by jwilli


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What is inflammatory bowel disease (IBD)?
A general term for a group of chronic inflammatory disorders of unknown etiology
What are the two major classifications of IBD?
Ulcerative Colitis
Crohn's Disease
What is the cure for IBD?
There is no cure for inflammatory bowel disease (IBD).  We just treat the symptoms
In Ulcerative Colitis, what is the body part that is primarily affected?
The colon and 90-95% of people diagnosed with Ulcerative Colitis are only affected in the colon area
What is the main characteristic Ulcerative Colitis?
Bloody Diarrhea
What are some of the key differences between Ulcerative Colitis and Crohn's disease?
Crohn's disease Has
- Fissures
- Strictures, Masses, and Pain, includes mouth to anus area

Ulcerative Colitis
- has more blood in the rectum and anus and is only localized to the anus
Which population is Ulcerative Colitis more common with?
Caucasions (The Whitey's, Crackers)..Evenly distributed among the sexes
Is Ulcerative Colitis more prevalent in Men or Women?
Neither...equal in both
What age group is Ulcerative Colitis typically seen?
Younger age groups 15-35 yrs old
What is the cause/etiology of Ulcerative Colitis?
Unknown cause and etiology
Even though the cause of Ulcerative Colitis is unknown what is a proposed etiological cause?
Defective reaction of immune system to gut bacterial antigen in genetically predisposed patients
What effect does cigarrette smoking have on Ulcerative Colis?
Smoking has protective effects in patients with Ulcerative Colitis
What effect does cigarrette smoking have on Crohn's?
Smoking has a deleterious effect in patients with Crohn's disease.  "Smoke isn't going to save an old Crohn"
What is the association of Ulcerative Colitis in monozygotic twins?
No correlation
What is the association of Crohn's in monozygotic twins?
There is a correlation
We know that the etiology is unknown for Ulcerative Colitis but what is the Autoimmune Theory about why patients have UC?
Enteric bacteria are acting as Ag, and Ulcerative Colitis forms by loss of tolerance to these Ag
What are some of the drugs that are used in treatment of Ulcerative Colitis via immunosuppressive mechanisms?
Corticosteroids
Azathioprine (Azasan, Imuran)
Which specific population (specific within caucasions) are susceptible to Ulcerative Colitis?
Jewish
Is there a genetic disposition to having Ulcerative Colitis?
Yes
What psychological factors can trigger Ulcerative Colitis to flare-up?
Anger
Depression
Anxiety
Ulcerative Colitis typically involves this specific site? (Name location and tissue layers)
Mucosa/Submucosa of Colon
Is the inflammation in Ulcerative Colitis, Uniform and Continuous?
Yes, inflammation in Ulcerative Colitis is uniform and continuous
There are four different general types of disease characteristics in Ulcerative Colitis, what are they?
Mild
Moderate
Severe
Fulminant
Specifically state what the mild disease symptoms are for Ulcerative Colitis?
Less than 4 stools/day semiformed stools with or without blood

No systemic manifestations

Normal ESR (Erythrocyte sedimentation rate) - one of the indication of systemic inflammation
Specifically state what the moderate disease symptoms are for Ulcerative Colitis?
More than 4 stools/day with or without blood.

Abdominal pain

Fever

Weight Loss

No or mild systemic symptoms (fevers, aches, and pains)
Specifically state what the severe disease symptoms are for Ulcerative Colitis?
Frequent diarrhea (>7/day) with blood and/or pus present

Abdominal cramping

Dehydration/Postural hypotension

Anemia

Constipation/tenesmus may be present if rectum involved

Fever/weight loss

Tachycardia

Leukocytosis

Left shift

Increased ESR
Hypokatemia reflects degree of diarhea
Hypoalbumineria
What is the worst possible state of Ulcerative Colitis to be in?
Fulminant
What are the characteristics of Fulminant stage of Ulcerative Colitis?
More than 10 bloody stools daily
Abdominal tenderness and distension
Continuous bleeding
Severe anemia and blood transfusion requirement due to severe blood loss
Colonic dilation in abdominal plain film
Recurrent inflammation with Ulcerative Colitis can lead to these happening?
Fibrosis
Logitudinal retraction (shortening)
Smooth "lead pipe" appearance
What are some of the systemic complications associated with Ulcerative Colitis?
Weight loss of 15-20 lbs over a couple of weeks
Electrolyte deficiencies
Anemia
Bile Salt deficiencies (poor fat soluble vitamin absorption)
Arthritis
Arthralgia
Fatty liver
Cholecystitis
Hepatitis
Cirrhosis
Skin and mucous membrance changes
Ocular changes (iritis, conjunctivitis)
If the symptoms from Ulcerative Colitis are worse, what does this mean?
The worse the symptoms are the more heavily involved the colon is
What is perforation in ulcerative colitis? Talk about it's consequences
Perforation is when the bowel has been perforated.  This is very bad since bacteria can leak out and cause a serious infection
What is Toxic megacolon in ulcerative colitis?
Its when a perforation occurs due to overusing hypomotility agents. (Codeine, Loperamide, Diphenoxylate, Anticholinergics)
What drugs can cause toxic megacolon?
Codeine
Loperamide
Diphenoxylate
Anticholinergics (atropine, bentyl)..drugs that block acetylcholine in the GI
Why general types of drugs are the drugs that cause toxic megacolon?
Hypomotility drugs
How do we treat toxic megacolon?
A way to treat toxic megacolon is to give nothing by mouth (NPO), Vigorous IV fluids, Electrolyte replacement, Blood transfusions, Cultures/Broad spectrum antibiotics (mainly gram negative), IV corticosteroids, may require emergency colectomy
How is toxic megacolon diagnosed?
It's difficult to diagnose directly, but abdominal x-ray is probably the most usefull diagnosis criteria.  You can also try air contrast barium enema or mucosal friability
To be sure the patient has UC, what should be ruled out?
Hemorrhoids, Neoplastic disease, diverticulitis

Infectios etiology deseases, Pseudomembranous colitis
What are the goals of therapy for UC?
Induce Remission
Maintain Remission
Improve nutritional  status
Improve quality of life
Return to normal daily life
What is the cure for Ulcerative Colitis?
There is no cure
What are some of the non-pharmalogical recommendations for Ulcerative Colitis?
Surgery even though harsh, may be a cure for UC....but the patient has to have an ostomy bag for the rest of their life since the entire colon is taken out, not just a part of it.
How does Pharmacological therapy help with Ulcerative Colitis?
It only treats the inflammation, it does not cure it.  Primary goal of pharmacotherapy is to treat inflammation, minimize GI symptoms, and improve the quality of life
What are the five main classes of Pharmacological agents used in the treatment of Ulcerative Colitis (irritable bowel disease)?
5-ASA compounds (Primary)
Corticosteroids
Anti-diarrheals
Immunosuppressants
Monoclonal antibodies
The primary class to help with irritable bowel disease is?
5-ASA compounds
What are the 5-ASA compounds?
Mesalamine (Ascol, Pentasa, Lialda, Rowasa)
Sulfasalazine (Azulfidine) (don't use in sulfa allergy)
Olsalazine (dipentum)
Balsalazide (Colazal)
What is the brand name for Mesalamine?
Ascol, Lialda, Pentasa, Rowasa
What is the brand name for Sulfalazine?
Azulfidine
What is the brand name for Olsalazine?
Dipentum
What is the brand name for Balsalazide?
Colazal
What are the components of Sulfasalazine? What is the active portion and what causes side effects?
Sulfalazine is composed of 5-ASA and sulfapyridine.  5-ASA is the active component.  Sulfapyridine causes the side effects
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