CIS Tieman I - IBS, etc Flashcards
highest incidence of IBD
in developed countries
more prevalent in US
ulcerative colitis
peak incidence of UC
bimodal
-equal incidence in men and women
29yo female presents with episodes of RLQ abdominal pain diarrhea
- over last 6 months
- fam hx UC
- smokes 1ppd
- ulcers inside of lower lip
- stool guiac positive
- erythematous nodules lower leg
DDx - crohns, ulcerative colitis, pregnancy, appendicitis
work up - CBC, pregnancy test
labs - WBC 12,000, ASCA elevated, ESR elevated, CRP elevated
colonoscopy - hyperemia of ascending colon, normal mucosa
IgA, IgG, and ASCA - tells you crohns**
crohns
can occur anywhere in GI tract
ulcerative colitis
primarily contained in rectum and colon
crohns and surgery
no place**
-except to treat complications
tx of crohns
5-ASA
infliximab
24yo M, 3 month generalized abdominal pain, diarrhea, urgency with defecation, bloody/mucousy stools
- fam hx - crohns
- no smoking
- 10lb weight loss
- joint aching
- abdomen - distended, hyperactive bowel sounds, mild tenderness
- rectal guaiac positive and BRB on finger
- knee swelling/erythema
DDx - UC, crohns
work up - CBC, pANCA, Ig levels
labs - pANCA elevated, ESR elevated, CRP elevated, IgA and IgG normal, ASCA normal
-WBC 12,000 57% polys
sigmoidoscopy - edematous friable mucosa
CRP and ESR
for inflammatory process
biopsy - submucosal inflammation, crypt formation
typical for ulcerative colitis
tx for ulcerative colitis
immunosuppression
ASA - targeted to location - oral, enema, etc.
Case 39yo male 2 day anorexia, LLQ pain, low grade fever and diarrhea
- appearas ill
- LLQ tender and guarding
- stool trace guiac positive
work up - WBC 16,000
CT scan - diverticulitis
LLQ pain with fever and tender palpation
diverticulitis until proven otherwise
do CT scan
no scope - bc don’t want to perforate
6 weeks after tx of diverticulitis
do a colonoscopy
-so you can look for cancer presence
