General Surgery/GIT / Inflammatory Bowel Disease Flashcards
What two diseases are classified as inflammatory bowel disease (IBD)?
- Ulcerative colitis (UC)
- Crohn disease
What layer(s) of the colon wall are inflamed in UC?
Mucosal layer only
What layer(s) of the colon wall are inflamed in Crohn disease?
All layers (transmural)
What portions of the GI tract are affected by UC?
UC affects the rectum and may extend and involve the proximal colon
What portions of the GI tract are affected by Crohn disease?
Any portion of the entire GI tract from mouth to anus (80% involve the distal ileum)
What are the risk factors for IBD?
- Caucasian or Jewish ethnicity
- age between 15 and 30 and 50 and 70 (bimodal age distribution)
- female gender (for Crohn disease) and male gender (for UC)
- family history of IBD
- cigarette smoking (for Crohn disease)
What genetic association does UC have?
HLA DR2
What are the typical symptoms of UC?
- Bloody diarrhea with mucus passage and abdominal pain
- possibly with tenesmus
- fever, and weight loss
What are the typical symptoms of Crohn disease?
- Prolonged history of diarrhea
- crampy abdominal pain
- fatigue
- weight loss
can present with or without gross bleeding
What is the name for the complication commonly seen in Crohn disease when inflammation results in impaired colonic motility, colonic dilation, and decreased frequency of bowel movements?
Toxic megacolon
What class of medications may precipitate toxic megacolon in Crohn disease?
Antidiarrheals
How does the patient with toxic megacologn present?
- High fever
- leukocytosis
- abdominal tenderness
- rebound tenderness
- dilated segment of colon on abdominal XR
How is a toxic megacolon treated?
- Bowel rest
- nasogastric tube
- IV fluids
- antibiotics to cover GI flora
- steroids (if the cause is IBD)
What are the gastrointestinal complications of Crohn disease?
- Bowel perforation
- fibrotic strictures with bowel obstruction
- abscess formation
- fistula formation
- anal fissures
- perirectal abscesses
- aphthous ulcers
- dysphagia
What are the extraintestinal complications of IBD?
- Uveitis, episcleritis
- erythema nodosum, pyoderma gangrenosum
- peripheral arthritis, ankylosing spondylitis
- sclerosing cholangitis
- venous thromboembolism
What endoscopic findings are consistent with a diagnosis of UC?
- Continuous involvement of the colon
- varying in severity from erythematous mucosa with petechiae and friability to macroulcerations and profuse bleeding
What biopsy findings are characteristic of UC?
- Crypt abscesses
- chronic changes
- atrophied glands
- lost mucin in goblet cells
What endoscopic findings are consistent with a diagnosis of Crohn disease?
- Skip lesions, with focal ulcerations adjacent to normal mucosa
- “cobblestone” appearance of polypoid mucosal changes
What biopsy findings are characteristic of Crohn disease?
- Focal ulcerations with both acute and chronic inflammation
- noncaseating granulomas
What features distinguish the diagnosis of colon-involving Crohn disease from ulcerative colitis?
- Rectal sparing
- coinvolvement of the small bowel
- lack of gross bleeding
- perianal involvement
- fistula formation
- granuloma presence
- focal lesions
What medication is considered first-line therapy in IBD?
- 5-aminosalicylate (5-ASA) containing compounds
What 5-ASA containing medication can be used for UC or Crohn disease limited to the colon?
Sulfasalazine (metabolized to 5-ASA in the colon)
What 5-ASA containing medication can be used for Crohn disease involving the small bowel?
Mesalamine
What autoantibodies have been classically associated with IBD?
- P-ANCA (UC)
- ASCA (Crohn disease)
