IBD Flashcards
def. IBD
chronic inflamm of the intestinal tract, variable systemic involvement
location of 2
UC - colon and rectum
CD - any portion
peak ages
bimodal - 20-30 and 60s
epi
more UC
Sx of CD
- abdo pain
- diarrhea
- mass in RLQ
- obstrcution
- weight loss
- fever
- stricture
- fistula and anal involvment
4 most common extraintestinal
- eye - episcleritis
- skin - erethyma nodosum
- mouth ulcers
- MSK - arthiritis
4 aspects to patho
- genes - CD>UC : NOD2 gene
- host immune system
- luminal bact
- env
what is the immune response
inappropiate extreme immune response
3 env factors
- altered mucous
- incr. permeability
- impaired repair mech.
what is actual path
normal>triggers>acute inflammation> not cleared> chronic inflammation
what to ask on Hx
- travel
- AB use
- diet
- sex hx
- fam hx
- extra intestinal Sx
labs
- CBC
- iron
- folate
- B12
- CRP
- ESR
- stool WBC
imaging
US, CT MR, endo
3 main goals and 2 additional of therapy
- remission induction
- remission maintenance
- prevent treat compl.
a. mucoal healing
b. QOL
5 classes of meds
- 5-ASA
- corticosteroids
- immunosuppresants - methotrexate
- ABs
- imunobiologics - mab’s
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
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
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,
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
action, use and SE of cyclosporine
action - inhib of t -cell mediated responses
use - acute and refractory UC
SE - nephrotox, infections, hypertension
action, use and SE of immunobiologics
action - antiTNF ABs
use - CD - active and perianal, UC severe
SE - delayed hypersenstivity and lotof others
use of ABs (
metronidazole and cipro
- no use in UC
-
what to do when refractory
Surgey
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
- fibrosteonitic - obstructive - pain, blaoating,
2. perforative - fistula, abscess, free perf
3 main types of surg
- resection
- strictureplasty
- diversion alone - rare
2 types of resection
- restorative - +/- protected anastamosis
2. non-restorative
what is surg for obstructing terminial illeum CD
illeocolic resection with anastamosis
**2 keys to a good anastamosis
- 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
- control Sx
- preserve function
- do no harm - don’t injure sphinter
gross appearnce of CD
stiff, thick walled bowel, linear ulcers
patho of CD (5)
- shallow aphthous ulcers from mouth to anus
- full thickness inflammation
- fissuring ulcers - epithelium enters
- patchy lesions (skip)
- granuloma
4 common UC sx
- abo pain
- diarrhea, freq, small volume
- rectal bleeds
- mucous
major complications of UC
toxic mega colon
4 malignant aspects of toxic megacolon
- duration - 8-10 years
- extensive disease
- comorbid liver disease
- chronic indolent disease
3 aspects to guide therapy
- extent
- severity
- complications
3 extents of disease
- proctitis - rectum only
- severity
- complications
5 aspects to consider for severty
- # BM (>6)
- rectal bleeds
- fever. tachy
- anemia
- 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
- 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)
- infection! - esp TB
- iscemia
- diverticular assoc. sigmoid
- behcet’s disease
- NSAID
- 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
- duration
- early age of onset
- extent
- primary sclerosin cholangitis
3 dysplasia risk factors for CD
- duration
- most in colon
- 20-500x risk of smal bowel adenocarcinoma
what to do with polyps and flat dysplastic lesions
polyp - remove endo
flat - consider colectomy
