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ENTREGA > IBD > Flashcards

IBD Flashcards

1
Q

What is IBD?

A

Inflammatory Bowel Disease

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2
Q

What are the two inflammatory bowel diseases?

A
  1. Crohn’s disease

2. Ulcerative colitis

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3
Q

What is another name for Crohn’s disease?

A

Regional enteritis

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4
Q

What is the cause of IBD?

A

Unknown; probably an autoimmune process with environmental factors

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5
Q

What is the differential diagnosis of IBD?

A

Crohn’s vs. UC, infectious colitis (e.g. C. diff, amebiasis, shigellosis), ischemic colitis, IBS, diverticulitis, ZES, colon cancer, carcinoid, ischemic bowel

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6
Q

What are the extraintestinal manifestations seen in both types of IBD?

A

A PIE SACK:
Ankylosing spondylitis, Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, Clubbing, Kidney disease (e.g. nephrotic syndrome, amyloid deposits)

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7
Q

What is the incidence of Crohn’s disease?

A

3-6/100,000

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8
Q

What is the at-risk population for Crohn’s disease?

A

Jewish, male, 25-40 yo or 50-65 yo

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9
Q

What is the incidence of UC?

A

10/100,000

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10
Q

What is the at-risk population for UC?

A

Jewish, male, 20-35 yo or 50-65 yo

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11
Q

What are the initial symptoms of Crohn’s disease?

A

Abdominal pain, diarrhea, fever, weight loss, anal disease

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12
Q

What are the initial symptoms of UC?

A

Bloody diarrhea, fever, weight loss

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13
Q

What is the anatomical distribution of Crohn’s disease?

A

“Mouth to anus”
Small bowel only: 20%
Large bowel only: 30%

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14
Q

What is the anatomical distribution of UC?

A

Colon only

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15
Q

What is the route of spread of Crohn’s disease?

A

Small bowel, colon, or both with skip lesions of normal bowel

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16
Q

What is the route of spread of UC?

A

Involves rectum and spreads proximally in a continuous route

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17
Q

What is “backwash” ileitis?

A

Mild inflammation of the terminal ileum in UC

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18
Q

What is the bowel wall involvement of Crohn’s disease?

A

Full thickness, transmural

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19
Q

What is the bowel wall involvement of UC?

A

Mucosa, submucosa only

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20
Q

What is the anal involvement of Crohn’s disease?

A

Common (fistulae, abscesses, fissures, ulcers)

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21
Q

What is the anal involvement of UC?

A

Uncommon

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22
Q

What is the rectal involvement of Crohn’s disease?

A

Rare

23
Q

What is the rectal involvement of UC?

A

100% of cases

24
Q

What are the mucosal findings in Crohn’s disease?

A
  1. Aphthous ulcers
  2. Granulomas
  3. Linear ulcers
  4. Transverse fissures
  5. Swollen mucosa
  6. Full-thickness wall involvement
25
Q

What are the mucosal findings in UC?

A
  1. Granular, flat mucosa
  2. Ulcers
  3. Crypt abscesses
  4. Dilated mucosal vessels
  5. Pseudopolyps
26
Q

What diagnostic tests are used for Crohn’s disease?

A

Colonoscopy w/ biopsy, barium enema, UGI w/ small bowel follow-through, stool cultures

27
Q

What diagnostic tests are used for UC?

A

Colonoscopy, barium enema, UGI w/ small bowel follow-through (r/o Crohn’s), stool cultures

28
Q

What are complications of Crohn’s disease?

A

Anal fistula or abscess, fistula, stricture, perforation, abscesses, toxic megacolon, colovesical fistula, enterovaginal fistula, hemorrhage, obstruction, cancer

29
Q

What are complications of UC?

A

Cancer, toxic megacolon, colonic perforation, hemorrhage, strictures, obstruction, complications of surgery

30
Q

What is the cancer risk of Crohn’s disease?

A

Overall increased risk, but half that of UC

31
Q

What is the cancer risk of UC?

A

5% risk of colon cancer at 10 years; risk increases 1% per year

32
Q

What are indications for surgery in Crohn’s disease?

A

Obstruction, massive bleeding, fistula, perforation, suspicion for cancer, abscess (refractory to antibiotics), toxic megacolon (refractory to meds), strictures, dysplasia

33
Q

What are indications for surgery in UC?

A

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

34
Q

What are common surgical options for UC?

A
  1. Total proctocolectomy, distal rectal mucosectomy, ileoanal pull through
  2. Total proctocolectomy, Brooke ileostomy
35
Q

What is toxic megacolon?

A

An acutely and massively distended colon in a patient that is septic, febrile with abdominal pain

36
Q

What are the medication options for IBD?

A

Sulfasalazine, mesalamine, steroids, metronidazole, azathioprine, 6-mp, infliximab

37
Q

What is infliximab?

A

An antibody against TNF-alpha

38
Q

What is the active metabolite of sulfasalazine?

A

5-ASA, which is released in the colon

39
Q

What is the medical treatment of choice for Crohn’s disease?

A

PO metronidazole

40
Q

What are the treatment options for long-term remission of IBD?

A

6-mp, azathioprine, mesalamine

41
Q

What medication is used for IBD flares?

A

Steroids

42
Q

What is a unique medication route option for UC?

A

Enemas (steroids, 5-ASA)

43
Q

Which disease has cobblestoning more often on endoscopic exam: Crohn’s or UC?

A

Crohn’s disease

44
Q

Which disease has pseudopolyps on colonoscopic exam?

A

UC

45
Q

What are pseudopolyps?

A

Polyps of hypertrophied mucosa surrounded by mucosal atrophy

46
Q

Which disease has a lead pipe appearance on barium enema?

A

Chronic UC

47
Q

What is the most common indication for surgery in patients with Crohn’s disease?

A

SBO

48
Q

What are the intraoperative findings of Crohn’s disease?

A

Mesenteric “fat-creeping” onto anti-mesenteric border of small bowel, shortened mesentery, thick bowel wall, fistulae, abscesses

49
Q

Why do you see fistulae and abscesses with Crohn’s disease and not UC?

A

Crohn’s is transmural

50
Q

What is the operation for short strictures of the small bowel in Crohn’s disease?

A

Stricturoplasty: open longitudinally and sew closed in transverse direction

51
Q

Should the appendix be removed during a laparotomy for abdominal pain if Crohn’s disease is discovered?

A

Yes, if the cecum is not involved with active Crohn’s disease

52
Q

What is pouchitis?

A

Inflammation of the pouch of an ileoanal pull through, treated with metronidazole

53
Q

Do you need a frozen section for margins during a bowel resection for Crohn’s disease?

A

No, only need grossly negative margins

54
Q

What is it called when the entire colon is involved?

A

Pancolitis

ENTREGA (40 decks)

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