Bernadino

Question 1

IBD Epidemiology

Answer 1

• Equal men and women (jews>non)
• Bimodal distribution
• 1st peak is 15-25 y.o.
• 2nd peak is +60 y.o.

Question 2

Symptoms of UC

Answer 2

bloody diarrhea and tenesmus

Question 3

Symptoms of CD

Answer 3

nonbloody diarrhea, ab pain, weight loss, anorexia

Question 4

Infectious mimics of IBD

Answer 4

Shigella, E. Coli, Campylobacter, Salmonella, C. diff, Vibrio, CMV

Question 5

UC

Answer 5

inflammatory disease affecting mucosa of rectum and parts of colon (continous)
- chronic and relapsing
- neutrophilic crypt abscess
pANCA (+)

Question 6

CD

Answer 6

pan-enteric transmural inflammatory disease (mouth to sigmoid --> spares rectum) 
- skip lesions (usually terminal ileum)
- granulomas!!!
- painful diarrhea, anemia
ASCA (+)

Question 7

IBD Extraintestinal manifestations

Answer 7

Musculoskeletal –> arthritis, ankylosing spondylitis, osteoporosis, sacroilitis
Skin and Mouth –> erythema nodosum, apthous ulcers, vitiligo, psoriasis, amyloidosis, pyoderma gangrenosum
Ocular –> uveitis, iritis, episcleritis
Hepatobiliary –> primary sclerosing cholangitis, cholangiocarcinoma, hepatitis

Question 8

Complications of UC

Answer 8

toxic megacolon, hemorrhage, stricture, CRC

Question 9

Complications of CD

Answer 9

abscess, perforation, obstruction, hemorrhage, CRCV

Question 10

CRC in IBD

Answer 10

increased risk at 10 and 30 years
- increased risk with proximal disease, long duration, fmaily history
5-ASA is protective

Question 11

Pathogenesis of IBD

Answer 11

abnormal function of gut mucosal barrier –> chronic inflammation

• there is genetic suceptibility
• dysregulation of mucosal inflammatory immunity (Th1)
• decreased Treg cells

Question 12

Environmental Influences

Answer 12

“Clean Kid hypothesis”

- more common in cold climates, industrialized areas,

Question 13

Expectations of IBD treatment

Answer 13

• induce clinical remission
• maintain remission
• improve quality of life

Question 14

Induction therapy

Answer 14

5-ASA
Steroids
Infliximab
Cyclosporine
Surgery

Question 15

Maintenance therapy

Answer 15

5-ASA
Immunomodulators
Infliximab

Question 16

Causes of Lower GI bleeding

Answer 16

Upper GI - 10%
Small Bowel - 5%
Colon - 85%

Question 17

Upper GI bleeds

Answer 17

peptic ulcer
esophageal varices
erosive
mallory-weiss

Question 18

Lower GI bleeds

Answer 18

angioectasia
ulcer
IBD
infections
fistula
hemorrhage
Meckel's

Question 19

Colon GI bleeds

Answer 19

Diverticular hemorrhage
angiodysplasia
ischemia
neoplasm
IBD
infection
radiation

Question 20

Acute Colonic Diverticulitis

Answer 20

symptoms occur in about 20% of patients that have them
- pain, diarrhea, fever, ab tenderness, hemorrhage (rare)
Complications
- abscess, rupture, fistula
Diagnosis by CT (not endoscopy)

Question 21

Treatment of diverticulitis

Answer 21

Mild -> oral hydration, liquid diet, antibiotics
Severe -> hospitalize, IV antibiotics, NPO, CT scan
Peritonitis -> surgical intervention

Question 22

Acute Diverticular Hemorrhage

Answer 22

accounts for 50% of acute lower GI bleeds
- massive - 5%
- self-limiting 80%
Tx -> resuscitation, reverse anticoagulation, transfuse, observe, colonoscopy

Question 23

Angioectasia

Answer 23

Angiodysplasia
tortuous, dilated submucosal capillaries/veins lacking smooth muscle
- spider-like, can occur anywhere
- presents as hemorrhage or anemia
- associated with aortic stenosis, renal failure, and old age
Tx -> colonoscopy with ablation

Question 24

Colitis

Answer 24

inflammatory -> Crohn’s, UC, NSAIDs
infectious -> salmonella, shigella, campylobacter, E. Coli
ischemia

Question 25

Infectious Colitis

Answer 25

Tx -> usually self-limiting - hospitalize if elderly, immunocompromised, dehydrated - IV hydration and antibiotics

Question 26

Ischemic Colitis

Answer 26

Non-occlusive -> hypoperfusion, drugs, heart disease, exercise Occlusive --> embolic, A fib, thrombosis, vascular procedure, vasculitis, hypercoaguable state Diagnosis --> history, CT, colonoscopy

Question 27

Neoplasm

Answer 27

Location-dependent symptoms (R-anemia, L-obstruction) - occult, slow bleed --> rarely hematochezia - treat with surgical resection

Question 28

Radiation Proctitis

Answer 28

acute radiation proctitis -> during radiation treatment chronic radiation proctitis -> delayed for months-years Tx -> endoscopic ablation

Question 29

Ano-rectal disorders

Answer 29

fissures hemorrhoids solitary rectal ulcers

Question 30

Anal Fissure

Answer 30

acute or chronic tear in anal canal - internal sphincter spasm - pain and bright red blood with stool passage - associated with constipation, diabetes, Crohn's

Question 31

Hemorrhoids

Answer 31

dilated plexus of submucosal middle and superior hemorrhoidal veins - symptoms = bleeding, pruritis, pain - associated wtih age, diarrhea, pregnancy, straining

Question 32

Solitary Rectal Ulcer

Answer 32

varying appearance --> erythema, nodularity, ulcer - etiology from rectal prolapse, puborectalis muscle, constipation, 4th decade - Symptoms -> bright blood, straining, pelvic fullness, constipation - Treatment -> stool bulking, softeners

Question 33

Gilbert's Syndrome

Answer 33

autosomal dominant inborn error of metabolism | - benign unconjugated hyperbilirubinemia

Question 34

Physical evidence of chronic liver disease

Answer 34

spider hemangiomas, ascites, edema, palmar erythema, caput medusa, jaundice, asterixis, xanthelasma, Dupuytren's contractures

Question 35

Hyperbilirubinemia

Answer 35

Unconjugated --> hemolysis, Gilbert's, medication | Conjugated --> intrinsic liver disease, meds, biliary tract obstruction

Question 36

Gallstones

Answer 36

cholesterol (90%) --> bile composition and biliary stasis pigment (10%) --> cirrhosis, hemolytic anemia - most often mixed composition RISKS - 4 F's female, fat, fertile, forty

Question 37

Transabdominal ultrasound

Answer 37

study of choice for gallstones and cholecystitis | - 95% sens, 98% spec

Question 38

Biliary Pain

Answer 38

colic --> rapid crescendo, slower decrescendo - spasm of GB in setting of obstruction, postprandial - RUQ pain, radiates to interscapular region

Question 39

Acute Cholecystitis

Answer 39

``` ab pain (murphy sign), fever, leukocytosis Acalculous cholecystitis --> no stone (after surgery, trauma, burn) ```

Question 40

Choledocholithiasis

Answer 40

stone/stones in common bile duct --> has exited the gallbladder - secondary --> migrate from GB - primary --> form in CBD Charcot's Triad --> fever, pain, jaundice

Question 41

Cholangitis

Answer 41

infection/inflammation of gallbladder | - most caused by gallstones, can be infectious, cancer, strictures