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37 Cards in this Set
- Front
- Back
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Small bowel studies?
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1. small bowel follow through
2. endoscopy 3. enteroclysis 4. Angiography 5. Double balloon endoscopy 6. capsule endoscopy 7. new technology - CTE + MRI |
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Which study allows us to see all 26 ft of intestine?
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capsule endoscopy
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Small Bowel Follow Through
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-not direct - radiological study
-For: upper GI lesion, mass, ulcer - low sensitivity and low specificity...not used much -cheap! |
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Endoscopy
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1. EGD: reach 1st and 2nd part of duodenum
2. push enteroscopy: incomplete! cant see whole thing 3. Retrograde ileoscopy: see distal colon 4. sonde method: use peristalsis to see further...not used 5. surgery |
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gold standard for upper GI?
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EGD = esophagogastroduodenoscopy
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enterocylsis?
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= small bowel enema
-less sensitive in distal ileum because of dilution -radiologist dont like to do this 1L dilute barium into duod to illeum...when infuse inflate si with air so barium coats mucosa and lesions...can see on xray |
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Double Balloon Endoscopy?
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- 2 balloons, one on tip, and other on distal end
-indication: obscure gi bleed -entire si visualized |
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Angiography
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- looks at vasculature
-indication: lower gi bleed, angiodysplasia -uses sup. mesenteric artery dx: via accumulation in arterial phase |
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Capsule Endoscopy
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-1st time can see mouth to anus!!!
-take capsule with camera and battery and swallow, leads on ant abdomen for si to be seen -indication: Obscure gi bleed, IBD, celiac, polyposis, ab pain -takes 8 hrs -no risk for infection -complication: retention |
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CT enterography
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-spatial resolution so not direct
-same sensitivity but better specificity than CE -Indication: mural thickening, fistulas, abscess, sacroiliitis |
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MRI Enterography
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-indication: distinguish active inflammation from fibrosis
-avoids ionizing radiation, safe in preg and renal failure |
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Crohns genetics
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-NOD2/CARD 15 gene : innate
-12, ompc, cbirl: adaptive -ASCA and antiCBirl are very aggressive...may need surgery |
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Crohns 4 types of immune response patterns
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type 1 - ASCA
Type 2 - OmpC +12 Type 3 - pANCA Type 4 - NO + CBir |
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Where is Crohn's most common?
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distal ileum and proximal colon
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predominant symptoms of crohns
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diarrhea
ab pain weith loss |
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Findings of Crohns?
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1. pale, weak, chronically ill
2. aphthous ulcers in mouth 3.rebound tenderness 4. leukocytosis, anemia, hypoalbuminemia, high ESR 5. duodenal crohns |
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What test helps tell between IBD and IBS
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fecal lactoferrin test
-iron binding glycoprotein -resistant to proteolysis -must freeze |
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Fecal lactoferrin vs. Fecal Calprotectin
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-2 tests to test for crohns
Fecal Lactoferrin: -iron binding glycoprotein -resistant to proteolysis -must freeze Fecal Calprotectin -ca and zinc binding protein -stable at room temp so dont freeze -active inflam sensitive -active disease less specific -best used in combo with lactoferrin |
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Extraintestinal complications of Crohns
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-peripheral arthritis
-axial arthritis -ankylosing spondylitis -sacroilitis -erythema nodosum -raised tender nodules on anterior tibia -uveitis, blurred vision, photophobia, conjunctiva infec, blind |
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Celiac Disease Pathology
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-loss of surface area
-blunting of villi -columnar to cuboidal or squamous cells -elongation of crypts -IELs |
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Celiac Clinical Presentation
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-diarrhea - bulky, float, smell bad
-ab distention -relatively asymp -anemia, night blind, muscle cramp |
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Celiac Physical Findings
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-nail change
-edema of lower extremeties -ecchymoses -pallor -cheilosis |
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Dx of Celiacs
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-IgA anti gliadin
-IgA anti-endomysial -anti transglutaminase autoab -biopsy -CE |
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Complications of Celiacs
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-malignancy - lymphoma of si
-ulcerative jejunoileitis -refractory sprue -collagenous sprue -neuropathy |
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Associated diseases of Celiacs
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- Dermatitis Herpetiformis!!!!
-dm -selective IgA def -PBC -PSC |
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IBD treatment
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1.general supportive therapy
2. sulfasalazine 3. mesalamine 4. corticosteroid 5. immunomodulator 6. ab/probiotic 7. infliximab |
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General Supportive care for IBD
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-doesnt affect level of disease activity...only deals with diarrhea
-antidiarrheals = loperamide, diphenoxylate, cholestyramine -antispasmodics= dicyclomine, hyoscyamine, propantheline bromide -analgesics = tricyclic antidep, narcotics...can get toxic megacolon |
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Sulfasalazine for IBD
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-only active in colon bc bacteria there cleave and activate it
-ADR: sperm prob, nv, hemolysis, hypersensitivity rxn, nephrotoxicity, folate def |
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Mesalamine for IBD
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-sulfasalazine enema
-watch for nephrotoxicity |
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Corticosteroids for IBD
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-Budesonide
-highly effective for remission, NOT for maintenance therapy -ADR: moon face, acne, insomnia, incfect, growth prob, depress DONT USE unless have to |
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Immunomodulators for IBD
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-Azothioprine= takes long to work, use for maintenance
-Methotrexate = takes long to work, for maintenance. can give bm dep, hepatotoxic, cirrhosis -Cyclosporine = QUICK, but use for few days only because very renal toxic |
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Antibiotics for IBD
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-no affect on remission rate
ADR: can cause pseudo. colitis *not main therapy for IBD |
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Probiotics for IBD
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-associated with epi cells
-stim innate immune response to improve epi integrity, influences t cell immune hyporesponsiveness |
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AntiTNF alph for IBD
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1. infliximab
2. natalizumab 3. adalimumab 4. certolizumab pegol |
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Infliximab
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-chimeric IgG monoclonal ab...part human and part murine
-neutralizes soluble tnf alpha -indications: RA, AS, CD...heals fistulas (crohns) -limited by ab production |
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CDP571 for IBD
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- humanized infliximab...part human and murine
-not anything great |
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Adalimumab for IBD
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-ALL human!!!
-recombinant monoclonal Ab specific for TNF alpha...binds to tnf alpha and prevents it from binding rec p75 and p55 -safe and effective |
