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IBD medical
WOCN program
| Question | Answer |
|---|---|
| what feature distinguishes Crohn's from Ulcerative Colitis | mucosa vs transmural, patchy vs continguous, no granulomas vs granulomas, colon only vs entire gut, TNF vs no TNF involvement, fistula vs none, perianal involvement or not, CD has finger clubbing, |
| UC extending from rectum up to splenic flexure is called what | Left sided UC |
| what is a common immunosuppresant given for Crohn's | metronidazole |
| which therapy would be the choice for peristomal pyoderma gangrenosum related to UC or CD? | wound care and medical management |
| what type of diet could help alleviate symptoms of IBD | diet has not been shown to affect IBD |
| which treatment would be considered for a perianal fistula without an abscess | metronidazole, AZA, 6-MP, cyclosporine, infliximab |
| what drug can be used in the treatment of UC that acts directly on the colonic mucosa with limited systematic absorption | Budesonide high topical activity and low bioavailability Entocort is enteric formulation taken orally, useful for mild to moderate ileal or and right sided colonic CD |
| what is the goal of medical management of UC and CD | induction and maintenance- get them well and keep them well (Medications, Diet,(CD only) Nutritional therapy (improve nutritional intake) Supportive care, Management of extraintestinal complications |
| the highest incidence and prevalence rates of IBD have been reported from where | UK, US, and Scandinavia, Caucasian, Jewish |
| which relative would be most likely to see an inherited predisposition for IBD | 4-20 x increase in risk in first degree relatives, 7% absolute risk in first degree relations 20% risk of a second family member |
| what is the most important environmental factor impacting the pathogenesis and course of IBD | Cigarette smoking is an environmental factor - strongly associated with CD, as protective effect in UC |
| what is the hypothesis of pathogenesis for IBD | IBD may be an aberrant response to environmental factors in genetically susceptible host . affected individuals have impaired ability to down regulate inflammatory response once it has started |
| why is the discovery of NOD2 one of the most significant findings in IBD pathogenesis in years | when found in people who are homozygous (they have two of these genes) for NOD2 may indicate a relative risk of CD 14.3-44% Is part of immune mediation in the gut |
| is the rectum always involved in UC | yes |
| clinical distinctions of CD | transmural, entire GI tract, patchy, mucosa cobblestoning, ileocecal most common, wgt loss common, pain more likely, higher % of obstructive sx's, variable perirectal involvement |
| the reason that CD patients are more likely to have symptoms of abdominal pain is what | transmural involvement |
| fistula formation is only seen in which of the IBD's | CD |
| what are the principles in treating ulcerative colitis and crohns disease | induce and maintain, improve QOL |
| name two aminosalicylate drugs used to treat mild to moderate UC or CD | 5 ASA, mesalamine |
| what is the average dose of corticosteroids used in the treatment of moderately severe UC in the outpatient setting | 40mg/day oral |
| name an immunomodulatoratory agent used in the induction and maintenance of remission in UC and CD | methotrexate, azothioprine (AZA) and 6-mercaptopurine (6-MP) cyclosporine |
| what antibiotic has been shown to be effective in the treatment of patients with CD and perianal fistulas | metronidazole or cipro |
| what is infliximab | biologic agent, anti TNF |
| what otc med may precipitate disease exacerbation | NSAIDs |
| what layers of the bowel are affected by UC? | submucosal |
| what layers of the bowel are affected by CD? | transmural |
| which disease can have abscesses and fistulas | CD |
| UC | Mucosa only, Inflammation is contiguous and circumferential, no perianal disease, minimal pain, pyoderma, arthritis, iritis, uveitis, erythema nodosum |
| CD | transmural, patchy, granulomas, entire gut, no TNF involvement, fistula, perianal involvement or not, CD has finger clubbing, also has extraintestinal se's |
| what are complications of UC and CD | bleeding (CD>UC), severity of bleeding depends on depth of inflammation, fistulas (CD>UC) toxic megacolon (UC>CD) colonic wall decompensates from inflammation can be caused by meds that slow peristalsis, strictures (CD>UC) and malignancy (UC>CD) |
| what is the goal of medical management of UC and CD | induce and maintain remission, improve quality of life |
| is there a cure for UC or CD | no |
| clinical presentation of UC | mucosal, colonic, contiguous, rectum always involved, perianal normal, pain not typical, rectal bleeding/diarrhea may be present |
| pathophysiology of CD | Full thickness (transmural), Granulomas (15-30% in biopsy specimens; 40-60% in surgically resected bowel) Fistula, abscesses, fibrotic strictures inflammation predisposes to strictures and fistulas high levels of TNF-a |
| Sulfa free aminosalicylates | Olsalazine (dipentum) Mesalamine (Asacol- pH dependent coating, pentasa-encapsulated in thylcellulose beads) Mesalamine enema (rowasa) Mesalamine suppository (canasa) |
| Corticosteroids | prednison and budesonide Can be given in delivery system that delivers to certain locations in gut and reduce systemic exposure |
| what is the mainstay treatment for moderate to severe UC and CD | corticosteroids (antiinflammatory and immunomodulatory,) |
| dose of prednisone to be given | 40mg/day oral |
| what corticosteroid has low systemic action | Budesonide high topical activity and low ioavailability Entocort is enteric formulation taken orally, useful for mild to moderate ileal or right sided colonic CD |
| Immunomodulatory agents | T-cell inhibitors (cyclosporine and tacrolimus) Azathioprine (AZA) and 6-mercaptopurine (6-MP) Methotrexate, |
| Antibiotic used for CD | metronidazole useful to tx CD of colon and perianal fistulas may require high doses, neurotoxicity may occur and limit use |
| Biologic agents | anti-TNF's Infliximab (remicade) IV infusion can reactivate TB |
| explain chronic inflammation in the gut | controlled inflammation, gut has adaptive state to maintain equilibrium |
| explain inflammation in IBD | inappropriate and exaggerated response to an antigen by most of the mucosal immune elements, including T cells and tissue macrophages-these recruit other inflammatory elements |
| which disease responds to anti-TNF treatment | text says UC but newer sources say both infliximab (remicade) and adalimumab (humira) certolizumab for CD golimumab for UC |
| which meds are T- cell inhibitors | tacrolimus and cyclosporine |
| anti-TNF meds | infliximab |
| monoclonal antibody but not anti- TNF | vedolizumab- blocks integrin |
| Classifications of UC | Proctitis=rectum only, Proctosigmoiditis =rectum and sigmoid colon, Left sided UC=rectum to splenic flexure, Extensive UC =rectum beyond splenic flexure |
Created by:
Beth Perry
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