IBD/Crohn/Colitis Flashcards
How does smoking affect risk of getting Crohn’s and Colitis?
Smoking ↑ risk of Crohn’s
Smoking ↓ risk of Colitis
IBD more C in what people?
Jewish
Crohn’s details?
Can affect entire GI tract (mouth to anus)
Most C in distal ileum
Transmural (entire thickness of mucosa)
Causes ulcers, strictures, fistuals, abscesses
Crohn’s in ileum only called?
In terminal ileum and prox ascending colon called?
In colon?
ileitis
Ileocolitis
Crohn’s colitis
Crohn’s intestinal presentation? (5)
Gradual sxs onset, U intermittent
Abd pain (U) colicky RLQ Palpable fullness RLQ Chronic/intermit diarr (C) at night Low fever/weight loss (P) Hematochezia/Rectal bleeding
Crohn’s extra-intestinal presentation? (6)
Arthralgia/itis (U) large joints Aphthous (mouth) ulcers Erythem nodosum Episcleritis/iritis/uvitis Gallstones Sclerosing cholangitis (inflamm of bile duct)
Crohn’s rectal exam (P) results? (3)
skin tags, abscess, fistual
Crohn’s DDX?
Infection (c diff, salmonella, e coli, etc) Ulcerative colitis Colon CA IBS Diverticulitis Lactose intolerance Celiac Lymphoma Endometriosis Ischemia
Crohn’s diagnostics?
Colonoscopy (test of choice)
CT w/ contrast of abd/pelvis
ESR/CRP (high)
IBD Ab’s
Crohn’s colonoscopy findings? (3)
Skip lesions (area w/o dz)
Cobblestone mucosa
(P) abscess, strictures, fistulas
Crohn’s management? (7)
Base on severity/frequency
1) salicylates
2) immunosuppressants)
3) Abx
4) Corticsteroids
5) TNF block
6) Surgery (if perf)
7) nutrition (lactose, B12/folate, Fe)
Crohn’s mgmt: Salicylate meds?
S/E?
sulfasalazine w/ folic acid
mesalamine
nephrotox, GI upset
Crohn’s mgmt: Immunosupp meds?
S/E?
(2nd step)
Mercaptopurine, Imuran
(closely monitor)
pancreatitis, hepatotox, leukopenia, infection
(if get pancreatitis, NEVER use these meds again)
Crohn’s mgmt: Abx meds?
Use when?
Cipro, Metronidazole
Acute flair of sxs
Crohn’s mgmt: Corticosteroid meds?
Used when?
Budesonide, prednisone
Acute flair
Crohn’s mgmt: Tumor Necrosis Factor (TNF) blocker meds?
Used?
S/E?
(also immunosup)
infliximab
if step 1 or 2 don’t help or can’t take
for mod to severe dz
don’t use with other immuno supp
(P) heal fistulas
infusion rxn
infection (test for TB before tx)
hematologic
malignancy
Crohn’s sxs exacerbated by?
Increases risk of?
smoking
NSAIDs
Colon CA
Ulcerative Colitis details?
Colon only (U) rectum
Mucosa surface only
Causes friability, erosions, bleeding
Ulcerative Colitis in rectum only called?
In rectosigmoid?
To but not beyond splenic flexure?
Beyond splenic flex but not into cecum?
Into cecum?
proctitis
proctosigmoiditis
left-sided colitis
extensive
pancolitis
Ulcerative Colitis intestinal presentation? (6)
Gradual sxs onset (U) intermit
Rectal bleeding Diarr (U) bloody/mucus and at night Crampy abd pain Tenesmus (rectal urgency) Constip if proctitis (P) anemia, fever
Ulcerative Colitis extra-intestinal presentation? (4)
Arthralgia/itis (U) large joints Erythem nodosum Episcleritis/iritis/uvitis Sclerosing cholangitis (inflamm of bile duct)
Ulcerative Colitis (P) exam findings? (3)
anemia
abd tenderness,
+ guaiac (blood present)
Ulcerative Colitis diagnostics?
same as Crohn’s
Ulcerative Colitis colonoscopy findings? (8)
No small bowel involvement No skip lesions Inflamm starts distal Loss of haustra Petechiae/exudate/friability Frank hemorr Crypt abscess Rarely see strictures
Ulcerative Colitis management? (5)
Base on severity/frequency
1) salicylates
2) immunosuppressants
3) Corticsteroids
4) TNF block
5) Surgery (if perf, hemorr, refractory)
Ulcerative Colitis complications? (2)
Sxs exacerbated by?
Increases risk of what?
Toxic Megacolon (dilated > 6cm w/ toxicity) Hemorr
NSAIDs
Colon CA
SUMMARY:
Differences of Crohn’s and Colitis
Crohns: Mouth to anus Transmural (U) terminal ileum Fistulas Skip lesions Smoking = worse sxs
Colitis: Colon only Mucosal surface (U) rectum Toxic megacolon Smoking = better sxs
Celiac Disease is?
NOT IBD
Immune d/o triggered by environment
Gluten toxic to sm intest
Celiac Disease: Gluten causes what rxns in sm intest?
Mucosal inflamm
Crypt hyperplasia
Villous atrophy
Celiac Disease: epidemiology?
A/W? (5)
Whites from N Europe
\+ Family Hx Autoimm dz DM I Thyroid dz Down's
Celiac Disease intestinal presentation?
Signs of malabsorption:
Diarr w/ bulky, smelly, steatorrhea
Gas/bloating
Celiac Disease non-intestinal findings?
Dermatitis herpetiformis (burn/itch pap/pust) Fe def anemia Osteopenia Vit B defic caused neruo disorders High LFT Weight loss Kids = failure to thrive
Celiac Disease diagnostics?
Must do while pt eating gluten
EGD sm bowel biopsy (test of choice) = villous atrophy
Celia dz panel: IgA anti’s (IgA levels must be N for test to be valid)
Celiac Disease tx?
avoid gluent
Celiac Disease complications?
Malabsorb issues (Fe def, B def, osteoporo)
(P) increase in malignancy
Celiac Disease AEIOU?
Anemia Elevated LFT Iron def Osteopenia Uncomfortable digestion
Erythema Nodosum is?
Inflamm of fatty layer of skin,
Painful nodules,
U on shins
