- abdo pain - diarrhea - mass in RLQ - obstrcution - weight loss - fever - stricture - fistula and anal involvment

1. genes - CD>UC : NOD2 gene 2. host immune system 3. luminal bact 4. env

1. altered mucous 2. incr. permeability 3. impaired repair mech.

- travel - AB use - diet - sex hx - fam hx - extra intestinal Sx

- CBC - iron - folate - B12 - CRP - ESR - stool WBC

1. 5-ASA 2. corticosteroids 3. immunosuppresants - methotrexate 4. ABs 5. imunobiologics - mab's

IBD Flashcards by Seth Davis

def. IBD

chronic inflamm of the intestinal tract, variable systemic involvement

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location of 2

UC - colon and rectum

CD - any portion

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peak ages

bimodal - 20-30 and 60s

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epi

more UC

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Sx of CD

abdo pain
diarrhea
mass in RLQ
obstrcution
weight loss
fever
stricture
fistula and anal involvment

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4 most common extraintestinal

eye - episcleritis
skin - erethyma nodosum
mouth ulcers
MSK - arthiritis

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4 aspects to patho

genes - CD>UC : NOD2 gene
host immune system
luminal bact
env

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what is the immune response

inappropiate extreme immune response

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3 env factors

altered mucous
incr. permeability
impaired repair mech.

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what is actual path

normal>triggers>acute inflammation> not cleared> chronic inflammation

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what to ask on Hx

travel
AB use
diet
sex hx
fam hx
extra intestinal Sx

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labs

CBC
iron
folate
B12
CRP
ESR
stool WBC

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imaging

US, CT MR, endo

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3 main goals and 2 additional of therapy

remission induction
remission maintenance
prevent treat compl.

a. mucoal healing
b. QOL

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5 classes of meds

5-ASA
corticosteroids
immunosuppresants - methotrexate
ABs
imunobiologics - mab’s

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preps, uses, action, effect, formulation and SE of 5-ASA

preps - mesalamine
uses - UC, mild crohn ilitis
action - oxy free radical scavenger
effect - local only
formulation - oral, rectal
adverse effects - pancreatitis, nephritis

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preps, uses, action, effect, and SE of steroids

preps - prednisone, budesonide
uses - remission induction, no use for maintenance
action - inhib inflam. cytokines
adverse effects - cushins, ** avasc. necrosis

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action, use and SE of azathroprine

action - purine analog- DNA syn. inhib
use - remission and maintenance, healing of fistula
SE - bone marrow sup., pancreatitis, lymphoma,

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ction, use and SE of methotrexate

action - folic acid antag - no DNA, cort. sparing
use - remission and maintenance
SE - liver, leukopenia, N/V, diarrhea, hypersensitivity

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action, use and SE of cyclosporine

action - inhib of t -cell mediated responses
use - acute and refractory UC
SE - nephrotox, infections, hypertension

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action, use and SE of immunobiologics

action - antiTNF ABs
use - CD - active and perianal, UC severe
SE - delayed hypersenstivity and lotof others

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use of ABs (

metronidazole and cipro
- no use in UC
-

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what to do when refractory

Surgey

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2 indications for surg

failure of meds

2. disease complications - CA, perfs, stenosis

what is surg CD mantra

- do not harm - can't cure - preserve function

2 gen classes of IBD for a surg

1. fibrosteonitic - obstructive - pain, blaoating, | 2. perforative - fistula, abscess, free perf

3 main types of surg

1. resection 2. strictureplasty 3. diversion alone - rare

2 types of resection

1. restorative - +/- protected anastamosis | 2. non-restorative

what is surg for obstructing terminial illeum CD

illeocolic resection with anastamosis

**2 keys to a good anastamosis

1. tension-free | 2. well-vascularized

what is role of the protecting stoma

lower leak rates

complications of ileo-colic resection

- leak - bad - localized abscess - diffuse peritonitis

how common is recurrence

very high over time - esp @ ileocolic jct

surg for segmental colon, diffuse colon, anorectal colon

segmental - segmental resection diffuse - subtotal colectomy anorectal +/- colon - prectectomy

3 CD mantra for anal CD

1. control Sx 2. preserve function 3. do no harm - don't injure sphinter

gross appearnce of CD

stiff, thick walled bowel, linear ulcers

patho of CD (5)

1. shallow aphthous ulcers from mouth to anus 2. full thickness inflammation 3. fissuring ulcers - epithelium enters 4. patchy lesions (skip) 5. granuloma

4 common UC sx

1. abo pain 2. diarrhea, freq, small volume 3. rectal bleeds 4. mucous

major complications of UC

toxic mega colon

4 malignant aspects of toxic megacolon

1. duration - 8-10 years 2. extensive disease 3. comorbid liver disease 4. chronic indolent disease

3 aspects to guide therapy

1. extent 2. severity 3. complications

3 extents of disease

1. proctitis - rectum only 2. severity 3. complications

5 aspects to consider for severty

1. # BM (>6) 2. rectal bleeds 3. fever. tachy 4. anemia 5. extraintestinal

use of ASA for UC

remisson and maintenance

use of ABs for UC

none

use of steroids for UC

induction only

use of innumonosuppression for UC

all remission and maintenance - except methotrexate, no maint

use of anti-TNF

both

what to do for severe attack of UC

try rescue therapy, and if fails > colectomy

2 options for colectomy

1. permanent ileostomy | 2. modified pouch attached to the anus

complications of colectomy

- bowel obst. - infection/leak - pouchitis - fistula - infert and SD

classic histo of UC

- diffuse and continuous inflammation the entire length of region affected - flat broad based ulcers - usually limited to the mucosa - crypt abscesses

what is prioblem in diagnosing IBD

- not always classical - can get illeal backwash in UC - can get patches in UC after treatment -

DDX for both IBDs (6)

1. infection! - esp TB 2. iscemia 3. diverticular assoc. sigmoid 4. behcet's disease 5. NSAID 6. tumours

what is issue with fulminant

can be severe and go deep which makes it hard to diff. between UC and CD - most act like UC - need to diff. because doing colectomy can be bad in CD

4 dysplasia risk factors for UC

1. duration 2. early age of onset 3. extent 4. primary sclerosin cholangitis

3 dysplasia risk factors for CD

1. duration 2. most in colon 3. 20-500x risk of smal bowel adenocarcinoma

what to do with polyps and flat dysplastic lesions

polyp - remove endo | flat - consider colectomy