Bernadino: IBD Flashcards
What is IBD?
Idiopathic and chronic intestinal inflammation
What is UC?
MUCOSAL disease
involves the rectum and extends proximally to involve part of the entire colon
Chronic and relapsing
What is CD?
Effects ANY portion of the luminal GI tract
*more aggressive b/c has ability to generate TRANSMURAL inflammation and BEYOND
Presents in two patterns:
- obstructive/fibrostenotic (inflammatory> hard woody strictures)
- Penetrating/fistulilzing
Who is IBD most commonly seen in?
15-25 yrs but SECOND peak 60-70 (more aggressive)
Men= women
Jews>non jews
*usually chronic
A pt presents w/ bloody mucoid diarrhea and tenesmus.
Dx?
UC (mucosal involvement> blood)
A pt presents w/ nonbloody diarrhea, abdominal pain, weight loss/anorexia, perianal abscess, and growth failure.
Dx?
Crohns (mores systemic, penetration> fistulas)
What infections can mimic IBD/cause bloody diarrhea/have a RIGHT pref.?
Bacteria: c. diff
Parasites: e. histolytica, trichinella
Viruses: CMV (punched out ulcers and bloody diarrhea)
What are complications of UC?
Mucosal shedding> bloddy diarrhea
Starts in the rectum and moves UP> chronic/relapsing
30% will undergo colectomy over 30 years
Colon cancer: 18% over 30 years (1 in 5 people)*
Primary Sclerosing Cholangitis 4%** (almost never seen w/ crohns)
*cryptitis
What is Crohn’s Disease?
A pan-enteric transmural inflammatory disease
(Mouth to sigmoid, usually spares rectum)
Usually (70%) involves the terminal ileum
Skip lesions (patchy distribution)
Perianal involvement (fistulas/fissures/red boil around anus)
80% require surgery by 15 yrs
What complications are associated w/ CD?
fistulae
abscess
strictures
A pt presents w/ painful diarrhea, anemia and less bleeding than seen in UC.
Dx?
CD
*biopsy> granuloma
What is the microscopic morphology of IBD?
noncaseating granulomas and lymphoid aggregates (Th1 medaited)
What serologies can be useful in diagnosing CD?
*ASCA (anti-saccharomyces cerevisiase Abs)
What serologies can be useful in diagnosing UC?
*pANCA
What are Extraintestinal manifestations of IBD?
Pancreatitis
Thyroiditis
Bronchiolitis
Erythema Nodosum
Pyoderma Gangrenosum
Oral/Opthalmmalogic: APTHOUS ulcers, uveitis, iritis
What are common complications of UC?
Toxic megacolon
What are common complications of CD?
Fistulae
Obstruction
How does IBD increase the risk of CRC?
Happens more w/ duration and extent of disease
Increased risk with: Disease proximal to splenic flexure > 8 years duration; young age at diagnosis Primary sclerosing cholangitis Family history of CRC Pseudopolyps at colonoscopy
Flat or depressed adenomas–fields of dysplasia> CRC
What is a protective treatment against CRC used to tx pts w/ IBD?
5-ASA
How does CRC present in IBD?
Doesn’t follow adenoma-carcinoma sequence:
Dysplasia/ DALM (dysplasia associated lesion or mass)–> colon comes out
Dysplasia–> colectomy
What type of surveillance for CRC occurs in a pt who has had IBD for more than 7 yrs?
colonoscopy and biopsies every 1-2 years
IBD induction therapy?
- 5-ASA (mild disease):
Sulfasalazine, mesalamine - Steroids:
Prednisone, budesonide - Biologics – Infliximab
- Cyclosporine (pt not getting better w/ anything, transition to surgery)
- Surgery:
UC – cure
Crohn’s – to treat complications
What is maintenance therapy for IBD?
5-ASA:
Sulfasalazine, mesalamine
Immunomodulators:
Azathioprine
6 Mercaptopurine
Methotrexate
Biologics – Infliximab
*NO ONE WILL BE ON MAINTENANCE STEROIDS
What medications are used to specifically treat the sml bowel and R colon?
Pentasa (mesalmine)
Budesonisde (steroid)
