3.04 IBD: UC + Crohn's Flashcards
IBD is a broad term that describes what?
chronic or recurring inflammation of GI tract
What are the two most common IBD?
Crohn’s and ulcerative colitis
What is IBD thought to be caused by?
aberrant immune response to gut bacteria in genetically susceptible host
Located at any portion of the GI tract except the rectum?
Crohn’s
Has skip lesions and usually affects the ileum the most?
Crohn’s
Continuous damage that always has rectal involvement?
ulcerative colitis
Transmural inflammation? (entire gut wall thickness impacted)
Crohn’s
“lead pipe” appearance on imaging due to loss of haustra?
ulcerative colitis
noncaseating granulomas Th1 response?
Crohn’s
no granulomas and Th2 response?
ulcerative colitis
malabsorption, malnutrition, and colorectal cancer increased risk associated with what IBD?
both
blood diarrhea is more characteristic of?
ulcerative colitis
kidney stones (calcium oxalate) associated with?
Crohn’s
sclerosing cholangitis associated with?
ulcerative colitis
ASCA associated with?
Crohn’s
P-ANCA is associated most commonly with?
Ulcerative colitis
pseudopolyps are more common in what IBD?
ulcerative colitis
“string sign” on barium enema associated with what IBD?
Crohn’s
In what IBD can severity worsen when patients stop smoking?
ulcerative colitis
1/3 of patients with UC have the disease confined to the?
rectosigmoid
1/3 of patients with UC have the disease that extends to what (left-sided colitis)?
splenic flexure
1/3 of patients with UC have the disease that spreads more proximally referred to as?
extensive colitis
Severe UC is graded based on?
stool frequency increases, large amount of blood in stool, extraintestinal symptoms (ESR, Hg, Temp, heart rate)
What are you looking for/worried about in severe UC, especially in terms of extraintestinal symptoms?
toxic megacolon
(perforation risk)
What extracolonic manifestations are specific to UC?
sclerosing cholangitis + thromboembolic events
How common are extracolonic manifestations in UC?
50%
erythema nodosum, pyoderma gangrenosum, oral ulcers, spondylitis, uveitis, and arthritis are common extracolonic manifestations seen in?
Both Crohn’s and UC
What are some UC differentials?
infectious colitis
ischemic colitis
Crohns
diverticular disease
colon cancer
radiation colitis/proctitis
What can be used to assess the possible consequences of UC?
hematocrit, ESR, and serum albumin
What should you rule out for a UC and Crohn’s diagnosis?
Bacterial stools exam (C. diff) cultures, ova/parasites
What establishes a UC diagnosis?
sigmoidoscopy
What can precipitate a toxic megacolon in UC patients and is of little diagnostic use?
barium enema
What diet should you recommend for UC patients?
regular diet, reduce caffeine or gas prod veggies, avoid opioids or anticholinergics
UC complications?
toxic megacolon, colon cancer
With patients with extensive colitis, when are biopsies recommended?
every 1-2 years beginning 8-10 years after diagnosis
For most patients how is UC managed?
medical therapy
What can lead to a complete cure of the colonic disease in UC (but not the extraintestinal manifestations)?
surgery
Supplementation with what can decrease the risk of colon cancer in UC patients?
folate 1mg oral
What is frequently involved in crohn’s disease?
terminal ileum
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?
crohn’s
What is very unique to Crohn’s that hints at its transmural nature?
fistulization leading to
intraabdominal/retroperitoneal abscesses manifested by fevers, chills, tender abdominal mass, and leukocytosis
Fistulas between the small intestine and colon are typically?
asymptomatic but can result in diarrhea, weight loss, bacterial overgrowth, malnutrition (lots of infections)
Are extraintestinal manifestations unique to Crohn’s?
gallstones, nephrolithiasis (b/c fat malabsoprtion: fat binds to oxalate)
Differentials for Crohn’s?
UC
appendicitis
mesenteric adenitis
segmental colitis (2ndary)
diverticulitis with abscess
NSAID induced
IBS
What can be used to differentiate Crohn’s from appendicitis?
CT scan abdomen
How do you evaluate the consequences of Crohn’s?
B12, blood loss, iron deficinecy, anemis, leukocytosis
Imaging for Crohn’s?
upper GI series barium
Diagnostic procedures for Crohn’s disease?
colonoscopy
biopsy of the intestine ( only 25% granulomas)
What are the indications for surgery with Crohn’s disease?
medical therapy no go
intarabdomnainal abcess
massive blee
obstruction fibrous
incision and drain abscess
resection of the stenotic area/strictoplastuy
Crohn’s diet recommendations?
no lactose
fiber supplementation
low roughage diets (obstruction)
low-fat diet
vitamin B12 supplement (IM)
What is Crohn’s prognosis?
most able to cope and few die
Prevention recommendations for patients with Crohn’s?
annual colonoscopy with 8+ year history of crohns colitis
