164. Clinical Features of IBD

Question 1

IBD

• epidemiology - global, age, gender, race
• pathogenesis

Answer 1

Highest in US, Canada, N EU; 20s-30s age, M = UC, F = CD, whites highest

PGen: interaction of genetics (NOD2/CARD15 - activates proinflammatory molecules), immune response, enviro (smoking), microbial antigens

Question 2

Dx of IBD

• sx
• gut and non-gut manifestations

Answer 2

sx: bloody diarrhea, abd pain, abd mass, abd/perianal FISTULA FORMATION, joint swelling, apthous ulcers
- Spondyloarthropathy: axial skeleton (Sacroiliitis - HLA B27, Ankylosing Spondylitis), peripheral (Type 1 - HLA B27, large joints, correlates with activity; Type 2 - small joints, independent of bowel activity)
- osteopenia/osteoporosis - due to malnutrition, chronic inflammation
- derm: pyoderma gangrenosum, erythema nodosum, cutaneous crohn’s disease (apthous stomatitis)
- ocular: episcleritis, anterior uveitis (pain redness, photophobia, blurred vision)
- biliary: PSC!!!!! cholangiocarcinoma
- hepatic: fatty liver, steatohepatitis
- kidney stones
- gut: strictures, fistulas, perforations, toxic megacolon, short gut syndrome (not enough functional gut to absorb), colon cancer