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General Medicine & Family Medicine > General Surgery/GIT / Inflammatory Bowel Disease > Flashcards

General Surgery/GIT / Inflammatory Bowel Disease Flashcards

1
Q

What two diseases are classified as inflammatory bowel disease (IBD)?

A
  1. Ulcerative colitis (UC)
  2. Crohn disease
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2
Q

What layer(s) of the colon wall are inflamed in UC?

A

Mucosal layer only

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3
Q

What layer(s) of the colon wall are inflamed in Crohn disease?

A

All layers (transmural)

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4
Q

What portions of the GI tract are affected by UC?

A

UC affects the rectum and may extend and involve the proximal colon

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5
Q

What portions of the GI tract are affected by Crohn disease?

A

Any portion of the entire GI tract from mouth to anus (80% involve the distal ileum)

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6
Q

What are the risk factors for IBD?

A
  • 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)
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7
Q

What genetic association does UC have?

A

HLA DR2

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8
Q

What are the typical symptoms of UC?

A
  • Bloody diarrhea with mucus passage and abdominal pain
  • possibly with tenesmus
  • fever, and weight loss
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9
Q

What are the typical symptoms of Crohn disease?

A
  • Prolonged history of diarrhea
  • crampy abdominal pain
  • fatigue
  • weight loss

can present with or without gross bleeding

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10
Q

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?

A

Toxic megacolon

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11
Q

What class of medications may precipitate toxic megacolon in Crohn disease?

A

Antidiarrheals

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12
Q

How does the patient with toxic megacologn present?

A
  • High fever
  • leukocytosis
  • abdominal tenderness
  • rebound tenderness
  • dilated segment of colon on abdominal XR
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13
Q

How is a toxic megacolon treated?

A
  • Bowel rest
  • nasogastric tube
  • IV fluids
  • antibiotics to cover GI flora
  • steroids (if the cause is IBD)
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14
Q

What are the gastrointestinal complications of Crohn disease?

A
  • Bowel perforation
  • fibrotic strictures with bowel obstruction
  • abscess formation
  • fistula formation
  • anal fissures
  • perirectal abscesses
  • aphthous ulcers
  • dysphagia
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15
Q

What are the extraintestinal complications of IBD?

A
  • Uveitis, episcleritis
  • erythema nodosum, pyoderma gangrenosum
  • peripheral arthritis, ankylosing spondylitis
  • sclerosing cholangitis
  • venous thromboembolism
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16
Q

What endoscopic findings are consistent with a diagnosis of UC?

A
  • Continuous involvement of the colon
  • varying in severity from erythematous mucosa with petechiae and friability to macroulcerations and profuse bleeding
17
Q

What biopsy findings are characteristic of UC?

A
  • Crypt abscesses
  • chronic changes
    • atrophied glands
    • lost mucin in goblet cells
18
Q

What endoscopic findings are consistent with a diagnosis of Crohn disease?

A
  • Skip lesions, with focal ulcerations adjacent to normal mucosa
  • “cobblestone” appearance of polypoid mucosal changes
19
Q

What biopsy findings are characteristic of Crohn disease?

A
  • Focal ulcerations with both acute and chronic inflammation
  • noncaseating granulomas
20
Q

What features distinguish the diagnosis of colon-involving Crohn disease from ulcerative colitis?

A
  • Rectal sparing
  • coinvolvement of the small bowel
  • lack of gross bleeding
  • perianal involvement
  • fistula formation
  • granuloma presence
  • focal lesions
21
Q

What medication is considered first-line therapy in IBD?

A
  • 5-aminosalicylate (5-ASA) containing compounds
22
Q

What 5-ASA containing medication can be used for UC or Crohn disease limited to the colon?

A

Sulfasalazine (metabolized to 5-ASA in the colon)

23
Q

What 5-ASA containing medication can be used for Crohn disease involving the small bowel?

A

Mesalamine

24
Q

What autoantibodies have been classically associated with IBD?

A
  • P-ANCA (UC)
  • ASCA (Crohn disease)
25
Q

What class of medications is used to induce remission in flare-ups of moderate to severe disease, treat extraintestinal manifestations or when 5-ASA medications do not work?

A

Glucocorticoids

26
Q

What medications can be used for refractory cases of IBD?

A
  • Immunomodulating medications
    • 6-mercaptopurine
    • azathioprine
    • methotrexate
    • cyclosporine
    • infliximab
27
Q

When should surgery be considered for IBD?

A
  • Life-threatening bleeding
  • fistulas
  • obstruction
  • perforation
  • abscesses
  • medically refractory disease or
  • neoplastic transformation
28
Q

s the risk for colorectal cancer higher for Crohn or UC?

A

UC

General Medicine & Family Medicine (150 decks)

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