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GEM > 3.04 IBD: UC + Crohn's > Flashcards

3.04 IBD: UC + Crohn's Flashcards

1
Q

IBD is a broad term that describes what?

A

chronic or recurring inflammation of GI tract

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2
Q

What are the two most common IBD?

A

Crohn’s and ulcerative colitis

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3
Q

What is IBD thought to be caused by?

A

aberrant immune response to gut bacteria in genetically susceptible host

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4
Q

Located at any portion of the GI tract except the rectum?

A

Crohn’s

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5
Q

Has skip lesions and usually affects the ileum the most?

A

Crohn’s

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6
Q

Continuous damage that always has rectal involvement?

A

ulcerative colitis

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7
Q

Transmural inflammation? (entire gut wall thickness impacted)

A

Crohn’s

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8
Q

“lead pipe” appearance on imaging due to loss of haustra?

A

ulcerative colitis

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9
Q

noncaseating granulomas Th1 response?

A

Crohn’s

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10
Q

no granulomas and Th2 response?

A

ulcerative colitis

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11
Q

malabsorption, malnutrition, and colorectal cancer increased risk associated with what IBD?

A

both

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12
Q

blood diarrhea is more characteristic of?

A

ulcerative colitis

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13
Q

kidney stones (calcium oxalate) associated with?

A

Crohn’s

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14
Q

sclerosing cholangitis associated with?

A

ulcerative colitis

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15
Q

ASCA associated with?

A

Crohn’s

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16
Q

P-ANCA is associated most commonly with?

A

Ulcerative colitis

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17
Q

pseudopolyps are more common in what IBD?

A

ulcerative colitis

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18
Q

“string sign” on barium enema associated with what IBD?

A

Crohn’s

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19
Q

In what IBD can severity worsen when patients stop smoking?

A

ulcerative colitis

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20
Q

1/3 of patients with UC have the disease confined to the?

A

rectosigmoid

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21
Q

1/3 of patients with UC have the disease that extends to what (left-sided colitis)?

A

splenic flexure

22
Q

1/3 of patients with UC have the disease that spreads more proximally referred to as?

A

extensive colitis

23
Q

Severe UC is graded based on?

A

stool frequency increases, large amount of blood in stool, extraintestinal symptoms (ESR, Hg, Temp, heart rate)

24
Q

What are you looking for/worried about in severe UC, especially in terms of extraintestinal symptoms?

A

toxic megacolon
(perforation risk)

25
Q

What extracolonic manifestations are specific to UC?

A

sclerosing cholangitis + thromboembolic events

26
Q

How common are extracolonic manifestations in UC?

A

50%

27
Q

erythema nodosum, pyoderma gangrenosum, oral ulcers, spondylitis, uveitis, and arthritis are common extracolonic manifestations seen in?

A

Both Crohn’s and UC

28
Q

What are some UC differentials?

A

infectious colitis
ischemic colitis
Crohns
diverticular disease
colon cancer
radiation colitis/proctitis

29
Q

What can be used to assess the possible consequences of UC?

A

hematocrit, ESR, and serum albumin

30
Q

What should you rule out for a UC and Crohn’s diagnosis?

A

Bacterial stools exam (C. diff) cultures, ova/parasites

31
Q

What establishes a UC diagnosis?

A

sigmoidoscopy

32
Q

What can precipitate a toxic megacolon in UC patients and is of little diagnostic use?

A

barium enema

33
Q

What diet should you recommend for UC patients?

A

regular diet, reduce caffeine or gas prod veggies, avoid opioids or anticholinergics

34
Q

UC complications?

A

toxic megacolon, colon cancer

35
Q

With patients with extensive colitis, when are biopsies recommended?

A

every 1-2 years beginning 8-10 years after diagnosis

36
Q

For most patients how is UC managed?

A

medical therapy

37
Q

What can lead to a complete cure of the colonic disease in UC (but not the extraintestinal manifestations)?

A

surgery

38
Q

Supplementation with what can decrease the risk of colon cancer in UC patients?

A

folate 1mg oral

39
Q

What is frequently involved in crohn’s disease?

A

terminal ileum

40
Q

intestinal obstruction is a common complication in what IBD due to inflammation, spasm, or fibrotic stenosis that can lead to postprandial bloating, cramping, and loud growling?

A

crohn’s

41
Q

What is very unique to Crohn’s that hints at its transmural nature?

A

fistulization leading to
intraabdominal/retroperitoneal abscesses manifested by fevers, chills, tender abdominal mass, and leukocytosis

42
Q

Fistulas between the small intestine and colon are typically?

A

asymptomatic but can result in diarrhea, weight loss, bacterial overgrowth, malnutrition (lots of infections)

43
Q

Are extraintestinal manifestations unique to Crohn’s?

A

gallstones, nephrolithiasis (b/c fat malabsoprtion: fat binds to oxalate)

44
Q

Differentials for Crohn’s?

A

UC
appendicitis
mesenteric adenitis
segmental colitis (2ndary)
diverticulitis with abscess
NSAID induced
IBS

45
Q

What can be used to differentiate Crohn’s from appendicitis?

A

CT scan abdomen

46
Q

How do you evaluate the consequences of Crohn’s?

A

B12, blood loss, iron deficinecy, anemis, leukocytosis

47
Q

Imaging for Crohn’s?

A

upper GI series barium

48
Q

Diagnostic procedures for Crohn’s disease?

A

colonoscopy
biopsy of the intestine ( only 25% granulomas)

49
Q

What are the indications for surgery with Crohn’s disease?

A

medical therapy no go
intarabdomnainal abcess
massive blee
obstruction fibrous
incision and drain abscess
resection of the stenotic area/strictoplastuy

50
Q

Crohn’s diet recommendations?

A

no lactose
fiber supplementation
low roughage diets (obstruction)
low-fat diet
vitamin B12 supplement (IM)

51
Q

What is Crohn’s prognosis?

A

most able to cope and few die

52
Q

Prevention recommendations for patients with Crohn’s?

A

annual colonoscopy with 8+ year history of crohns colitis

GEM (28 decks)

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