Shared Flashcard Set

Details

Gastrointestinal
Inflammatory Bowel
40
Medical
Graduate
01/24/2010

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Cards

Term
Inflammatory bowel disease most commonly applies to what 2 condition?
Definition
Ulcerative colitis and Crohn's disease
Term
The highest incidence of IBD occurs in what ages?
Definition
15-35yo
Term
Is there an increased risk of developing IBD if there is a family history of the condition?
Definition
Yes - 10X greater risk if sibling has IBD
Term
What race is IBD most prevalent?
Definition
White - American Jews of European descent 4-5X greater
Term
What are risk factors for IBD?
Definition
Smoking, urban, developed nations, Northern climates
Term
An abnormality in what gene occurs 2X as often in pts w/ Crohn's?
Definition
NOD2/CARD15
Term
What % of cases of colitis can't be defined as UC or CD? What are these cases called?
Definition
10%. Indeterminent colitis.
Term
An idiopathic inflammatory condition that involves the mucosal surface of the colon.
Definition
Ulcerative colitis
Term
What portion of the bowel is affect by UC?
Definition
Colon - starts at rectum and may move proximally in a continuous fashion
Term
What is the hallmark sx of UC?
Definition
bloody diarrhea
Term
Describe the clinical presentation in a mild case of UC.
Definition
Intermittently bloody, mild diarrhea (<4-5), LLQ cramping relieved by defecation, tenesmus, periods of constipation
Term
Describe the clinical presentation in moderate UC.
Definition
Frequent bloody diarrhea (10), mild anemia, non-severe abd pain, low grade fever, low alb
Term
Describe the clinical presentation of severe UC.
Definition
>10 loose stools, abd pain/tenderness, severe anemia, fever, low alb, hypovolemia (high PR)
Term
A subset of severe UC characterized by rapidly worsening sx and signs of toxicity.
Definition
Fulminant colitis
Term
What portion of the colon is affected in mild, moderate, and severe UC?
Definition
Mild - rectum or rectosigmoid. Mod - inflammation extending to splenic flexure. Severe - extensive colonic involvement.
Term
A condition in which inflammation extends beyond the mucosa to the muscle of the colon causing impaired mobility and dilation of the colon poss. leading to perforation.
Definition
Toxic megacolon
Term
What test is diagnostic for acute UC?
Definition
Flex sig
Term
What test should be avoided during an acute episode of UC? Why?
Definition
Colonoscopy - very painful and risk for perforation
Term
Name 4 complications of UC.
Definition
1)Massive hemorrhage 2)Fulminant colitis 3)Benign stricture 4)Colon CA
Term
What are the first line med. to tx UC?
Definition
5-ASA - anti-inflammatory (Sulasalazine, mesalamine)
Term
Other than first line meds, what other drugs are used to tx UC?
Definition
COrticosteroids and immunomodulating drugs (methtrexate)
Term
What is the drug of choice to tx distal colitis? Second choice?
Definition
Topical Mesalamine (suppository). Top. corticosteroid or oral 5-ASA
Term
What is the tx for severe colitis?
Definition
Hospitalization, NPO X 24-48hrs, IV corticosteroids
Term
When would you consider surgery to tx severe UC?
Definition
/p 7-10days if IV tx has failed
Term
What is Crohn's disease? What portion of the GI tract does it involve?
Definition
Transmural inflammatin of the GI tract from mouth to anus.
Term
What is the most common presentation of CD? Describe it.
Definition
Ileitis or ileocolitis. Nonbloody diarrhea, low grade fever, malaise, wt loss, RLQ tenderness and palpable tender mass
Term
How does CD cause intestinal obstruction?
Definition
Narrowing of the SB d/t inflammation, spasm, or fibrotic stenosis
Term
Describe the sx in a pt w/ intestinal obstruction d/t Crohn's dz.
Definition
Postprandial bloating, cramping, and loud borborygmi
Term
Name 2 types of penetrating dz that occur in CD as a result of its transmural nature.
Definition
Sinus tracts and fistulas
Term
What portion of CD pts have perianal disease? How is it manifested?
Definition
1/3. Painful skin tags, fissures, abscesses, and fistulas.
Term
Name 6 extraintestinal manifestations of CD.
Definition
Arthralgia, arthritis, uveitis, aphthous ulcers, gallstones, and nephrolithiasis
Term
What are the dominant features on endoscopy in CD?
Definition
ulcers
Term
Describe the visual appearance of ulcers on endoscopy in CD.
Definition
linear and discontinuous - "skip lesions", early may be erythema and apthoid ulcers
Term
Describe the visual appearance of CD on barium enema.
Definition
Cobblestone - diffuse thickening of SB mucosa
Term
Describe s/sx in a pt w/ CD and abscess. What would you need to do if abscess is suspected?
Definition
tender abd mass, fever, leukocytosis. Emergent CT
Term
When are abx used for CD?
Definition
W/ active inflammatory, fistulous, and perianal CD, /p surgery to tx complications and prevent recurrence
Term
What meds are used in the maintenance of glucocorticoid dependent IBD?
Definition
Azathriopine and 6-Mercaptopurine - immunosuppressant of leukocytes
Term
What med used for CD alters immune response by inhibiting T cell responses and helps maintain remission w/ Azathioprine and 6-Mercaptopurine?
Definition
Cyclosporine
Term
What med used for CD is a potent anti-folate drug used for CA tx d/t its immune effect?
Definition
Methotrexate (MTX)
Term
What is infliximab?
Definition
Blocks action of TNF which is a key inflammatory cytokine, used to tx CD
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