GI 2 Flashcards
what are the 2 types of IBD
Crohn’s disease
Ulcerative Colitis (UC)
genetics of IBD
genetic predisposition
ATG16L1
NOD2
IL23R
environmental factors of IBD
smoking
environment
hygiene
diet
secondary insult/trigger of IBD
infections
drugs
disease initiation of IBD characterized by
- loss of epithelial barrier integrity
- loss of tolerance to enteric commensal bacteria
- dysbiosis
IBD has __ inflammation
IBD has sub-clinical inflammation
what is sub-clinical inflammation overview
has to do with hyperglycemia and insulin resistance
sub-clinical inflammation specific to IBD
- expansion of auto-inflammatory process
- activated innate and acquired immune responses
- circulating antimicrobial antibodies
5 factors IBD is diagnosed based on
- symptoms
- lab data
- imaging studies
- endoscopic evaluation
- histology
IBD diagnosis requires (2)
- uncontrolled immune response
- bowel damage/tissue remodeling
Crohn’s symptoms are very __
Crohn’s symptoms are very variable, depends on location
constitutional symptom of Crohn’s
weight loss
symptoms more common in Crohn’s than UC
abdominal pain
fever
growth retardation
Crohn’s may present with
small bowel obstruction
UC symptoms
diarrhea
rectal bleeding
tenesmus
urgency
what is tenesmus
feeling that you need to pass stools even when your bowels are empty
__ and __ are only seen in severe UC
fever and weight loss are only seen in severe UC
goal of endoscopy
guide treatment by looking into body
what type of endoscopy used to looke at disease extent in Crohn’s
capsule endoscopy
goal of treatment
mucosal healing (absence of ulcerations and erosions)
mucosal healing in IBD associated with
decreased need for __
decreased __ rates
sustained __
decreased risk of __
mucosal healing in IBD associated with
decreased need for corticosteroids
decreased hospitalization rates
sustained clinical remission
decreased risk of colorectal cancer
histology of UC
inflammation limited to __ and __
__ often compromised
epitheloid granulomas __
histology of UC
inflammation limited to mucosa and submucosa
submucosa often compromised
epitheloid granulomas absent
histology of Crohn’s disease
__ inflammation with __ aggregates
__ expanded by __ and __
epitheliod granulomas __
histology of Crohn’s disease
transmural inflammation with lymphoid aggregates expanded by **inflammation ** and fibrosis
epitheliod granulomas present
complication of Crohn’s
- incidence of enterocutaneous or perianal fistulas (35%)
- internal fistulas (35%)
- rectovaginal fistulas (5-10% of females)
- strictures
2 types of strictures in Crohn’s
1. __ (__) at areas of acute inflammation
2. __ at areas of long-standing inflammation and at anastomotic areas
- edematous (inflammatory) at areas of acute inflammation
- fibrotic at areas of long-standing inflammation and at anastomotic areas
indications for surgery in Crohn’s
- abcess
- fistula
- fibrotic stricture causing obstruction
- toxic megacolon
- hemorrhage
- cancer
- symptoms refractory to medical therapy
indications for surgery in UC
- toxic megacolon
- uncontrolled colonic bleeding
- perforation
- obstruction and stricture with suspicion for cancer
main nutritional issue in IBD
weight loss
how common is weight loss
IBD:
Crohn’s:
how common is weight loss
IBD: 70-80% of hospitalized patients
Crohn’s: 20-40% of outpatients
4 causes of weight loss in IBD
- decreased food intake
- nutrient malabsorption
- increased intestinal loss
- drug interactions
diarrhea causes increased loss of
Zn
K
Mg
IBD causes Steatorrhea which is
increased loss of fat from stools
Steatorrhea causes increased malabsoption of __ and loss of __
fat soluble vitamins
Zn, Mg, Ca, Cu
drug interactions causing weight loss in IBD
drugs interacting with absorption of foods/nutrients
parenteral nutrition in IBD pros
- remission! (short-lived though, ususally only 3 months)
- fistula healing
risks of parenteral nutrition in IBD
bacteremia
thrombosis
when is parenteral nutrition used in IBD
severe malnutrition
nutritional support pre- and post-op
EEN in IBD pros
reduces remission in 85% of newly diagnosed patients
in IBD, EEN has similar efficacy to
corticosteroids
Rome IV definition of IBS
- Recurrent Abdominal pain on average at least 1 day per week in the last 3 months associated with 2 or more of the following criteria:
- Associated with defecation
- Change in Stool Frequency
- Change in Form of Stool
*Criteria should be fulfilled for last 3 months with symptoms onset at least 6 months prior to diagnosis
who is most likely to have IBS?
females
<50
who is most likely to have IBS?
females
< 50
3 subtypes of IBS
IBS-C (constipation)
IBS-M (mixed bowel habits)
IBS-D (diarrhea)
parenteral vs enteral nutrition
parenteral = through IV
enteral = tube that goes into stomach/small intestine (bypasses digestive system)
Bristol stool form scale (BSFS)
Type 1: separate hard lumps (hard to pass)
Type 2: sausage-shaped, but lumpy
Type 3: sausage with cracks
Type 4: sausage/snake, smooth and soft
Type 5: soft blobs with clear-cut edges (passed easily)
Type 6: fluffy pieces with ragged edges, mushy
Type 7: entirely liquid
IBS-C
> 25% type:
< 25% type:
IBS-C
> 25% type: 1 or 2
< 25% type: 6 or 7
IBS-M
> 25% type:
> 25% type:
IBS-M
> 25% type: 1 or 2
> 25% type:
IBS-D
> 25% type:
< 25% type:
IBS-D
> 25% type: 6 or 7
< 25% type: 1 or 2
predominant bowel habits are based on stool form on days with
at least 1 abnormal bowel movement
