IBD Flashcards
inflammatory bowel disease is most common in what patient population
Jews
smoking has what affect on risk of inflammatory bowel disease
- smoking increases risk of crohns disease
- smoking decreases risk of ulcerative colitis
- pt diagnosed once they quit smoking
Crohns disease affects what portion of the GI tract
- mouth to anus
- transmural: affects all entire thickness of mucosa
what are possible complications of crohns disease
- ulcer
- stricture
- fistula
- abscess
- colon cancer
- obstruction, perforation
- Nutritional deficiencies (Fe, B12)
most common site of involvement of Crohns disease is
distal ileum
What is a fistula
tunnel between two epithelial lined organs
Define the following fistulas
- enteroenteric
- enterovesicular
- enterovaginal
- enterocutaneous
- enteroenteric: bowel to bowel
- enterovesicular: bowel to bladder
- enterovaginal: bowel to vagina
- enterocutaneous: bowel to skin
differentiate between crohns ileitis, ileocolitis, and colitis
- crohns ileitis: disease limited to ileum
- crohns ileocolitis” disease of terminal ileum and adjacent proximal ascending colon
- crohns colitis: disease of the colon
clinical presentation
- highly variable
- colickly RLQ pain
- chronic, intermittent diarrhea
- often noctural
- rectal bleeding
Crohn’s disease
List the extra-intestinal manifestations of Crohn’s disease
- aphthous ulcerations
- arthralgias, arthritis (primarily large joints)***most common
- erythema nodosum
- episcleritis, iritis, uveitis
- gallstones
- sclerosing cholangitis
procedure of choice to evaluate suspected crohns disease
colonscopy
colonoscopy showing skip lesions and rectal sparing is characteristic of what form of IBD
Crohn’s disease
biopsy showing granulomas is diagnostic of what type of IBD
- Crohn’s disease
- seen in 30% of patients
small bowel follow-through: string sign is seen with what form of IBD
Crohn’s disease
list other diagnostic/lab tests (besides colonoscopy) used to assess IBD
- CT scan with contrast
- inflammation (thickened walls), abscesses, fistulas
- ESR, CRP: elevated in active disease
- IBD specific antibodies
long term inflammation caused by IBD increases risk of colon cancer, how often should pt be screened
- colonoscopy ever 1-2 yrs
if patient has IBD, he/she should not take what pain medication
- NSAIDs
- can cause flare-ups
List tx options for crohns disease
step up therapy or top-down
- salicylates (5-ASA)
- antibiotics (fistulas, abscesses)
- corticosteroids (flares)
- immunosuppressants
- TNF blockers- remicade
- surgery
-
nutrition
- **unique to crohns
ulcerative colitis affects what portion of GI tract
-
colon only
- almost always involves rectum
- occurs distal -> proximal (continuous)
- mucosal surface only
proctitis
ulcerative colitis limited to rectum
left sided colitis
ulcerative colitis that extends to but not beyong splenic flexure
pancolitis
ulcerative colitis that extends to cecum
clinical presentation
- rectal bleeding
- diarrhea, often bloody and includes mucous,
- often nocturnal
- crampy abd pain
- tenesmus (feeling of constantly needing to pass stools)
ulcerative colitis
List extra-intestinal manifestations of ulcerative colitis
- arthralgias, arthritis (primarily large joints)***most common
- erythema nodosum
- episcleritis, iritis, uveitis
- sclerosing cholangitis
How is ulcerative colitis diagnosed
- flex sig or colonoscopy
- only colon affected
- continuous area of involvement, no skip lesions
complications of ulcerative colitis
- colon cancer
- hemorrhage
- toxic megacolon: colonic dilation > 6 cm with signs of toxicity
list tx options for ulcerative colitis
step up therapy
- salicylates (5-ASA) **first line
- corticosteroids (flares)
- immunosuppressants
- TNF blockers- remicade
- surgery
first line therapy for IBD
- salicylates (5-ASA)
if patient is taking the salicylate (5-ASA) sulfasalazine, he/she must take what
folic acid
side effects of salicylates (5-ASA)
- nephrotoxicity
- GI upset
When patient with IBD is given corticosteroids, what do you need to know about taking them off
- not used for maintenance, only for flares
- slow taper
What corticosteroid is commonly used for ileal/ rt sided colonic disease
- Budesonide
- steroid-light-> less systemic side effects
side effects of prednisone
- osteoporosis
- insomnia
- worsening of DM
- weight gain
- adrenal insufficiency
- psychosis
- increased infection risk
Which abx are commonly used in crohns tx
- ciprofloxin and flagyl (metronidazole)
- used in acute disease
side effects of Flagyl (Metronidazole)
- peripheral neuropathy
- metallic taste
- disulfuram rxn (avoid alcohol)
side effects of ciprofloxin
- tendinitis (tendon rupture)
- photosensitivity
- prolongation of QT interval
red flags of IBD
- severe bleeding
- severe abd pain -> peritoneal signs
- weight loss
- signs of dehydration
- signs of obstruction
- failure to respond to medical therapy
What is celiac’s disease
- immune disorder triggered by environmental exposure
- gluten is toxic to small intestine
- causes mucosal inflammation, crypt hyperplasia and villous atrophy
celiac disease is prevalent in what patient populations
- whites of northern european ancestry
- relative with celiacs
- autoimmune disease
- DM I
- thyroid disease
- down’s syndrome
clinical presentation
- diarrhea with bulky, foul-smelling, floating stool due to steatorrhea, bloating and flatulence
- Fe deficiency anemia
- osteopenia
- dermatitis herpetiformis
- B vitamin deficiencies
- elevated LFT
celiac’s disease
dermatitis herpetiformis is pathonmeumonic for
celiac disease
how is celiac disease diagnosed
- must do testing while patient is eating gluten
-
small bowel biopsy via EGD is gold standard
- find villous atrophy
- blood testing: celiac disease panel
tx of celiac disease
- avoid gluten
- supplement as needed
celiac disease complications
- malabsorption
- Fe deficiency anemia
- B vitamin deficiency
- osteoporosis
- slight increase in
- non-hodgkins lymphoma
- GI malignancies
