IBD Flashcards
What are two types of Inflammatory Bowel Dz?
- Ulcerative Colitis
2. Crohn’s Dz
This condition describes the inflammatory changes in the GI tract caused by an immune response against gut bacteria.
Inflammatory Bowel Disease
When is the age of onset for IBD?
Two peaks (Bimodal), though more common in the first peak
Peak 1: 15-30
Peak 2: 60s
True/False: Only infections are the cause of IBD?
False, it can be non-infectious as well.
This condition is characterized by diffuse mucosal inflammation in a continuous pattern limited to the colon usually beginning in a rectosigmoid area and proceeding proximally. It may also develop in extensive areas of the colon at the same time.
Ulcerative Colitis
This condition is characterized by transmural inflammation in a discontinuous pattern that can occur in any part of the GI tract from mouth to anus. The distal ileum and colon are the most common sites of this disease.
Crohn’s Disease
The incidence of this type of IBD is on the rise over the past couple decades. The other type of IBD has remained relatively the same.
Crohn’s Dz is increasing!
What are the two main causes of IBD?
- Environmental
2. Genetic (particulary Crohn’s)
Cigarette smoking worsens this type of IBD. But surprisingly “protects” the other kind.
Worsens Crohn’s Dz
Protects Ulcerative Colitis
Role of Diet in IBD?
- Fat intake = risk factor for UC
- Consumption of fruit, vegetables, and fiber REDUCE IBD risk
- NSAIDs have consistently been assc. with disease flares
- Appendectomy at an early age apparently has a protective effect against UC
5-10% of IBD patients have a first-degree relative with the dx and first-degree relatives have a 10-15x increased rate for developing IBD.
Cool facts
True/False: Genetic factors play a bigger role in UC than CD
False, Genetics are more important in Crohn’s Dz.
What are some of the common environmental factors?
- Infections -Mycobacteria/measles
- Abx
- Diet - Low Fiber, Refined Sugars (Alterations in colonic flora?)
- Stress
- NSAID use
- Improved Hygiene? (Lack of immune education or parasites?)
- Smoking (Protective against UC, Risk factor for CD)
The lumen of the intestines with Crohn’s Dz would look like
Fat wrapping the colon, cobble stoning in the colon. Some fissuring, and a thickened wall.
The lumen of the intestines with Ulcerative Colitis would look like
Ulcerations, pseudopolyps, a loss of haustra, and crypt distortion.
Are blood tests good by themselves?
Nope, but they may be helpful
Which IBD-specific Antibod(y/ies) is/are more commonly seen in Ulcerative Colitis?
pANCA
Which IBD-specific Antibod(y/ies) is/are more commonly seen in Crohn’s Dz?
ASCA
Omp C
UC and CD have some symptoms in common, such as persistent diarrhea, fatigue, and loss of appetite. There are a number of clinical features, however, that appear predominantly in one or the other .
Okay
Commonly seen in UC
Bloody diarrhea
Infrequent Abdominal Pain
SMOKING IS PROTECTIVE
Commonly seen in CD
Abdominal Pain Occ Bloody Diarrhea Abdominal Mass Intestinal Obstruction Perianal Dz Common Fistulae SMOKING IS BAD
DDx of IBD
- Infectious Colitis
- Ichemic Colitis
- Drug-Induced (NSAID) enterocolitis (or oral contraceptives)
- Solitary Rectal Ulcer Syndrome
- Radiation enterocolitis
- Diversion colitis
- Endometriosis
- Malignancy
- Functional IBS
- Diverticular Dz
What is the role of endoscopy in IBD?
- Confirm Diagnosis
- Differentiate UC from CD
- Obtain histologic confirmation, severity and extent.
- Excludes other etiologies and neoplasms
Endoscopic features of UC
- Diffuse, continuous, superficial ulceration of mucosa
- Rare (always neoplastic) strictures
- Rectal involvement at diagnosis
Endoscopic features of CD
- Focal, asymmetric, aphthoid or linear ulcerations or cobblestoning of muscosa
- Common strictures
- Rectal sparing
- Granulomas in 30-40%
True/False: Irritable Bowel Syndrome has blood in stool or fecal leukocytes
False, IBS NEVER HAS THIS
