CLIPP 27 - IBD

Question 1

Functional Abdominal Pain - definition

Answer 1

pain without demonstrable evidence of a pathologic condition such as an anatomic, metabolic, infectious, inflammatory, or neoplastic disorder

Question 2

Functional Abdominal Pain - causes (3)

Answer 2

• abnormal bowel reactivity to physiologic stimuli (meals, gut distension, hormonal changes)
• noxious stressful stimuli (inflammation)
• psychological stressful stimuli (parental separation, anxiety)

Question 3

Concerning symptoms with abdominal pain (9)

Answer 3

-involuntary weight loss, growth deceleration, GI blood loss, significant vomiting, chronic severe diarrhea, persistent RU or RLQ pain, unexplained fever, family hx IBD, abnormal or unexplained physical findings

Question 4

Reasons for rectal exam (4)

Answer 4

-GI bleeding, Intussusception, rectal abscess, impaction

Question 5

Causes of Microcytic Anemia (3)

Answer 5

• iron deficiency
• blood loss
• thalassemia

Question 6

Crohn’s Disease Red Flags (9)

Answer 6

-pain awakens child at night, localized pain, weight/height loss, extraintestinal symptoms, sleepiness after pain attacks, positive family hx, abnormal labs (guaiac stool, anemia, increased platelets, ESR, hypoalbuminemia), abnormal bowel function, vomiting, dysuria

Question 7

Crohn’s treatment goals (4)

Answer 7

• eliminate symptoms,
• improve quality of life
• restore normal growth
• eliminate complications

Question 8

Crohn’s treatment methods

Answer 8

• remission induction: steroids
• maintenance: immunomodulators (thiopurines, methotrexate), Anti-TNFa, surgery
• Aminosalicylates no longer supported

Question 9

Labs for abdominal pain with bloody stool (6)

Answer 9

• CBC (anemia, inflammation)
• ESR/CRP (inflammation)
• LFTs (malnutrition, hepatic disease, protein-losing enteropathy)
• TTG (celiac disease)
• O&P (parasites)
• stool culture (bacterial gastroenteritis, NOT C. diff)

Question 10

Ulcerative colitis features

Answer 10

• generalized inflammation confined to mucosa
• rectum to proximal colon
• crypt abscesses

Question 11

Crohn’s Disease features

Answer 11

• any portion of alimentary canal (mouth to anus)
• inflammation may extend from mucosa into submucosa, muscularis, and serosa
• can result in fistula formation

Question 12

DDX abdominal pain with bloody stools (6)

Answer 12

• IBD
• Celiac Disease (chronic pain, distension, diarrhea, anorexia, vomiting, poor weight gain, occult blood)
• bacterial gastroenteritis
• giardiasis (travel hx, less likely bloody stool)
• PUD (uncommon in kids, occult blood)
• HSP (rash/palpable purpura, occult blood)

Question 13

UC vs CD diagnosis

Answer 13

colonoscopy + upper endoscopy