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