Disorders of the Intestines Flashcards
Inflammatory Bowel Disease:
Populations at risk
- Urban > Rural
- Whites > Blacks and Asians
- Peak age 20-40
- Increased Chron’s Disease in smokers
- Decreased Ulcerative colitis in smokers
Inflammatory Bowel Disease:
Patho
Exact pathophysiology unknown: Many hypotheses
- Genetics
a. Differences in ethnicities
b. Increased rate of transmission in monozygotic twins
c. First degree relative with IBD = 40% chance - Infection
a. Overproduction of normal bowel flora
b. Exogenous bacterial/viral pathogen(s) revs up inflammatory cascade - Immune function
a. Dysfunction in mucosal immune specific genes
b. Increases in T-cell immune response
c. Decrease in suppressor or regulatory immune cells
d. Triggers inflammatory cytokines, TNF-α, macrophages, prostaglandins and reactive oxygen species
Inflammatory Bowel Disease:
- What is it?
- Location?
Chronic, idiopathic inflammatory disease of the GI tract
- Results in edema, ulceration and tissue destruction
- Relapsing/remitting in nature
- Generally requires maintenance treatment to help prevent flares
- Classified as:
a. Ulcerative Colitis (UC): Confined to colon and rectum
b. Crohn’s disease (CD):
i. Anywhere from mouth to anus
ii. Most common to have terminal ileum involvement
iii. Colon and perianal involvement also common
Inflammatory Bowel Disease: UC & CD Ulcer patterns
UC:
- Continuous pattern
- Crypt abscesses
CD:
- Patchy
- Discontinuous
- Deep
- Mucosa has a “Cobblestone pattern”
Inflammatory Bowel Disease: Signs and Symptoms
- Diarrhea
- Blood in stool (usually bright red)
- Abdominal pain/cramping
- Weight loss
- Fatigue
- Change in daily activities
CD Sequelae
-Strictures can lead to obstruction
- Fistulas:
a. Internal: Enterovesical, Enteroenteric
b. External: Enterocutaneous, Perianal fistulas common
-Malnutrition and vitamin deficiencies
UC Sequelae
- Colonic hemorrhage
- Peri-rectal abscesses
- Anal fissures
- Hemorrhoids
- Colon Cancer: Increased risk (~50%) in UC
Toxic Megacolon
- a. What is it?
- b. Symptoms?
- c. Sequelae?
a. Extreme dilation of the colon
Severe ulceration of the colon that can progress
to perforation
More common in UC
High mortality rate
b. Symptoms: Fever, leukocytosis, abdominal distension, tachycardia
c. Sequelae: Severe cases require colectomy
Also a complication of Clostridium difficle (C.diff)
colitis
Diagnosis of Inflammatory Bowel Disease
-Clinical symptoms
- Labs
a. Increased ESR, CRP
b. ANCA - Stool studies: Leukocytes or lactoferrin
- Radiologic findings: CT scans
- Endoscopy: Upper (EGD) and lower (colonoscopy)
Inflammatory Bowel Disease: Treatment
Medications organized into those which:
a. Induce remission: Used to treat flares
b. Maintain remission: Maintenance therapy
Further organized into targeted area: Determine whether or not disease extends beyond the splenic flexure
a. Below = Distal Disease
b. Above (proximal) = extensive disease
Drug treatment options:
- 5-Aminosalicylates: Mesalamine
- Immunomodulators: Azathioprine
- Antibiotics: Metronidazole, Ciprofloxacin
- Corticosteroids: Prednisone
- Biologics: Infliximab
Irritable Bowel Syndrome
a. What is it
b. Patho
c. Symptoms
d. Diagnosis
e. Treatment Goals
a. Chronic, relapsing gastrointestinal problem: Abdominal pain, bloating, changes in bowel habits
b. Pathophysiology
- Not exactly known
- Disturbances in GI motility
- Visceral hypersensitivity
- Stress response
- Diet
- Dysregulation of brain-gut interactions
c. Symptoms: Intermittent with periods of remissions
- Pain or discomfort linked to bowel function:
i. Relieved by defecation (Suggests a colonic link)
ii. Associated with change in bowel frequency or consistency (Suggests a link to transit time)
- Bloating
- Abnormal stool consistency or frequency
- Straining at defecation
- Urgency
- Feeling of incomplete evacuation
- Passage of mucus
d. Diagnosis:
-Signs and symptoms of disorder are not sensitive or specific: Diagnosis of exclusion
-Symptoms should be present for at least 6 months to
distinguish from other causes
e. Treatment Goals: Chronic condition
- No single consistently successful treatment
- Focus on: Patient reassurance, Education, Symptom improvement rather than cure
- Pharmacotherapy
i. Fiber
ii. Antidiarrheals (loperamide)
iii. Laxatives: Senna, Polyethylene Glycol 3350 (Miralax)
iv. Antispasmodics: Dicyclomine
v. Antidepressants: SSRIs
