8.1.3 Inflammatory Bowel Disease

alpha-4-integrin inhibitor for Crohn's disease

- natalizumab(Tysabri)

This test (______) can help distinguish between______, but it cannot help distinguish between Crohn's and UC.

Calprotectin, IBS and IBD

Between the two types of IBD, skip lesions are characteristic of _____but not_____

Crohn's disease, Ulcerative Colitis.

t is known that____ is a potent activator of TH 17 cells.

IL-23

Under the influence of______, Th17 cells secrete a lot of ______cytokines.

IL-23, pro inflammatory

The immune system attempts to "wall off" the substance by surrounding it with these immune cells.

A granuloma

Areas involved: Primarily left descending colon and rectum

Ulcerative Colitis

Development of Cancer: More Common

Ulcerative Colitis

Diarrhea: Common and more likely to be bloody

Ulcerative Colitis

Fistulas: rare

Ulcerative Colitis

For those that do not respond to medications and more conservative treatments, surgery can be done to remove _______ for _____patients.

the rectum and entire colon, UC

Crohn's disease most typically effects individuals in their ____.

20s

Peak incidence for UC occurs in the_______ and is confined to ________where it spreads_____.

3rd decade, the rectum and colon, proximally

Medications reduce the inflammation associated with Crohn's disease

5-aminosalicylic acid agent (5-ASA) immunosuppressant drug TNF-alpha blocker alpha-4-integrin inhibitor

________is a localized swelling that is comprised of an aggregation of immune cells (mostly macrophages).

A granuloma

____________form when the immune system perceives something as foreign but has been______ at getting rid of it.

A granuloma, unsuccessful

______levels are up, it would suggest that there is an aggressive immune response.

Calprotectin

__________is another feature of Crohn's disease.

Cobblestoning mucosa

Areas involved: Primarily ileum but can be anywhere in GI tract

Crohn's Disease

Development of Cancer: Less Common

Crohn's Disease

Diarrhea: Common

Crohn's Disease

Fistulas: common

Crohn's Disease

Rectal Bleeding: Rare

Crohn's Disease

Strictures: Common

Crohn's Disease

Tissue Involvement: Primarily submucosa and find skip lesions

Crohn's Disease

Type of inflammation: Granulomatous

Crohn's Disease

NOD2 mutations are strongly correlated with_______.

Crohn's disease

Inflammatory bowel disease can be broken down further into two categories:

Crohn's disease and Ulcerative colitis.

A nutritious diet is especially important in the treatment of ______because patients may experience nutrition deficiencies due to_____

Crohn's disease, diarrhea and steatorrhea and other malabsorption problems.

Since the submucosal layer is affected more than the mucosal layer with_____, there is_______ with Crohn's disease compared to UC.

Crohn's disease, less bloody diarrhea

it is necessary for those with________ to avoid excessive consumption of fats because fat aggravates _____

Crohn's disease, the diarrhea.

Granulomatous lesions (Granuloma) are common in _____

Crohn's disease.

This diet is usually composed of amino acids, fats, sugars, vitamins, and minerals.

Elemental diets

______may be used during times of acute flare up for ______

Elemental diets, Crohn's disease

____,______,_____are all useful in the diagnosis of Crohn's disease.

Endoscopy, stool cultures, and CT scans

_____,_______,______, and the intestinal microbiome all play a role in the pathogenesis of IBD.

Genetics, deranged mucosal immune responses, epithelial defects

________is an antibiotic used to treat bacterial overgrowth in the small intestine for Crohn's disease

Metronidazole (Flagyl)

Molecular patterns on a specific gut bacteria can trigger immune responses against them through______

NOD2

_________ recognize particular bacterial antigens in the gut.

NOD2

______codes for an intracellular protein that binds to bacterial PAMPs and activates signaling events that trigger an immune response.

NOD2 (nucleotide oligomerization domain 2)

It does seem kind of strange that a mutation that causes decreased ability to mount an immune response would result in a disease that has too much immune response (autoimmune).

NOD2, Crohn's disease

With a______ mutation, we may see increased growth of bacteria that can cause ___ inflammation.

NOD2, chronic

With_____ out of the picture, there may be more______ antigens for these APCs to get hold of.

NOD2, dangerous

________occurs more often when the daytime symptoms are severe with _____

Nocturnal diarrhea, UC

_______are patchy areas of inflammation or even wounds that represent intestinal tissue damage.

Skip lesions

This tissue damage can extend through all the layers of the GI tract and create_____ (or openings) from the lumen of the GI to______

Skip lesions, fistulas, the peritoneal cavity.

NOD2 mutation appears to trigger_______, especially __ and___. This of course leads to damage by excessive inflammation.

T helper cells, Th1, Th17

Bloody diarrhea is more common with _____

UC

Diagnosis includes colonoscopy, biopsy, and stool examinations to rule out infections for ________patients.

UC

Granulomatous inflammation is not a characteristic.

UC

Other complications include severe anemia, hypovolemia and impaired nutrition with hypoalbuminemia for______

UC

Stool of________ patients normally contains blood and mucous.

UC

We don't find skip lesions or cobblestoning.

UC

_________patients should avoid food with caffeine, lactose, spicy foods, fatty foods and gas-forming foods.

UC

____________ Patients also have a relatively high risk for developing cancer, so it is highly recommended that patients have annual or biannual ______.

UC, colonoscopies

Rectal Bleeding: Common

Ulcerative Colitis

Strictures: Rare

Ulcerative Colitis

Tissue Involvement: Primarily mucosa and continuous without skip lesions

Ulcerative Colitis

Type of inflammation: Ulcerating and Exudate

Ulcerative Colitis

IBD can stunt a child's growth because of its effect's on________

absorption of vital nutrients.

IL-23 is secreted by_______ that line the gut.

activated antigen presenting cells

Ulcerative proctitis with UC

affects only the rectum.

Proctosigmoiditis with UC

affects rectum and sigmoid colon.

Pancolitis:

affects the entire colon.

This diet, however, may lack whole or partial protein due to the possibility of these proteins triggering _______ in some people

an allergic reaction

Systemic manifestations of IBD include______, skin lesions, inflammatory conditions of the eye like_____, and blood disorders including anemia and________.

arthritis, uveitis, hypercoagulability

NOD2 helps protect our gut from ________by certain types of bacteria.

being overrun

Stool cultures are taken to look for a protein called______ that is secreted by____ blood cells.

calprotectin, white

TNF-alpha blocker for Crohn's disease

certolizumab pegol(Cimzia).

In UC, the damage to the mucosa is _______ (which means to weep or "leak" fluid onto the surface of the damaged epithelial surface).

continuous and exudative

Pseudopolyps for UC

due to inflammation process, the mucosal layer forms tongue-like projections resembling polyps.

These particular gut bacteria can trigger excessive_______ and immune responses that can lead to_______.

inflammation, gut tissue damage

Both types of IBD cause

inflammation, have a pattern of familial occurrence, and diarrhea.

The "cobblestone" appearance arises because of_______ that develop in the mucosa.

longitudinal and circumferential fissures

The _______ for UC are similar as those used for Crohn's disease.

medications

5-aminosalicylic acid agent (5-ASA) for Crohn's disease

mesalamine(Asacol) corticosteroids - budesonide(Entocort EC)

immunosuppressant drug for Crohn's disease

methotrexate(Trexall)

an elemental diet includes foods that are _______

nutritionally balanced and bulk and residue free

This means that nutrition is not ingested but is delivered via a gastric feeding tube or intravenous line.

parenteral nutrition supplementation

in more severe cases an elemental nutritional supplement may be given by total________

parenteral nutrition supplementation

Crohn's disease can affect________ anywhere from the mouth to the anus.

the GI tract

Interestingly, those with defects in ________have reduced risk for developing both Crohn's disease and UC.

the IL-23 receptor

UC affects ______primarily.

the mucosal layer

Crohn's disease is known for skip lesions that can be______ (meaning it affects all the layers of the GI tract).

transmural

The fistulas together with associated________,________,_______,______ gives the mucosa an appearance that resembles "cobblestones".

ulcerations, submucosal inflammation, granulomas, and wall thickening