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IM GASTRO > IBD > Flashcards

IBD Flashcards

1
Q

ULCERATIVE COLITIS

  • age of onset
  • ethnicity
  • gender
  • smoking
  • oral contraceptives
  • appendectomy
  • Monozygotic twins
  • dizygotic twins
  • Infections in the 1st yr of life
A
  • age of onset: 2nd-4th decades and 7th-9 decades
  • ethnicity: jewish> non> black>latin>asian
  • gender: male
  • smoking: may prevent
  • oral contraceptives: no increased risk
  • appendectomy: protective
  • Monozygotic twins: 6-18%
  • dizygotic twins: 0-2%
  • Infections in the 1st yr of life: more risk by the age of 10 and 20
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2
Q

CROHN’S DIEASE

  • age of onset
  • ethnicity
  • gender
  • smoking
  • oral contraceptives
  • appendectomy
  • Monozygotic twins
  • dizygotic twins
  • Infections in the 1st yr of life
A
  • age of onset: 2nd-4th decades and 7th-9 decades
  • ethnicity: jewish> non> black>latin>asian
  • gender: male
  • smoking: may cause
  • oral contraceptives: hazardous
  • appendectomy: not protective
  • Monozygotic twins: 38-58%
  • dizygotic twins: 4% concordance
  • Infections in the 1st yr of life: more risk by the age of 10 and 20
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3
Q
  • Involves the rectum and extend proximally to
    involve all or part of the colon
  • Limited to the mucosa and superficial
    submucosa
A

ULCERATIVE COLITIS

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4
Q

2 major histology [catures: ULCERATIVE COLITIS

A
  • Distorted crypt
    architecture, basal plasma cells
  • multiple basal lymphoid aggregates
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5
Q
  • Erythematous mucosa with fine granular surface that resembles “sandpaper”
  • Backwash ileitis
  • Pscudopalyps
  • Toxic megacolon
A

ULCERATIVE COLITIS

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6
Q

ULCERATIVE COLITIS : Signs and symptoms

A
  • Diarrhea
  • Rectal bleeding
  • ‘Tenesmus *
  • Passage of mucus
  • Crampy abdominal pain
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7
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

EXTENT
E1: Ulcerative proctitis
INVOLMENT:

A

limited to the rectum

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8
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

EXTENT
E2: Left-sided UC (distal UC)
INVOLMENT:

A

limited to the colorectum distal to the splenic flexure

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9
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

EXTENT
E3: Extensive UC (pancolitis)
INVOLMENT:

A

extends proximal to the splenic

flexure

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10
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
Absence of symptoms
SEVERITY

A

S0: Clinical remission

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11
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
=4 stools/d (with or without blood), absence of systemic illness, normal inflammatory markers (ESR)

A

S1: Mild disease activity

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12
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
>/=4 stools/d but minimal signs of systemic toxicity

A

S2: Moderate disease

activity

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13
Q

Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
>/=6 bloody stools/d, pulse >/= 90 beats/min,
temperature >/=37.5°C, hemoglobin <10.5 g/100 mL, and ESR 230 mm/h

A

S3: Severe disease activity

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14
Q

ULCERATIVE COLITIS
Diagnostics

  • CRP
  • PLT
  • ESR
  • FECAL LACTOFERRIN
  • CALPROTECTIN
  • pANCA
  • Surgeries
A

Elevated

  • CRP
  • PLT
  • ESR
  • FECAL LACTOFERRIN
  • CALPROTECTIN
  • pANCA

Surgeries

  • Sigmoidoscope
  • colonscopy
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15
Q
  • Affects any part of the GI tract from the mouth to the anus
  • Rectum is often spared
  • Segmental w/ skip areas
  • Transmural
  • Aphthoid ulceration and focal crypt abscesses w/ loose
    aggregations of macrophages forming non caseating
    granuloma —> earliest lesion
  • Cobblestone appearance
  • Creeping fat
  • Pseudopolyps
A

CROHN’S DISEASE

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16
Q

CROHN’S DISEASE

2 patterns of disease:

A
  • Fibrostenotic obstructing pattern

- Penetrating fistulous pattern

17
Q
  • mc site of inflammation is Terminal Ileum
  • RLQ pain (colicky) and diarrhea
  • Low grade fever, weight loss
A

Ileocolitis

18
Q

CROHN’S DISEASE
* DIAGNOSTICS

  • ESR
  • CRP
  • ASCAs
A

Elevated

19
Q

Endoscopic feature of Crohn’s Disease

A
  • rectal sparing,
  • aphthous ulcerations,
  • fistulas,
  • skip lesions
20
Q

Infectious Etiologies of Crohn’s Disease

BACTERIAL

A
  • Salmonella
  • Shigella
  • Toxigenic
  • Escherichia coli
  • Campylobacter
  • Yersinia
  • Clostridium difficile
  • Gonorrhea
  • Chlamydia trachomatis
21
Q

Infectious Etiologies of Crohn’s Disease

VIRAL

A
  • Cytomegalovirus

- Herpes simplex

22
Q

Infectious Etiologies of Crohn’s Disease

Mycobacterial

A
  • Tuberculosis

- Mycobacterium avium

23
Q

Infectious Etiologies of Crohn’s Disease

PARASITIC

A
  • Amebiasis
  • Isospora
  • Trichuris trichiura
  • Hookworm
  • Strongyloides
24
Q

Infectious Etiologies of Crohn’s Disease

FUNGAL

A
  • Histoplasmosis
  • Candida
  • Aspergillus
25
Q

NonInfectious Etiologies of Crohn’s Disease

Drugs and Chemicals

A
  • NSAIDs
  • Phosphosoda
  • Cathartic colon
  • Gold
  • Oral contraceptives
  • Cocaine
  • Immune checkpoint
  • inhibitor colitis
  • Mycophenolate mofetil
26
Q

EX TRAINTESTINAL
MANIFESTATION

Exythema Nodusom
- Pyoderma Ganerenosum

A
  • Exythema Nodusom - UC (10%), CD (15%)

- Pyoderma Ganerenosum - UC (1-12’%o), less common in CD

27
Q

RHEUMA

  • ,Peripheral arthritis -
  • Ankylosing spondylitis
  • Sacroilitis
A
  • Peripheral arthritis - 15-20% of IBD, more common in CD
  • Ankylosing spondylitis - 10% of IBD, more common in CD than UC
    • Sacroilitis both
28
Q

OCULAR MANIFESTATION IN IBS

A
  • conjunctivitis,

- uveitis/iritis, - episcleritis

29
Q

MANIFESTATION

» HEPATOBILIARY

A
  • Hepatic steatosis,
  • cholelithiasis,
  • primary sclerosing
    cholangitis
30
Q

MANIFESTATION

UROLOGIC

A
  • Calculi,

- ureteral obstruction, - - ileal bladder fistula

31
Q

MANIFESTATION

METABOLIC BONE D/O

A
  • low bone mass,

- osteonecrosis

32
Q

‘Treatment for IBS

A
  • 5 ASA agents
    Sulfasalazine, Balsalazide, Delzicol, Asacol, Lialda,
    Apniso, Pentasa, Rowasa, Canasa
  • Glucocorticoids
    Prednisone, Hydrocortisone
  • Antibiotics
    Metronidazole, Ciprofloxacin
  • Azathioprine and 6 Mercaptopurine

IM GASTRO (10 decks)

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