crypt abscesses?
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-PMNs invade teh epithelium and concentrate in the crypt lumen
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What is tenesmus
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-the feeling of having to evacuate constantly, when nothing is there
-always present in any severity of UC |
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***What will the barium enema test look like for UC?
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-"lead pipe" due to loss of haustration
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What is the most affected site of CD?
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-TERMINAL ILEUM however can affect anyplace from mouth to anus
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What is a capsule endoscopy?
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-a capsule goes through the GI tract and takes pictures and transmits these pictures to computer
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What is the gross endoscopic appearance for CD?
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1. apthous ulcerations - "looks like a cold sore"
2. non-caseating granulomas is a diagnostic test for CD |
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***Diarrhea from small bowel vs colonic involvement
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1. Small bowel diarrhea will have 3-5 BM w/ large amounts of liquid loss each session
2. Colonic diarrhea will have 15+ w/ smaller amounts of fluid loss w/ each session |
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**Lab test for CD
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-there are no single pathognomoic feature for CD except for caseating ganulomas which is a rare finding
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***What is the mainstay drug tx for UC and CD?
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-5-ASA compounds but must be used in combo w/ another drug in order to get to the colon
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***What 2 drugs include 5-ASA w/ another drug so as to be used for CD and UC?
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1. Sulfasalzaone: combo of 5-ASA and sulf that is bound together w/ a diaza bond, cleaved by bacteria in LI so as to give therapeutic effect
2. Asacol: not sulfa based and releases the 5-ASA component when it reaches the correct pH in the colon |
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Immunomodulators for IBD
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-azathioprine and 6MP have similar effects
-they take a while to start to work so start w/ steroids and then after 6 weeks wean pt off of steroids -in Europe they like MTX |
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When it is ulcerative proctitis alone what is the best therapy?
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-topical therapy (includes suppositories) b/c you are limiting systemic SEs
-if that isn't working they you can add in oral therapy |
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Surgery for CD?
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-section of SI taken out, 6 months later pt comes back w/ another section that needs to be taken out, cycle continues --> pt has short bowel syndrome so best to avoid surgery
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What do infliximab/adalimumab/certolizumab do?
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-inhibit cytokines
-use for refractory (diseases that come back constantly) -also fistulas -ONLY Infliximab is FDA approved for CD and UC, the other two are in the process to be approved for CD |
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***Natalizumab
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-anti-adherence molecule for tx of CD
-blocks adhesion and migration of WBCs into the gut reducing chronic inflam a/w CD -binds to VCAM and MadCAM-1 which are necessary for the leukocyte to exit the vasculature |
