Term
| What are the anatomical differences between CD and UC? |
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Definition
- CD - Deep inflammation, entire GI tract, inconsistent/patch development. Concentrated in ileocecal - right lower quadrant pain
- UC - Superficial inflammation, colon only, uniform development |
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Term
| What is the etiology of IBD? |
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Definition
- CD - TH1 response --> IL-6. Smoking increases risk. Genetics?
- UC - TH2 response |
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Term
| What is the clinical presentation of CD? |
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Definition
- 1st major sign - perirectal lesions
- 2nd sign - fistulas - passage between organs
- Elevated ESR in 80% of cases. |
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Term
| What is the clinical presentation of UC? |
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Definition
Diarrhea!! Classified based on # of stools/day
Dull pain
Complication: Toxic megacolon |
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Term
| What are local complications for IBD? |
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Definition
- CD - narrowing off the passageway during the inflammation. Fistulas
- UC - Bleeding risks anemia. Fissures, abcesses, toxic megacolon |
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Term
| What are systemic complications of IBD? |
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Definition
- Anemia - in UC
- Biliary - Gall stones and inflammation
- Joint - Arthritis, bending of spine
- Ocular - common, inflammation
- Skin - Oral (CD) and gangrene (UC)
- Renal - UTI
- Emotional - Eating = pain |
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Term
| What are non-pharmacologic txs for IBD? |
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Definition
- Nutritional support - EN, PN, diet modification
- Stress reduction
- Surgery - ostomy |
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Term
| How do aminosalicylates work for IBD? |
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Definition
- moderate release of cytokines and ROS for mild/mod UC/CD. Not used in ASA allergy
- Mesalamine - many formulations
- Sulfasalazine - pro-drug, cheap. Causes anemia. Supplement folate.
- Olsalazine/Dipentum or Balsalazide/Colazal |
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Term
| How do corticosteroids work for IBD? |
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Definition
- anti-inflammatories for active UC/CD
- Prednisone, Methylprednisolone, Dexamethasone, Hydrocortisone
- Budesonide in CD to target the ileum |
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Term
| How do immunomodulators work for IBD? |
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Definition
Suppresses the immune system to keep IBD in remission. Steroid sparing.
- AZA/Imuran
- MTX - Only for CD. Serious side effects - Folic acid supplements and leukovorin rescue
- CsA - fastest acting, only for patients w/ fistulas. |
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Term
| How do biological response agents treat IBD? |
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Definition
- Antibodies to TNF, for CD
- Infliximab/Remicade - for fistulas (1st line). AE: lymphoma and anemia
- Adalimumab/Humira - AE: Occular nerve damage
- Certolizumab/Cimzia
- Natalizumab/Tysabri
- Ustekinumab/Stelara |
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Term
| How are antibiotics used for IBD? |
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Definition
Inhibit growth of bacteria in CD
- Cipro
- Metronidazole |
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Term
| What adjunctive agents are used for IBD? |
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Definition
- Antidiarrheals - can trigger toxic megacolon in UC
- Psychotropics - BZDs and SSRIs
- NSAIDs
- Nicotine - for active UC |
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