IBD Flashcards
What does IBD stand for?
Inflammatory Bowel Disease
Etiology of ulcerative colitis?
idiopathic
some genetic tendency
What are the groups in which ulcerative colitis typically presents?
Adolescence or young adulthood.
Whites, Jews of Eastern European descent
Presentation of UC?
BLOODY DIARRHEA ABD PAIN RELIEVED BY BM fever, anorexia, wt loss, anemia arthritis uveitis jaundice skin lesions
What is the most common location effected by UC?
Almost always involves distal colon and rectum
What percentage of pt’s go into complete remission?
90%
There are 3 disease severities for UC describe all 3
Mild-fewer than 4BMS qd, intermittent bleeding Normal labs
Moderate-4-6BMs qd frequent bleeding, HCT drop and ESR 20-30
Severe-more than 6BM’s qd, HCT drop , wt loss greater than 10%, ESR greater than 30
Why is ESR increased during mod-acute attack of UC?
sed rate is marker for inflammation
What distinguishes UC from Ulcerative proctitis?
limited extent of inflammation, good prognosis and lack of serious complications
relapses are more common
What are the main differences between UC and Crohn’s dz?
Crohn’s is chronic
and can effect the entire GI system (and extends through all layers of bowel wall)
What is believed to be the etiology of Crohn’s disease?
autoimmune
Peak incidence of Crohn’s occurs at what age?
20-40yo
Most common site effected by Crohn’s dz?
Distal ileum and Right colon - can involve small bowel (infrequent)
Symptoms of Crohn’s dz?
ABD PAIN diarrhea (may be bloody) wt loss/anorexia vomiting feer perianal discomfort/bleeding constipation
Describe 3 severities of Crohn’s dz
Mild to mod-wt loss less than 10%, no dehydration
Moderate to severe-fever, anemia, wt loss greater than 10%
Severe-fever, obstruction, abscess
What might be seen on PE for Crohn’s
RLQ abd mass Perianal fistula tract inflamed joint erythema nodosum pyoderma uveitis aphthous ulcer Nephrolithiasis obstruction osteoporosis/penia
What does GALS stand for in “only GALS can be Crohn’s”
Granulomas
All
Layers
Skin lesions
DX for UC
clinical dx sigmoidoscopy colonoscopy rectal bx Seriolgoy-elevated CRP, Leuk, ESR, Platelet, and decrease in HgB and albumin
What additional test should be done to rule out Cause of diarrhea when considering UC?
stool for toxins, bacteria O&P
Dx for Crohn’s
clinical presntation
rad contrast *UGI, air contrast BE
serology-elevated CRP, Leuks, ESR, Platelet and decrease in HgB and albumin (same as UC)
Endoscopic-rectal sparing, fistulization, skip lesions
UC tx options:
Sulfasalazine Sulfapyridine-Free 5-aminosalicylate agents oral corticosteroids immunosuppressives opiates physch. support surgery screen for ca.
What is the first medication typically prescribed for UC moderate-mild symptoms?
sulfasalazine
What might sulfasalazine be combined with for UC with more severe sx.?
steroids.
Why might sulfasalazine not be initiated to start with mod-mild UC?
some pt’s don’t tolerate it well
What is the more expensive and more effective new tx for UC?
Sulfapyridine-free 5-aminosalicylates
What is the benefit/drawback to prescribing Suflapyridine-free 5-aminosalicylates as opposed to sulfasalazine?
Doesn’t have the side effects as sulfasalazine
MUCH MORE EXPENSIVE
For distal UC what is an additional alternate to sulfasalazine bat can be used for maintenance of UC and prevents the concern about systemic steroid absorption?
5-ASA enemas
When is the use of glucocorticosteroids indicated in UC?
moderately severe to severe cases
For those that require chronic high-dose steroid tx and have had inadequate response to conventional therapies what is an additional modality that can be tried?
Immunomodulator agents.
What must be monitored in the use of immunomodulator agents?
potential side effects of infection, heptotoxicity, bone marrow suppression
For those unable to function at all due to diarrhea what may also be prescribed?
opiods/opiates
What are indications for surgery for UC?
high grade dysplasia, toxic megacolon, hemorrhage, obstruction, unresponsiveness to maximal medical management.
What screening in necessary for pt’s with UC or crohn’s (but more common in UC)?
Colorectal cancer
What patients are screened for colorectal cancer with IBD?
all pt’s with punctilios of 7 years or more than 12 years after L sided colitis (whichever comes first)
eery 2-3 years until 20yr hx then annual
When is Metranidazole given in the presence of Crohn’s dz?
2nd step w/ failure to sulfasalazine
So Metronidazole - second step tx in ________
and 5-ASA is second step tx in ______
Metronidazole = Crohn's 5-ASA = 5ASA
Should pt increase or decrease fiber during Crohn’s flare?
decrease fiber
Should pt increase or decrease fiber while not experiencing a Crohn’s flare?
Increase fiber
when do you admit a pt with Crohn’s?
bleeding toxicity sever pain or too ill to obtain adequate nutrition orally bowel rest nasogastric feeding parenteral steroids surgical consult
Define Rome Criteria for IBS
Abd pain/discofort relieved with BM and 2 or more of the following for at least 3 days/mo x 3mos: change in stool frequency Change in stool consistency Difficult stool passage Sense of incomplete evacuation Presence of mucus in the stool
What age group is IBS more common in?
Young (under 45)
Sx of IBS
altered bowel habits flatulence abd pain upper GI symptoms Symptoms are almost always during waking hours
Characteristics of Abdominal pain in IBS?
location varies frequent episodic crampy ache intensity varies pain exacerbated by stress Pain relieved by BM
What sx makes you think IBS and not UC?
If the pt is able to sleep through the night, no night-time awakenings they probably have IBS.
What is the most common pattern of altered bowel habit in IBS?
Constipation alternating with diarrhea
What percentage of pt’s c/o upper GI problems with IBS?
25-50%
What does the workup for IBS depend on?
onset of symptoms, severity and age of pt.
diagnostics for IBS?
diagnosis of exclusion CBD flex sig stook for O&P older than 40 BE/colonscopy UGI dietary (lactose intollerance) UGI workup US gallbladder postprandial RUQ pain
tx for IBS?
counseling/dietary stool bulking agents/high fiber diet antispasmodics (starting to fall out of fashion) antidiarrheals (temporary) antidepressants Antiflatulence GI motility enhancers
