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86 Cards in this Set
- Front
- Back
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mucosal inflammatory condition confined to the rectum and colon
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ulcerative colitis
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transmural inflammation of the gi
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crohn's disease
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UC is mucosal inflammatory condition confined to the --- and -----
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rectum
colon |
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5% of the initial UC dx changes to ---
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CD
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crohn's disease can be from the --- to the ---
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mouth
anus |
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cd is can be found in the:
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transverse
jejunum ascending colon ileum cecum |
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uc can be found in the:
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descending colon
sigmoid colon |
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s/s of uc
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abd pain
anorexia weight loss fever bloody stool |
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when do you see md for uc
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blood diarrhea
increace in bms |
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bright red blood per rectum
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hematochezia
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black tarry stools
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melena
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cd's s/s
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abd pain
anorexia fever bloody diarrhea: rare malabsorption |
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when to see md for cd
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n/v
increased diarrhea abd pain |
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5-ASA maintenance decreases inflammation by inhibiting --- and ---
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cyclooxygenase
lipoxygenase |
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nonresponders to 5-asa should receive
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short term corticosteroids
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what will inhibit tpmt
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5-asa
furosemide |
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when should azathioprine be given
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hs
to avoid nausea |
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what's an early approach to ibd
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monoclonal antibodies
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antibiotics given for ibd
why |
mainly for bowel overgrowth or postoperative in genreal 5 vs 10 day course
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5-asa
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sulfasalazine
balsalazide pentasa asacol lialda apriso rowasa canasa |
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monoclonal antibodies: ---/--- immune mediated inflammation
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slow/reverse
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monoclonal antibodies
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infliximab
adalimumab certolizumab natalizumab |
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mild uc stools
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< 4/day
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tx of mild uc
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sulfasalazine 4-6 g/d
or oral mesalamine |
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remission of mild uc
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reduce sulfasalazine or mesalamine by 50%
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what's mod uc
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>4/day
minimal systemic disturbances |
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tx of mod
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mild or
mesalamine enema 1-4gm or corticosteroid enema plus prednisone 40-60mg/day |
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if no response to mod tx what do you give
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infliximab
azathioprine mercaptopurine |
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remission of mod uc
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ok to give mild remission meds
or mesalamine enema 1gm/day |
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remission of mod if taking prednisone
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taper prednisone after 1-2 mo's
reduce sulfasalazine or mesalamine to above |
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severe uc stools
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>6/day
systemic disturbances or ESR> 30 |
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severe uc tx
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infliximab, azathoprine or mercaptpurine
hydrocortisone 100 mg IV q 6-8 hr bridge tx w/ cyclosporine IV 4 mg/kg/day 7-14 days |
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remission of servere
change to ------ maintenance add ------ attempt to withdraw ----- after 1-2 mo's |
change to prednisone
maintenance add sulfasalazine attempt to withdraw steroid after 1-2 mo's |
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mild cd
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no dehydration, anemia or toxicity
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tx of mild ileocolonic or colonic cd
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sulfasalazine 3-6gm/day
or oral mesalamine 3-4 gm/day |
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tx of mild perianal cd
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sulfasalazine or oral mesalamine
and/or metronidazole up to 10-20 mg/kg/day |
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tx of mild small bowel cd
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oral mesalamine (pentasa or asacol)
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what's mod cd
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failure to respond to mild tx or w/ prominent symptoms or obstruction
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tx of mod cd
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mild tx plus
prednisone 40-80mg/day |
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response ot mod
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taper prednisone after 2-3 weeks
add azathioprine, 6-mercaptopurine or methotrexate or swithch to adalimumab |
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what's severe cd
persisiting symptoms despite -----, obstruction, ------ tenderness, cachexia or abscess |
fulminant
persisiting symptoms despite steroid, obstruction, rebound tenderness, cachexia or abscess |
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tx of severe cd
refractory or fistulazing |
add infliximab
hydrocrotisone 100 mgIV 6-8 hr |
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if no response to hydrocortisone w/ severe cd what do you give
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cyclosporine IV 4mg/kg/day
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ibs: recurrent -- -- or discomfort at least 3 days per month in the last 3 months associated w/ 2 or more of the following:
releived by ---; and/or onset associated w/ a change in---- of stool; and or onset associated w/ a change in --- of stool |
abd pain
defectation frequency form (appearance) |
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chronically recurring symptoms of ibs include:
lower abd pain alter ------ fx incomplete ------- extreme ------ abd ------- and distension |
lower abd pain
alter bowel fx incomplete evacutaion extreme urgency abd bloating and distension |
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altered bowel fx:
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diarrhea predominant
constipation predominant mixed diarrhea and constipation |
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alarm symptoms of ibs:
-- unintentional weight ---- fx hx: age: severe unrelenting large-volume ----- fever, -----, redent travel to endemic region -- symptoms, ----- Phys exam: arthritis, skin lesions, ----, --- mass |
anemia
loss hx: colorectal ca, inflammatory bowel disease, or celiac sprue age >/= 50 diarrhea chills nocturnal hematochezia lympadenopathy abd mass |
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tx for ibs pain
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anticholinergics
antispasmodics tca/ssri alosetron peppermint oil |
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tx for ibs bloating
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antispasmodics
antiflatulents probiotic antibiotic |
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tx for ibs diarrhea
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loperamide
alosetron cholestyramine methylcellulose |
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tx for ibs constipation
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lactulose
sorbitol psyllium peg solns miralax lubiprostone |
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tx constipation ibs:
symptomatc tx include --- management and -- --- |
stress management
pt education |
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tx constipation ibs:
increase --- -- |
fluid intake
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tx constipation ibs:
--- laxatives |
osmotic
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tx constipation ibs:
local -- channel activator |
chloride
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tx constipation ibs:
consider --- agents for pain |
antispasmodics
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tx constipation ibs:
add ----- behavior modifications |
psychotx
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tx constipation ibs:
dietary --- |
fiber
start slow to add to diet |
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ex of osmotic laxatives
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mom - tbsp po qd to bid
polyethylene glycol 17 g in 8 oz of fluid |
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tx constipation ibs:
lubi pros tone is selective for -- channel activator; increases intestinal --- --- and intestinal --- |
Cl
fluid motility |
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dose of lubi pros tone
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8mcg po bid
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ae of lubi pros tone
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n/d/abd pain
abd distention ha w/ 24mcg po bid |
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tx diarrhea ibs: symptomatic tx include -- management and pt ---
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stress
education |
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tx diarrhea ibs:
add ---- or other --- |
loperimide
antispasmodic |
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tx diarrhea ibs:
add ---- behavior modifications |
psychotx
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tx diarrhea ibs: possible role of low ------/---- diet
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fructose
sorbitol check for food triggers |
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tx diarrhea ibs:
give -- for episodic management of urgent diarrhea |
loperamide
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loperimide will decrease --- ----
enchance -- and --- absorption strengthen -- --- tone |
intestinal transit
water electrolyte rectal sphincter tone |
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dose of loperimide
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2 mg po 4 x day
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tx diarrhea ibs:
bile acid sequestrants: use: idiopathic bile ---- or following ---- |
malabsorption
cholecystectomy |
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bile acid sequestrants dose
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1 gm po bid to 4 x day
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tx diarrhea ibs:
alosetron is a ---- antagonist |
5HT3
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alosetron available for only -- w/ symptoms > 6 via a restricted program
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women
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dose of alosetron
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0.5 mg po bid
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dose of alosetron
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0.5 mg po bid
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tx diarrhea ibs:
--- antidepressants and ------ |
tricyclic
ssri's |
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tca's and ssri's modulate preception of -- ---, alter --- transit time, and tx underlying ------
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visceral pain
GI comorbities |
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antispasmodics used for
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pain
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moa of antispasmoidcs
direct effect of -- ---- muslce or by -- or ---- |
instestinal
anticholinergic antimuscarinic |
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ae of antispasmodics
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dry mouth
constipation urinary retention visual disturbances |
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ex of antispasmodics
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hyosyamine: 0.125 mg SL/PO 4 x daily prn or 0.375 mg po bid
dicyclomine 10 mg po bid |
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antibiotics used for
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bowel overgrowth
(rimfaximin usu used) |
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rifaximin is a --- antibiotic
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nonabsorable
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rifaximin improves --- ibs symptoms and/or --- symptoms
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global
bloating |
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dose of rifaximin
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1200 mg/day in divided doses for 10-14 days
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ae of rifaximin
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ha
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