27. IBD Flashcards
What are the two type of IBD?
Ulcerative colitis 50%
Crohn disease 50%
What countries have the highest incidence of IBD?
US
Canada
Europe
What is UC?
Continuous inflammation in the colon only
Limited to the superficial mucosa, LP, submucosa
Increased risk for cancer and has extraintestinal manifestations
What is the clinical presentation of UC?
Diarrhea with blood and mucus Abdominal pain and tenderness Loss of appetite and weight Fever and fatigue Urgency for bowel movement
What is the presentation of UC in children?
Growth and development failure
What are the endoscopic findings in UC?
Erythema Loss of fine vascular pattern Granularity of the mucosa Friability Edema Pseudopolyps Erosions and ulcers Spontaneous bleeding Cecal patch Backwash ileitis
What is fulminant colitis?
Severe UC with:
- Fever, elevated WBC, and unstabile vitals
- High risk of preforation
What is Crohn’s disease?
Patchy, full thickness inflammation with mouth to anus involvement
Cobblestone appearance
Fistulae, strictures
Extraintestinal manifestations
What area is MC involved in Crohn’s disease?
Ileocecal
What is the presentation of Crohn’s in a pediatric patient?
Abdonminal pain ** Diarrhea Weight loss and anorexia Vomiting Rectal bleeding Stunted growth Fevers
What are the three major endoscopic findings that are specific to Crohn’s disease?
Aphthous ulcers
Cobblestoning
Discontinuous lesions (skip lesions)
What are 5 findings that favor Crohn’s over UC?
- Rectal sparing (UC will always affect rectum)
- Normal vasculature next to affected tissue
- Fistulas or strictures
- Isolated involvement of the terminal ileum
- Granulomas on biopsy
When is backwash ileus seen?
Pancolitis (severe UC)
What are the MC extraintestinal manifestations of IBD?
Acute arthropathy 15-20% ** Erythema nodosum 15% ** Choledocholithiasis 15-30% ** Ocular complications 5-15% ** Sacroilitis 9-11% ** Nephrolithiasis 5-10% Ankylosing spondylitis 3-5% Pyroderma gangrenosum 1-2% PSC 1-2% Amyloidosis (rare)
What is the main difference of presentation of epischleritis and uveitis, two manifestations of IBD?
Episcleritis: white part of the eye is inflamed, but not painful
Uveitis: more painful
What are the goals of management of IBD?
Confirm accurate dx Induce remission Maintain remission Surgery? Enhance quality of life Avoid complications
What is the best characterized mutation that is associated with Crohns?
NOD2
What are the 4 potential forms of pathogenesis of IBD?
- Genetic: NOD2
- Mucosal immune responses: Th17 cells
- Epithelial defects: in tight junctions
- Microbiota
What cytokine released from Th1 in IBS is the main target for therapy?
TNF
Of the penetrating, stricturing, and inflammatory forms of IBD, what do most poeple present with?
Inflammatory
can progress to stricturing and penetrating
What are the key biologics that are used to treat IBD?
Infliximab (anti-TNF)
Certolizumab pegol (anti-TNF)
Adalimumab (anti-TNF)
Natalizumab (anti alpha 4 integrin)
What % of patients require maintenence thereapy
95%
What are the two kinds of microscopic colitis?
Collagenous colitis
Lymphocytic colitis
What is the presentation of microscopic colitis?
Chronic, nonbloody, watery diarrhea without weight loss
Normal radiological and endoscopic findings
