IBD Flashcards
What is IBD?
Inflammatory Bowel Disease
What are the two inflammatory bowel diseases?
- Crohn’s disease
2. Ulcerative colitis
What is another name for Crohn’s disease?
Regional enteritis
What is the cause of IBD?
Unknown; probably an autoimmune process with environmental factors
What is the differential diagnosis of IBD?
Crohn’s vs. UC, infectious colitis (e.g. C. diff, amebiasis, shigellosis), ischemic colitis, IBS, diverticulitis, ZES, colon cancer, carcinoid, ischemic bowel
What are the extraintestinal manifestations seen in both types of IBD?
A PIE SACK:
Ankylosing spondylitis, Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, Clubbing, Kidney disease (e.g. nephrotic syndrome, amyloid deposits)
What is the incidence of Crohn’s disease?
3-6/100,000
What is the at-risk population for Crohn’s disease?
Jewish, male, 25-40 yo or 50-65 yo
What is the incidence of UC?
10/100,000
What is the at-risk population for UC?
Jewish, male, 20-35 yo or 50-65 yo
What are the initial symptoms of Crohn’s disease?
Abdominal pain, diarrhea, fever, weight loss, anal disease
What are the initial symptoms of UC?
Bloody diarrhea, fever, weight loss
What is the anatomical distribution of Crohn’s disease?
“Mouth to anus”
Small bowel only: 20%
Large bowel only: 30%
What is the anatomical distribution of UC?
Colon only
What is the route of spread of Crohn’s disease?
Small bowel, colon, or both with skip lesions of normal bowel
What is the route of spread of UC?
Involves rectum and spreads proximally in a continuous route
What is “backwash” ileitis?
Mild inflammation of the terminal ileum in UC
What is the bowel wall involvement of Crohn’s disease?
Full thickness, transmural
What is the bowel wall involvement of UC?
Mucosa, submucosa only
What is the anal involvement of Crohn’s disease?
Common (fistulae, abscesses, fissures, ulcers)
What is the anal involvement of UC?
Uncommon
What is the rectal involvement of Crohn’s disease?
Rare
What is the rectal involvement of UC?
100% of cases
What are the mucosal findings in Crohn’s disease?
- Aphthous ulcers
- Granulomas
- Linear ulcers
- Transverse fissures
- Swollen mucosa
- Full-thickness wall involvement
What are the mucosal findings in UC?
- Granular, flat mucosa
- Ulcers
- Crypt abscesses
- Dilated mucosal vessels
- Pseudopolyps
What diagnostic tests are used for Crohn’s disease?
Colonoscopy w/ biopsy, barium enema, UGI w/ small bowel follow-through, stool cultures
What diagnostic tests are used for UC?
Colonoscopy, barium enema, UGI w/ small bowel follow-through (r/o Crohn’s), stool cultures
What are complications of Crohn’s disease?
Anal fistula or abscess, fistula, stricture, perforation, abscesses, toxic megacolon, colovesical fistula, enterovaginal fistula, hemorrhage, obstruction, cancer
What are complications of UC?
Cancer, toxic megacolon, colonic perforation, hemorrhage, strictures, obstruction, complications of surgery
What is the cancer risk of Crohn’s disease?
Overall increased risk, but half that of UC
What is the cancer risk of UC?
5% risk of colon cancer at 10 years; risk increases 1% per year
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
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
What are common surgical options for UC?
- Total proctocolectomy, distal rectal mucosectomy, ileoanal pull through
- Total proctocolectomy, Brooke ileostomy
What is toxic megacolon?
An acutely and massively distended colon in a patient that is septic, febrile with abdominal pain
What are the medication options for IBD?
Sulfasalazine, mesalamine, steroids, metronidazole, azathioprine, 6-mp, infliximab
What is infliximab?
An antibody against TNF-alpha
What is the active metabolite of sulfasalazine?
5-ASA, which is released in the colon
What is the medical treatment of choice for Crohn’s disease?
PO metronidazole
What are the treatment options for long-term remission of IBD?
6-mp, azathioprine, mesalamine
What medication is used for IBD flares?
Steroids
What is a unique medication route option for UC?
Enemas (steroids, 5-ASA)
Which disease has cobblestoning more often on endoscopic exam: Crohn’s or UC?
Crohn’s disease
Which disease has pseudopolyps on colonoscopic exam?
UC
What are pseudopolyps?
Polyps of hypertrophied mucosa surrounded by mucosal atrophy
Which disease has a lead pipe appearance on barium enema?
Chronic UC
What is the most common indication for surgery in patients with Crohn’s disease?
SBO
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
Why do you see fistulae and abscesses with Crohn’s disease and not UC?
Crohn’s is transmural
What is the operation for short strictures of the small bowel in Crohn’s disease?
Stricturoplasty: open longitudinally and sew closed in transverse direction
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
What is pouchitis?
Inflammation of the pouch of an ileoanal pull through, treated with metronidazole
Do you need a frozen section for margins during a bowel resection for Crohn’s disease?
No, only need grossly negative margins
What is it called when the entire colon is involved?
Pancolitis
