IBD and Colitis Flashcards
What 2 areas of the abdomen cause lower abdominal pain?
- Hindgut
2. Genitourinary
67 yr old is on day 3 of treatment of pneumonia with fluids and antibiotics and develops sudden onset acute abdominal pain rated 10/10 with hypertension and tachycardia. What happened?
Diverticular rupture (perforation)
Rome III criteria for IBS
2/3 sx for 3 months over 12 months period:
- Abdominal pain relieved by defecation
- Change in stool frequency
- Change in stool consistency
also:
- Recurrent abdominal pain for 6 months
- Marked change in bowel habit for 6 months
- Symptoms 3 days/month for 3 month
What is the PPV of the Rome III symptom criteria for IBS?
98%
What are alarm indicators for IBS symptoms?
Male, old age, nocturnal awakening, rectal bleeding, weight loss, fever, FH of colon cancer
What are the classic symptoms of ischemic colitis?
Crampy abdominal pain with rectal bleeding or bloody diarrhea within 24 hours after that in an elderly person with athersclerotic disease. Usually blood is not a huge amount, unlike diverticulosis
What is the triad for diverticulitis?
- LLQ pain
- Fever
- Leukocytosis
How do you evaluate diverticulitis?
Contrast enhanced CT of abdomen and pelvis. It can confirm the diagnosis and check for perforation, abscess, obstruction, fistula at the same time.
What are symptoms of radiation proctitis?
Diarrhea and tenesmus within 6 weeks of radiation therapy
How is radiation proctitis diagnosed and evaluated?
Biopsy. Must see submucosal fibrosis and arteriole endarteritis (sigmoidoscopy or endoscopy necessary)
Difference between ischemic colitis and acute mesenteric ischemia?
ISCHEMIC COLITIS: Bloody stool, mild abdominal tenderness. Colonscopy can sometimes show segmental hemorrhagic nodules, ulcers, gangerene. Much more common than AMI.
ACUTE MESENTERIC ISCHEMIA: Usually +FOBT but no overt blood in the stool. Pain out of proportion to examination.
What can precipitate ischemic colitis?
- Long distance running
- Cardiac surgery
- Oral contraceptives
- Cocaine
- Hypercoagulable states
- Age>60
What do you treat ischemic colitis?
- IV fluids
2. Broad spectrum antibiotics (less evidence for this. Not really an infection, more of a preemptive thing)
How do symptoms of diverticulosis differ from diverticulitis?
DIVERTICULOSIS: Massive painless bleeding
DIVERTICULITIS: Pain in the LLQ, fever, leukocytosis. Usually no overt rectal bleeding.
What are the most common causes of painless lower GI bleeding?
DiverticulOSIS and vascular ectasia
How do you manage painless lower GI bleeding? List tx steps in order
- Hemodynamic stabilization (I think this means RBC and NS)
2. Nasogastric tube aspirate, gastric lavage, or something to distinguish upper from lower source
What are the symptoms of erythema nodosum?
- Small, very tender nodules on the anterior tibial surface. Usually you can feel them better than you can see them. May look ecchymotic as they age.
- Often occurs with Crohn disease
- Usually preceded by joint pain, fever, malaise
What are the most common skin manifestations in Crohn disease? In UC?
Crohn: Erythema nodosum (tender nodules on shins)
UC: Pyoderma gangrenosum (small ulcers that at first look like bug-bites or pustules, and then can get really big and painful. Pretty uncommon.)
How do you treat erythema nodosum?
Usually treat the underlying Crohn disease
What is dermatitis herpetiformis?
Grouped vesicles that look like herpes that often occur on the extensor surfaces and extremely closely associated with celiac disease. However, only 25% of these patients will have SYMPTOMATIC celiac disease!
Which disease weirdly gets worse when you stop smoking?
ulcerative colitis
*memory: U for Upside-down-thinking and Ulcerative-colitis
What is microscopic colitis?
Colon disease where you get non-bloody diarrhea and colonoscopy shows normal mucosa, but histology shows increased lymphocytes or collagen. Need multiple biopsies to diagnose it.
Does Crohn or UC more often cause bleeding?
ulcerative colitis (think of it like Crohns is higher up so the blood doesn’t make it all the way down… idk)
Can crypt abscesses be seen in infectious colitis?
No, this is usually a chronic change seen in IBD
Does ischemic colitis typically involve the rectum?
No because the rectum has dual blood supply
What area is typically spared by crohn disease?
The rectum (but the colon is fair game)
How do you treat ulcerative colitis?
Mesalamine/Mesalazine/5-ASA (all the same thing)
It’s an anti-inflammatory drug that acts locally in the gut
How do you treat distal ulcerative colitis?
Topical therapy is better, so suppositories (mesalamine or steroids) or enema (mesalamine or hydrocortisone)
When is oral prednisone used to treat UC?
When symptoms don’t response to 5-ASA (like mesalamine, sulfasalazine)
If prednisone and 5-ASAs don’t work for patients with UC, what other drugs can you try?
Azathioprine or 6-mercaptopurine. Usually given at the same time as a 3-4 month course of prendisone because they have delayed onset of action
Also, infliximab (antibody to TNF alpha)
What age patients usually get microscopic colitis?
Collagenous type: 50-60
Lymphocytic type: 60-70
How do you treat microscopic colitis?
- Loperamide (Imodium)
- Diphenoxylate
- Bismuth subsalicylate
What are the symptoms of toxic megacolon?
Dilation of trasnverse and descending colon. Pt may have IBD or C Diff. Fever, tachycardia, abdominal tenderness. May have bloody diarrhea.
What are the msot common cauess of ischemic small bowel?
- Mesenteric arterial embolism from the heart (50%)
- Mesenteric arterial thrombus (25%)
- Mesenteric venous thrombosis (10%)
