IBD Flashcards
smoking with IBD
- nicotine is bad for CD but helps with UC
bacteria as a trigger for IBD
- IBD involves a loss of tolerance for normal GI microflora
- IBD patients have altered composition of commensal enteric bacteria
symptoms of UC
- mucosal ulceration of the colon,
- continuous inflammation
- generally affects the colon
- mucosal inflammation
- fistulas and strictures seldom
- risk of colorectal cancer
- extraintestinal manifestations
- lower risk for smokers
- granulomas extremely rare
symptoms of CD
- patchy inflammation
- mouth to anus involvement
- transmural inflammation
- fistulas and strictures common
- risk of cancer
- extraintestinal manifestations
- higher risk for smokers
- can have granulomas (50%)
extraintestinal manifestations of IBD
- peripheral arthritis: arthralgia more common in CD
- axial arthritis: ankylosing spondylitis more common in UC
- osteoporosis more common in CD
- renal, dermatological, eye, thromboembolic, hepatic complications
ankylosing spondylitis
- clinical course independent of bowel disease
- associated with HLA-B27
- bamboo spine on plain X-rays
sacroilitis
- independent of bowel disease
- associated with HLA-B27
peripheral arthritis
- activity parallels bowel disease activity
- mono-articular in IBD
nephrolithiasis
- urate stones associated with UC
- calcium oxalate stones associated with CD
obstructive hydronephritis
- associated with CD but not UC
erythema nodusum
- red, raised, painful nodular rash
- directly related to bowel disease
pyoderma gangrenosum
- ulcerates
- course is independent of bowel disease
uveitis
- independent of bowel disease
- associated with HLA-B27
- painful, injected eye with synechiae and opacity in the anterior chamber
episcleritis
- painful, injected eye
- independent of bowel disease
primary sclerosing cholangitis
- 70% of PSC patients have UC
- associated with DRW-52A haplotype
cholelithiasis
- cholesterol stones may occur in CD patients with terminal ileal involement
ulcerative proctisis
- rectum only
left sided colitis
- extends to splenic flexure
extensive colitis
- beyond splenic flexure
presentation of UC
- diarrhea, typically bloody with mucous
- abdominal pain and tenderness
- loss of appetite and weight
- fever
- fatigue from anemia developing from blood loss
- urgency for bowel movement
- children: growth and developmental failure
UC symptoms on flexible sigmoidoscopy
- mucosal involvement is continuous and non-segmented
- mucosa is granular/ friable with discrete ulcerations
differentiating UC from CD with antibodies
- ASCA+: CD
- pANCA+: UC
induction of remission in UC
- mild disease: aminosalicylate
maintenance therapies for UC
- aminosalicylates- mild disease
- Azathioprine/ 6MP - moderate disease
- anti-TNF agents- infliximab
presentation of CD in children
- abdominal pain
- diarrhea
- weight loss
- anorexia
- vomiting
- rectal bleeding
- stunted growth
- fevers
presentation of CD in adults
- similar presentation
- growth and developmental issues less apparent
induction of remission in CD
- aminosalicylates
- antibiotics (not for UC)
- corticosteroids
- immunomodulators
- infliximab
corticosteroids in CD
- induce remission
- provide rapid symptomatic relief
- do not maintain remission
methotrexate toxicity
- fertility related
- teratogenic
anti-TNF alpha agent side effects
- drug induced lupus
- opportunistic infections
- non-hodgkins lymphoma
genetics in CD
- CARD15/NOD2 linked to more aggressive CD
- can be used to identify high risk patients
IBD during pregnancy
- mostly occurs during first trimester
- associated with preterm birth, SA, LBW
medications for IBD during pregnancy
- yes: 5-ASA, steroids, 6MP, AZA, infliximab
- no: methotrexate and thalidomide
