IBD Flashcards by Maha Aziz

US alwasy incilved the rectum except in these patient whom?

Using rectal steroid ( rectal sparing)

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Inflmmation of US colitis charcatterize by?

Superfical, diffuse

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Layers affected inUS
A) Deep Submucosa, mucosa
B) superfical submucosa , mucosa
C all layers trach serosa

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Psuedoplypsis is more seen in which IBD?

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25 years old male known case of UC presented with stricutres , what from the following statement is true
1- the disease is crohn , US dont present with stricure
2- there is possibility of milgnancy so investigate
3- common finding in px with Us so ignored

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Presense  of dysplasia asosiated lesion or mass as orregular mucosal seeling increase the likelyhood of?
- Coexit carcinoma
-Stricure
Sarcodosis 
TB

Carcinom

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US presentation
Rectum:
Colon:

Rectum: bleeding, tensmus, mucos discharge , extra mainfarij rare
Colon: bloody diarrhea, urgency , dehydration , anemia , hypoprotienenia electrolyte misbalance

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Classfication of US severity based on ….. and …..?

Mention the classes of mild, moderte , sever, flumie t, toxic megacolon

Number of stools
Systemic sign

Mild: stol<4 times, no systemic sign , normal ESR, CRP
Moderate : stol >4 time, there is few syestmic sign with elvated ESRcrp
sever: stol>8 time , sever systemic signs tachy fever , anemia, hypoalbuminia

Fluiment: >10 times with fever tachycardia hypoalbuminemia, anemia continous bleeding, abdominal tenderness and distenstion might require blood transfusion

Toxic megacolon: all above with dilation more than 6

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Common extra intestinal mainfstation in US except?
Arthriopathy
Uveitis , Episcleritis
Primary sclerosing cholngitis 
Erythema multiform

Erythema multiform

اللي موجود معه من السكن تشينج ارثيما نودين وبايودرم قانقرين

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What would you excpect to see in px with US in endoscopy ?

in procitis: hyperemic mucosa bleed in touch
polyps like appearance( psuedopolyps) or nodules
tiny tiny ulcer

In compartion to amoebic dysentry, there will be deep large ulcer with normal mucosa in between.

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What are the useful test done in patient with US

🔷Cbc for anemia and lucocytosis
🔷Fecal clorpton to determine disesse activity
🔷stool culture , toxicology to r/o infective colotis ( campylbacter)
🔷 xray detect mega colon
🔷 barrium( not done now) hosepipe colon appearance with loss of hysteiawith narrow featureless shorten colon.
🔷CT thick colon wall, inflammatory stranding

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Tratment of sever uc

Remission
- IV Steroid
- Or azthropoibe or cyclosprine
- Fluid electrolyte correction
- Mentor anemia, xray colon diamter, vitall
If no improvement in 48 hours interfer surgically

Maintaince
5-asa
Or
Biological inflixamab

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Surgical indication emergency and elective?

Emergency:

Toxic megacolonor fluiment megacolon not responding to ttt
Perforation
Massive hemorrhage
stenosis causing obstruction

Elective
-Failure to thrive
- sever delivrating symptoms as anemia, bleeding
- neoplastic changes
Inability to tolerate medical therapy
- extra intestinal mainfastation
- steriod depandent
- drugs serious side rffects

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Surgery used im emergency UC?

Subtotal colectomy with end ileostomy
Or mucus fistula
Take biposy if cancer susbected, continue defentive surgery when px is no longer in steroids with good nutrient and recovery

مافدر ابدا اسوي انستامويز هنا
وماقلنا بنشيل الركتم لانه ياخذ وقت طويل وانا هندي حاله طارئه لكم ممكن اسوي توتال كلوكتومي كبديل

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Elective surgery in uc disease

Protocolocetomy with ilieanal poutch

ماربط الاليم على طول بالركتك لان كذا بيصير وقت الاخراج بسرعه
فاسوي بوتش من خلال الامعاء بحيث يطول شوي الاكل فيهم

او اقدر ايتخدم خق الامرجيسن بس لان باقي ركتم فاحنتاج سنويا سيرفلينس

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Pouch ana ansatamisis complication following the surgery

Sepais
Feetility , vaginal dryness in female
Leakage
Pouchitis( increase frequency, tensmus, bleeding , prulent discharge and systemic ilness)

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Since using pouch annd anastomasis may result in infertility in femalle…., migt be offered to them insted

Colectomy with ileostomy and a pouch

Risk factor of developing milgnenccy in US is?
في احابتين صح
- Pancolitis
-Long duration
- prsense of extra intestinal mainfastion
- uncompliance to medicatio

Pancolitis

Long duration

Elstrate the difference between UC, CD with soechal finding and complication

Non caseting granulma seen comoinly in?
Da) crohn
B) uc

Crohn usualli when anirectal disease involved

Skip lesionand discontinueity of the inflmation

Charcteristic of crohn

Crohn charterizrd with conble ston appearance what does it indicated

Edamtous area between the ulcerted mucosa

Fat wrapping and narrowl lumen seen in?
Liner ir snale like pattern  seen in…
1- Fistula
2-Stricure
Fissure

Crohn

2 stricures

``` Most common fistula in crohn diseas? Enteroentric Ileo viscal Entrovagina Iliofoudnem Entercauutnpus ```

Enterentric Or iliosigmoid The rest not as common, entrocautnous fustula usally seen as complication of surgery

One of crohn conplication is ulcerarion two type of ulcer according to depth mention the difference

Superfical: pain less, heal with epithilum brodging Deep: painful, usually found in upper anal canel , lead to fistula, perinanel abcess , perforation and dischage around the anus.

One of the fistula is rectovaginal? In which direction ? | How will present

Posterior | Leakage of gas , stoo through vagina

Watering can perinuem | Describe one of the complication of crohn disease

يصير البرينيوم فابروتك ورجد و كله فتحات يطلع منها دستاشرج كانه برميل منقب 🥲

Why gall stone common in crohn disease? - autoimmune process cause destructiion of blood cell - impaied bile absorpfion in terminal ilum ( eaither surgicall removed or inflammed! - drug side effects

Impared bile absorption

Crohn disease seen in barrium

String sign of knantor | مثل نقاط المسباحة

Which one from the following fustula assisiated as complication of abdominal surgery? - enterocutnous fistula - entrovesicle fistula - rectovaginal fustula - entroenteric fistula

Entercutnous fistula ( discharge from abdomen wall )

``` Apperance of perianum with active anal disease appear? Bluish No change Erythmayous Necrotic ```

Bluish

``` Crohn can be assosuated with incontience affected strucure by the sustruction is? Internal sphibcter External sphincter Recral nerve Parasympathetic bundles ```

Intenal sphincter

Earilest pathological apperance of crohn disease?

Apathous ulcer surrounded by rim of erythmatous mucosa

Which from the folowing is incorrect refarding crohn structure? - mailgnancy need to be rule out - polypoid mucisa diffuclt to dustingush from milgnancy - dilation of inflmaed ulcated stricture is contraindicated. - never use entero capsula in the presense of stricture will cause obstruction - stricure occur early of the disewse

Stricure occur early of the disease

Laberatory needed in px with crohn?

``` Labs: Cbc :anemia ESR,CRP : high Albumin: low Zink, selenim mg: low ``` Imaging Colonscopy: patchy inflmation. Enterscipy : jujenal ulcerstion abd strucure Enetric capsule , useful in assesing chronic low gi bleeding whdn other measure fails Us: fluid collection and absess , inflamed thickned bowel loops. Barrium enema: string sign if kantor ct with luminal contrast: fistula, intraabdominal abcess, bowel thicning and dilatation. MRI: complex perinanal disease, small bowel investigation as well. Mr enteroclysis: small bowel stricture , good to decrease radation exposure to young px. If entercutnous fistula investigate with fistulography

Anastomasis conplication conmon in ? | Would you consuder primary anastomasis?

``` Fistula Absces Immunocomprimised Low albumin Steroid ``` No delay anastomasis till yyey recocer

Depletion of goblet cells is seen in?

Ulecertive colitus

Patient with high grade dysplasia in uC at … risk of developing milgnancy

40%

True or false Pain is unusual in uc

True