IBD and Celiac Disease Flashcards
What is the genetic connection associated with Crohn’s Disease?
40% chance of getting it with a 1st degree relative
Which disease does smoking increase and decrease risks in?
INcreased risk = Crohn’s
DEcreased risk = Ulcerative colitis
Crohn’s affects what part of the GI tract? What layers of the GI tract are affected?
The entire GI tract
It is Trasnsmural, affecting entire thickness of mucosa
What is the most common part of the GI tract that Crohn’s affect?
Ileium (right sided)
Can be mistaken for appendicitis
What are the 4 types of fistulas that occur with Crohn’s?
Enteroenteric- bowel to bowel
Enterovesicular- bowel to bladder
Enterovaginal- bowel to vagina
Enterocutaneous- bowel to skin
How do you differentiate between mild, moderate and severe crohn’s?
Mild → inflammation
Moderate → inflammation, strictures
Severe → inflammation, strictures, fistulae
What are symptoms seen with Crohn’s Disease
Colicky RLQ pain
Palpable RLQ fullness/mass
Diarrhea often NOCTURNAL
Low grade fever
Weight loss
Hematochezia / rectal bleeding may be present
Rectal exam may reveal abscess, fistulas or skin tags
What are extraintestinal things that are seen with Crohn’s?
Aphthous ulcerations
Arthralgias, Arthritis (Primarily involving the large joints)*
Erythema nodosum –> painful nodules on skin
Episcleritis, iritis, uveitis
Gallstones – related to bile acid malabsorption, unique to crohn’s disease
Sclerosing cholangitis - ↑ Alk. Phos.
What is the procedure of choice used to diagnose Crohn’s?
Colonoscopy
What are findings on colonoscopy that might be seen with colonoscopy?
Skip lesions
Ulcerations
Cobblestonning
Fistulas
What is person at an increased risk of developing with Crohn’s after 8-10 years?
What testing needs to be done to rule this out?
colon cancer
Colonoscopy every 1-2 years
What medication can make Crohn’s worse?
What nutritients are you deficient in Crohn’s
NSAIDS
Fe and Vitamin B12
What are treatment options for Chron’s?
Step-up versus Top-down Salicylates (5-ASA)- Antibiotics (fistulas/abscess – perianal disease) Cipro and flagyl Corticosteroids (flares) Immunosuppressants TNF blockers (are also immunosuppressive) [eg. infliximab (Remicade)] Surgery Nutrition
What area does Ulcerative colitis mostfly affect?
Colon
What is the pattern of infection with ulcerative colitis?
Spreads distal to proximal
What layers are affected with ulcerative colitis?
mucosal surface
What are symptoms seen with Ulcerative Colitis?
Rectal bleeding Diarrhea, often bloody & includes mucous, often nocturnal Crampy abdominal pain Tenesmus (aka rectal urgency) With proctitis, can see constipation
What symptoms can be seen with severe ulcerative colitis?
Anemia, fever, > 6 stools/day, weight loss, hospitalization
What are physical exam signs that can be seen with extensive ulcerative colitis?
Anemia signs
abdominal tenderness,
+ guaiac
What are extra-intestinal findings seen with ulcerative colitis?
Arthralgias, Arthritis (primarily involving large joints)*
Erythema nodosum
Episcleritis, iritis, uveitis
Sclerosing cholangitis - ↑ Alk. Phos.
What diagnostic tool can be used to diagnose Ulcerative colitis? Why?
Flex sig or colonoscopy usu.
It is usually found in the rectrm and sigmoid
What are internal findings seen on colonoscopy with ulcerative colitis?
Continuous area of involvement, no skip lesions
May see loss of haustral folds
Strictures rare
Petechiae, exudate, friability (signs of inflammation)
Long term inflammation increases risk of colon cancer, so what test must be dont routinely?
colonoscopy every 1-2 years
What medication will worsen with ulcerative colitis?
NSAIDS –> increases blood loss
