Crohn’s Disease, IBS, Ulcerative Colitis Flashcards

1
Q

Crohn’s disease

A

Definition-A nonspecific chronic transmural inflammatory disease that most commonly affects the distal ileum and colon but may occur in any part of the GI tract. Consists of skip areas

Etiology-unknown

Signs and symptoms

  • Abdominal pain
  • Chronic diarrhea
  • Bleeding
  • Anal Fistulas
  • Anorexia
  • A right lower quadrant mass or fullness

Extraintestinal manifestations

  • Weight loss
  • Fever
  • Anemia
  • Peripheral arthritis
  • Ophtalmic diseases (Episcleritis)
  • Aphthous stomatitis
  • Erythema nodosum
  • Pyoderma gangrenosum

Criteria for crohns disease

  • Small bowel is involved
  • Rectosigmoid is often spared; colonic involvement is usually right-sided.
  • Gross rectal bleeding is absent
  • Fistula, mass, and abscess development is common
  • Perianal lesions are significant
  • On x-ray, bowel wall is affected asymmetrically and segmentally, with “skip areas” between diseased segments.
  • Endoscopic appearance is cobblestone , with discrete ulcerations separated by segments of normal-appearing mucosa
  • Microscopic inflammation and fissuring extend transmurally; lesions are often highly focal in distribution.
  • Epithelioid (sarcoid-like) granulomas detected in bowel wall.
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2
Q

Diagnostic and treatment of crohn’s diseases

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CBC may reveal anemia casued either by blood loss or vitamin B12 deficiency.
• Inflammatory markers: ESR and C-reactive protein measurements can be useful to check the degree of inflammation. TH1 Mediated so granulomatous inflammation.
• Testing for Anti-Saccharomyces cerevisiae antibodies ( ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammation of the intestine.
• CT scan shows Crohn’s disease in the fundus of the stomach.
• Endoscopic image shows deep ulceration.
• Also colonoscopy helps in the visualization of the colon and terminal ileum.
•fecal calproctectin level
On barium swallow there are strings of kantor with thickened walls

Treatment for crohns
-Diet № 4
Immunosuppressant- azathioprine- 2.5mg/kg/day
Aminosalysilates-3-6g/day
Metronidazole  1-1.5g/day
Treat diarrhea with loperamide
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3
Q

Irritable bowel disease

A
Increased sensitivity of large bowel with no organic cause.
Clinical features;  abdominal pain, bloating, altered bowel habits
Criteria of abdominal pain
Relief by defecation
Altered stool form
Altered bowel frequency 
Incomplete evacuation 
Classes
Constipation dominant
Diarrhea dominant
Diagnosis 
Blood and stool test
Treatment 
Osmotic laxative for constipation- sodium hydroxide 
Antispasmodic- papaverine
Animotility- loperamide
Anticholinergics to reduce motility- for diarrhea
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4
Q

Ulcerative colitis

A

Definition-A chronic, inflammatory, and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea and affects the rectum mostly and it is a uniform and diffuse inflammation.

Etiology-unknown
Signs and symptoms
-Bloody diarrhea
-Abdominal pain
-Fever
-Anorexia
-Weight loss
-Malaise

Extracolonic problems

  • Peripheral arthritis
  • Ankylosing spondylitis
  • Sacroiliitis
  • Anterior uveitis
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Episcleritis
  • Primary sclerosing cholangitis
CLASSIFICATION OF ULCERATIVE COLITIS 
 a)mild course
-Defecation frequency :<4
-bleeding : mild
-fever :  absent
-hemoglobin g/l : > 110
-ESR mm/hour : <30
-Albumin g/l : norm
 Treatment -Aminosalicilates (Sulfasalazine, Salofalk)

b) moderate course
-Defecation frequency :>6
-bleeding : profuse
-fever : > 37,5 degree c
-hemoglobin g/l : 105-110
-ESR mm/hour : > 30
-Albumin g/l : 30-40
Treatment-Immunosuppressive drugs (Azathioprine)

C) severe form
-Defecation frequency :>10
-bleeding : continuous
-fever : > 38,8  degree c
-hemoglobin g/l : <105
-ESR mm/hour : > 50
-Albumin g/l : <30
Treatment - IV Corticosteroid therapy (Budesonid, Prednizolon) and biological agents -Remicade (infliximab)
Complication
-bleeding
-toxic megacolon
-perforation
-colon cancer
Diagnosis 
Blood, stool test, colonoscopy, endoscopic biopsy 
Pseudopolyps are isolated islands of regenerating mucosa bulging into lumen
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