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Surgical Recall > IBD > Flashcards

IBD Flashcards

1
Q

What is IBD?

A

Inflammatory Bowel Disease

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2
Q

What are the two inflammatory bowel diseases?

A
  1. Crohn’s disease

2. Ulcerative colitis

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3
Q

What is another name for Crohn’s disease?

A

Regional enteritis

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4
Q

What is the cause of IBD?

A

Unknown; probably an autoimmune process with environmental factors

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5
Q

What is the differential diagnosis of IBD?

A

Crohn’s vs. UC, infectious colitis (e.g. C. diff, amebiasis, shigellosis), ischemic colitis, IBS, diverticulitis, ZES, colon cancer, carcinoid, ischemic bowel

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6
Q

What are the extraintestinal manifestations seen in both types of IBD?

A

A PIE SACK:
Ankylosing spondylitis, Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, Clubbing, Kidney disease (e.g. nephrotic syndrome, amyloid deposits)

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7
Q

What is the incidence of Crohn’s disease?

A

3-6/100,000

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8
Q

What is the at-risk population for Crohn’s disease?

A

Jewish, male, 25-40 yo or 50-65 yo

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9
Q

What is the incidence of UC?

A

10/100,000

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10
Q

What is the at-risk population for UC?

A

Jewish, male, 20-35 yo or 50-65 yo

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11
Q

What are the initial symptoms of Crohn’s disease?

A

Abdominal pain, diarrhea, fever, weight loss, anal disease

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12
Q

What are the initial symptoms of UC?

A

Bloody diarrhea, fever, weight loss

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13
Q

What is the anatomical distribution of Crohn’s disease?

A

“Mouth to anus”
Small bowel only: 20%
Large bowel only: 30%

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14
Q

What is the anatomical distribution of UC?

A

Colon only

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15
Q

What is the route of spread of Crohn’s disease?

A

Small bowel, colon, or both with skip lesions of normal bowel

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16
Q

What is the route of spread of UC?

A

Involves rectum and spreads proximally in a continuous route

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17
Q

What is “backwash” ileitis?

A

Mild inflammation of the terminal ileum in UC

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18
Q

What is the bowel wall involvement of Crohn’s disease?

A

Full thickness, transmural

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19
Q

What is the bowel wall involvement of UC?

A

Mucosa, submucosa only

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20
Q

What is the anal involvement of Crohn’s disease?

A

Common (fistulae, abscesses, fissures, ulcers)

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21
Q

What is the anal involvement of UC?

A

Uncommon

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22
Q

What is the rectal involvement of Crohn’s disease?

23
Q

What is the rectal involvement of UC?

A

100% of cases

24
Q

What are the mucosal findings in Crohn’s disease?

A
  1. Aphthous ulcers
  2. Granulomas
  3. Linear ulcers
  4. Transverse fissures
  5. Swollen mucosa
  6. Full-thickness wall involvement
25
What are the mucosal findings in UC?
1. Granular, flat mucosa 2. Ulcers 3. Crypt abscesses 4. Dilated mucosal vessels 5. Pseudopolyps
26
What diagnostic tests are used for Crohn's disease?
Colonoscopy w/ biopsy, barium enema, UGI w/ small bowel follow-through, stool cultures
27
What diagnostic tests are used for UC?
Colonoscopy, barium enema, UGI w/ small bowel follow-through (r/o Crohn's), stool cultures
28
What are complications of Crohn's disease?
Anal fistula or abscess, fistula, stricture, perforation, abscesses, toxic megacolon, colovesical fistula, enterovaginal fistula, hemorrhage, obstruction, cancer
29
What are complications of UC?
Cancer, toxic megacolon, colonic perforation, hemorrhage, strictures, obstruction, complications of surgery
30
What is the cancer risk of Crohn's disease?
Overall increased risk, but half that of UC
31
What is the cancer risk of UC?
5% risk of colon cancer at 10 years; risk increases 1% per year
32
What are indications for surgery in Crohn's disease?
Obstruction, massive bleeding, fistula, perforation, suspicion for cancer, abscess (refractory to antibiotics), toxic megacolon (refractory to meds), strictures, dysplasia
33
What are indications for surgery in UC?
Toxic megacolon (refractory to meds), cancer PPx, massive bleeding, FTT, perforation, suspicion for cancer, acute severe symptoms, inability to wean off steroids, obstruction, dysplasia, stricture
34
What are common surgical options for UC?
1. Total proctocolectomy, distal rectal mucosectomy, ileoanal pull through 2. Total proctocolectomy, Brooke ileostomy
35
What is toxic megacolon?
An acutely and massively distended colon in a patient that is septic, febrile with abdominal pain
36
What are the medication options for IBD?
Sulfasalazine, mesalamine, steroids, metronidazole, azathioprine, 6-mp, infliximab
37
What is infliximab?
An antibody against TNF-alpha
38
What is the active metabolite of sulfasalazine?
5-ASA, which is released in the colon
39
What is the medical treatment of choice for Crohn's disease?
PO metronidazole
40
What are the treatment options for long-term remission of IBD?
6-mp, azathioprine, mesalamine
41
What medication is used for IBD flares?
Steroids
42
What is a unique medication route option for UC?
Enemas (steroids, 5-ASA)
43
Which disease has cobblestoning more often on endoscopic exam: Crohn's or UC?
Crohn's disease
44
Which disease has pseudopolyps on colonoscopic exam?
UC
45
What are pseudopolyps?
Polyps of hypertrophied mucosa surrounded by mucosal atrophy
46
Which disease has a lead pipe appearance on barium enema?
Chronic UC
47
What is the most common indication for surgery in patients with Crohn's disease?
SBO
48
What are the intraoperative findings of Crohn's disease?
Mesenteric "fat-creeping" onto anti-mesenteric border of small bowel, shortened mesentery, thick bowel wall, fistulae, abscesses
49
Why do you see fistulae and abscesses with Crohn's disease and not UC?
Crohn's is transmural
50
What is the operation for short strictures of the small bowel in Crohn's disease?
Stricturoplasty: open longitudinally and sew closed in transverse direction
51
Should the appendix be removed during a laparotomy for abdominal pain if Crohn's disease is discovered?
Yes, if the cecum is not involved with active Crohn's disease
52
What is pouchitis?
Inflammation of the pouch of an ileoanal pull through, treated with metronidazole
53
Do you need a frozen section for margins during a bowel resection for Crohn's disease?
No, only need grossly negative margins
54
What is it called when the entire colon is involved?
Pancolitis

Surgical Recall (68 decks)

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