Chapter 2- Inflammatory Bowel Disease

Question 1

define Inflammatory Bowel Disease (IBD)

Answer 1

term used for two inflammatory conditions of undetermined etiology: Ulverative colitis and Crohns disease.
They both are characterized by chronic inflammation with intermittent periods of exacerbation and remission.

Question 2

What are some genealogical and environmental factors that may increase the risk of developing IBD?

Answer 2

genertics - light association of increased risk based on family occurance. Some genes appear lunked to chromosome 16.
environment: use of NSAIDSa can alter intestinal barrier and cause flares. Appendectomy = protective. Smoking modifies a persons phenotype, its protective agaisnt UC but increases risk of crogns.
Diet: Western diet, high in fat and simple carbs.

Question 3

What are the clinical features of Ulcerative Colitis?

Answer 3

• manifests in colon, and only mucosa (inner lining) not the whole colon wall.
• continuous inflammatory pattern.
• most common sxs: rectal bleeding, then abdo cramping, fecal urgency, and mucipurulent discharge.
• severity usually determined in first 5 years, and is determined by endoscopy. Looking at: intestinal mucosa friability, is it hyperemic and does it exhibit mucosal ulcerations?
• recurrent inflammation can lead to fibrosis and shortened colon.

Question 4

What are the clinical features of Crohns Disease?

AKA: granulomatous enteritis, regional enteritis, ileitis, or terminal ileitis.

Answer 4

• inflammation of all layers of the bowel.
• can involve mesentery and possible nearby lymph nodes
• All parts of GI tract can be involved.
• physical findings will reflect disease location and severity. ileal disease = RLQ pain, Duodenal disease similar to peptic ulcer disease.
• younger dx = more likely to be recurrent.
• sxs: abdo pain, diarrhea, fever, weight loss and fatigue.
• endoscopy: skip leasions present (deep linear ulcerations seperated by normal mucosa). Fistulas can form between structures of loops of bowel. bowel wall can thicken and lead to obstruction.

Question 5

What are the 8 likely differential diagnosis’ of IBD?

Answer 5

1. infection diarrhea
2. bowerl ischemia
3. small bowel lyphoma
4. Diverticulitis
5. appendicitis
6. Drugs (NSAIDS or Abx)
7. Celiac sprue
8. Irritable bowel syndrome.

Question 6

What is the most common extra-intestinal manifestation of inflammatory bowel disease?

Answer 6

arthritis.

15-20% of pt develop a peripheral migratory arthritis.

Question 7

What are other less common extra-intestinal manifestation of inflammatory bowel disease, apart from arthritis?

Answer 7

Scroiliitis,
ankylosing spondylitis
anemia
Ocular manifestation (anterior uveitis, and episcleritis)
skin manifestations (erythema nodosum, pyoderma gangrenosym)
Thromboembolic complications (d/t hyper coagulable state)
Steatosis or fatty liver
gallstones, (CD)
primary sclerosing cholangitis. (UC >CD)

Question 8

What the most life-threatening complication seem with individuals with severe inflammatory bowel disease?

Answer 8

Toxic megacolon (UC > CD)

sxs: fevere, tachycardia, hypotension, leukocytosis,
tx: colectomy if not responding to medical management.

Question 9

Are fistulas more common in CD or UC?

Answer 9

CD, they can extend from any involved segment of bowel to the skin, bladder, or vagina.
- can cause chronic fecal soiling, malabsoption or crohnic UTI.

Question 10

What are the premalignant lesions in IBD?

Answer 10

CRC (colon-risk cancer) arises frm Flat dysplastic tissue. Biopsies are required for confirmed diagnosis.

Question 11

What is the use for UC?

Answer 11

total proctolectromy, otherwise symptom relief, maintenance of remission and improve quality of life.

Question 12

What is the typical treatment for IBD?

Answer 12

5-aminosalicylate-based compounds. (UC and CD).
Corticosteroids (acute flares of moderate to severe)
topical steroids (ulcerative proctitis, or rectosigmoid UC)
immunomodulating drugs (maintanence therapy in CD and useful for UC).
Biological agents (moderate to severe mucosal and distulizaing CD),
Surgery (UC- curative, only palliative in CD).

Question 13

What are steroid related complications, associated to prolonged use of steroids?

Answer 13

1. hypertension
2. muscle weakness
3. osteoporosis
4. Vertebral compression fractures
5. aspetic necrosis of both the humeral and femoral heads
6. peptic ulcers
7. perforation of small or large of bowel
8. pancreatitis
9. impaired wound healing
10. growth suppression
11. decreased carbohydrate tolerance
12. hyperglycemia and diabetes.

Question 14

What serologic markers are used in the diagnosis of inflammatory bowel disease?

Answer 14

Perinuclear antineutriphil cytoplasmic antibodies (p-ANCA)

anti-Saccharomyces cerevisiae Antibodies (ASCA)