Crohns & Colitis - 1 Flashcards
What is inflammatory bowel disease (IBD)?
A term that describes any condition or disease resulting in inflammation of the gastrointestinal tract, primarily Crohn’s disease and ulcerative colitis.
IBD can also include intestinal infections but is commonly reserved for Crohn’s disease and ulcerative colitis.
What are the two main types of inflammatory bowel disease?
- Crohn’s disease
- Ulcerative colitis
Where does inflammation primarily occur in Crohn’s disease?
Most often in the ileum and the colon, but it can also affect the esophagus, stomach, and upper parts of the small intestine.
The ileum is the last part of the small intestine.
Who first described Crohn’s disease as a specific disease entity?
Drs. Crohn, Ginzburg, and Oppenheimer in 1932.
What is the primary characteristic of ulcerative colitis?
Inflammation limited to the large intestine, including the rectum.
Other terms for ulcerative colitis include ulcerative proctitis and ulcerative pancolitis.
What distinguishes inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS)?
IBD is characterized by inflammation of the gastrointestinal tract, while IBS does not involve inflammation.
IBS symptoms arise from changes in bowel function or brain-gut interactions.
Define ‘abscess’ in the context of inflammatory bowel disease.
A localized collection of dead and infected tissue (pus) that may require drainage and antibiotic treatment.
What is the role of the colon in the gastrointestinal tract?
Primarily responsible for reabsorbing fluid and electrolytes from the stool.
What is a colonoscopy?
A diagnostic procedure that involves inserting a scope through the anus and rectum to examine the colon.
What does the term ‘peristalsis’ refer to?
The involuntary contractions that move food through the gastrointestinal tract.
Fill in the blank: The _______ is the last part of the small intestine where vitamin B12 is absorbed.
ileum
True or False: Smoking is associated with an increased risk of developing ulcerative colitis.
False
What age group has the highest incidence of inflammatory bowel disease?
Individuals aged 20 to 40.
What is the prevalence of inflammatory bowel disease among different genders?
Occurs at roughly the same rate in males and females, with some studies suggesting a slightly higher incidence in females.
What geographic trend is observed in the incidence of inflammatory bowel disease?
More frequently found in developed countries, but present in every race and country studied.
What is ‘stricture’ in relation to inflammatory bowel disease?
A narrowing of the central channel in a segment of the intestine, which can lead to obstruction.
What is an important function of the mucosa in the gastrointestinal tract?
It is essential for digestion of food and absorption of nutrients.
What is the definition of a ‘fistula’?
An abnormal communication or channel from the intestine to other organs or to the abdominal wall or skin.
What is the ‘smoking paradox’ in relation to IBD?
Smoking increases the risk of Crohn’s disease but seems to protect against ulcerative colitis.
What are villi and their function?
Fingerlike projections of the inner lining of the small intestine that increase the surface area for nutrient absorption.
Define ‘granuloma’ in the context of inflammatory bowel disease.
A distinctive collection of inflammatory or immune cells that occurs in tissues affected by certain conditions, including Crohn’s disease.
What is the role of lymphocytes in the immune system?
They are white blood cells important for immune protection against infections.
What has been observed about the incidence of inflammatory bowel disease (IBD) in the Jewish population?
The incidence of IBD is among the highest of any ethnic or racial group, with differences depending on country of origin.
Which group of Jews has a higher incidence of IBD?
Jews of Ashkenazi (European) descent have a higher incidence than those of Sephardic (Northern African and Middle Eastern) descent.
What does the increasing incidence of Crohn’s disease in Japan suggest?
It suggests that environmental factors significantly affect the risk of developing IBD.
What happens to the risk of IBD among South Asian immigrants in North America compared to their children?
Immigrants maintain the lower risk seen in their country of origin, but their children have a higher risk of developing IBD.
What is the north-south gradient in relation to IBD incidence?
IBD incidence is generally highest in North America and Northern European countries, and lower in countries at more southerly latitudes.
What are the two vital functions of the gastrointestinal tract?
- Nutrient absorption
- Immune protection
What are the principal parts of the gastrointestinal tract?
- Mouth
- Esophagus
- Stomach
- Small intestine
- Large intestine
- Anus
What role does the stomach play in digestion?
The stomach holds food, pushes it into the small intestine, secretes acid for protection and digestion, and signals when enough food has been eaten.
What is the primary function of the small intestine?
The primary job is to absorb nutrients from food.
What is the role of villi in the small intestine?
Villi increase the surface area for nutrient absorption.
What is the primary function of the large intestine?
To absorb fluid and minerals from intestinal contents back into the tissues and bloodstream.
What is fecal incontinence?
The loss of control over bowel function, leading to involuntary stool release.
What is the function of the liver in digestion?
The liver produces bile, which helps break down fats for absorption.
What happens when bile production is inadequate?
Fat absorption is reduced, resulting in fat appearing in the stool.
What does the pancreas produce that aids digestion?
The pancreas produces digestive enzymes that break down proteins, starches, and fats.
What are the classic signs of inflammation?
- Pain
- Swelling
- Redness
- Loss of normal function
What is the difference between normal intestinal inflammation and excessive inflammation?
Normal inflammation is regulated and not visible, while excessive inflammation is uncontrolled and can cause tissue damage.
What is pancolitis?
Inflammation of the entire colon, occurring in a continuous pattern.
What is proctitis?
A form of ulcerative colitis where only the rectum is inflamed.
What are skip lesions in Crohn’s disease?
Areas of inflammation that are not adjacent to one another in the gastrointestinal tract.
True or False: In ulcerative colitis, inflammation can occur in any part of the gastrointestinal tract.
False. Inflammation is limited to the colon.
Fill in the blank: The _______ is the last part of the large intestine.
rectum
What areas of the gastrointestinal tract can Crohn’s disease affect?
Esophagus, stomach, duodenum, jejunum
Crohn’s disease can affect multiple areas of the gut non-contiguously.
What are skip lesions in the context of Crohn’s disease?
Areas of inflammation that are not adjacent to one another
For example, inflammation may occur in the jejunum and another area of the large intestine with normal intestine in between.
How does inflammation in Crohn’s disease differ from that in ulcerative colitis?
Crohn’s disease inflammation penetrates through deeper layers of the bowel, while ulcerative colitis is limited to the innermost lining
This can lead to complications like abscesses and fistulas in Crohn’s disease.
What are granulomas and their significance in Crohn’s disease?
Tiny localized collections of inflammatory cells that are virtually diagnostic of Crohn’s disease
Granulomas can only be seen under a microscope.
What is indeterminate colitis?
A condition where it is not possible to differentiate between ulcerative colitis and Crohn’s disease
It may change over time to show features of one or the other.
List three complications specific to Crohn’s disease.
- Strictures
- Abscesses
- Fistulas
What are strictures?
Segments of the intestine where the opening becomes narrowed
They can be caused by swelling due to inflammation or scarring from repeated inflammation.
What symptoms indicate a bowel obstruction?
- Severe crampy pain
- Distension or bloating
- Reduced bowel motions
- Not passing gas
- Nausea and vomiting
What foods should be avoided when having an intestinal stricture?
- Popcorn
- Nuts
- Seeds
- Corn
- Raw vegetables
- Skins on fruits
What is an abscess in the context of Crohn’s disease?
A localized infection caused by bacteria accumulating in a walled-off area of tissue
This occurs when a deep ulcer penetrates through all layers of the intestine.
What are fistulas?
Abnormal channels or tracts joining parts of the intestine or to other organs
They can lead to nutrient absorption issues and recurrent infections.
What are perianal fistulas?
Fistulas that occur around the anus, often arising from infection or inflammation
They can cause significant distress and interfere with daily activities.
What are extra-intestinal manifestations of IBD?
- Joint symptoms
- Eye inflammation
- Skin lesions
- Liver disease
- Bone disease
What is sacroiliitis?
A specific type of arthritis affecting the lower back in IBD patients
It can lead to stiffness and discomfort in the lower back.
What are common types of eye inflammation associated with IBD?
- Iritis
- Uveitis
- Episcleritis
What are the two main types of skin lesions seen in IBD?
- Erythema nodosum
- Pyoderma gangrenosum
What is the significance of psoriasis in relation to IBD?
It can occur more frequently in patients with IBD, particularly Crohn’s disease
Psoriasis shares genetic factors with Crohn’s disease.
What might indicate that a skin lesion in IBD is worsening?
When the lesion becomes particularly painful or enlarges for no apparent reason
Prompt assessment by a doctor is advised.
What type of drug treatments overlap for inflammatory conditions?
Antitumor necrosis factor treatments (infliximab, adalimumab) and anti-interleukin-12/23 treatments (ustekinumab)
These therapies may be effective for both erythema nodosum and pyoderma gangrenosum.
What are the initial appearances of erythema nodosum and pyoderma gangrenosum lesions?
They often start as a bruise or an insect bite, then quickly enlarge and worsen
Patients should notify a doctor promptly when this occurs.
What is the characteristic appearance of erythema nodosum lesions?
Red or purplish, raised, and painful lesions
They commonly occur on the shins.
Where do pyoderma gangrenosum lesions typically occur?
On the legs and sometimes near ileostomy or colostomy sites
They can grow large and may ooze fluid.
How effective is infliximab in treating pyoderma gangrenosum lesions?
Particularly effective at healing pyoderma gangrenosum lesions.
What type of skin rashes can occur with anti-TNF treatments?
Unusual skin rashes that are generally not serious
They can usually be managed with creams or ointments.
What is the most serious liver condition related to IBD?
Primary sclerosing cholangitis (PSC)
It is more common in ulcerative colitis than Crohn’s disease.
What complications can arise from primary sclerosing cholangitis (PSC)?
Scarring and narrowing of bile ducts, liver cirrhosis, liver failure, and increased risk of bacterial infection
PSC can lead to severe liver damage if it progresses.
What percentage of people with IBD are affected by primary sclerosing cholangitis (PSC)?
No more than 5%.
What symptoms necessitate immediate assessment in someone with PSC?
Fever with jaundice (yellow color of skin or eyes).
What does osteoporosis involve?
A decrease in bone density due to reduced minerals such as calcium
It makes bones susceptible to fractures.
What are important nutritional factors for preventing osteoporosis in IBD patients?
Adequate intake of calcium, vitamin D, and overall nutrition (calories and protein).
What is the relationship between IBD and the risk of developing osteoporosis?
Increased risk, particularly in Crohn’s disease and with steroid use
Rates of osteoporosis can be around 30% in IBD patients.
What types of medications are associated with increased osteoporosis risk in IBD patients?
Steroid medications, such as prednisone.
What is the recommended frequency for bone density testing in IBD patients?
Every 1 to 2 years if bone density is lower than normal.
What is the estimated lifetime risk of developing colorectal cancer for individuals with ulcerative colitis?
10% to 15%.
What factors increase the risk of colorectal cancer in IBD patients?
- Extensive inflammation of the colon
- Early age of diagnosis
- Long duration of disease
- Active disease symptoms
- Family history of colorectal cancer
- Primary sclerosing cholangitis (PSC)
What is dysplasia in the context of IBD?
Precancerous changes in biopsies that indicate a higher chance of cancer
Dysplasia suggests a 10% to 20% chance of having or developing cancer.
What screening method is effective for IBD patients at risk of colorectal cancer?
Colonoscopy with random biopsy samples of the colonic lining.
What is the critical period for assessing bone health in adolescents with IBD?
Adolescence and early adult life
This period is crucial for achieving maximum bone density.
