IBD Flashcards
US alwasy incilved the rectum except in these patient whom?
Using rectal steroid ( rectal sparing)
Inflmmation of US colitis charcatterize by?
Superfical, diffuse
Layers affected inUS
A) Deep Submucosa, mucosa
B) superfical submucosa , mucosa
C all layers trach serosa
B
Psuedoplypsis is more seen in which IBD?
UC
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
B
Presense of dysplasia asosiated lesion or mass as orregular mucosal seeling increase the likelyhood of? - Coexit carcinoma -Stricure Sarcodosis TB
Carcinom
US presentation
Rectum:
Colon:
Rectum: bleeding, tensmus, mucos discharge , extra mainfarij rare
Colon: bloody diarrhea, urgency , dehydration , anemia , hypoprotienenia electrolyte misbalance
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
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
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.
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
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
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
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
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
Pouch ana ansatamisis complication following the surgery
Sepais
Feetility , vaginal dryness in female
Leakage
Pouchitis( increase frequency, tensmus, bleeding , prulent discharge and systemic ilness)
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
Us
