IBD/Crohn/Colitis

Question 1

How does smoking affect risk of getting Crohn’s and Colitis?

Answer 1

Smoking ↑ risk of Crohn’s

Smoking ↓ risk of Colitis

Question 2

IBD more C in what people?

Answer 2

Jewish

Question 3

Crohn’s details?

Answer 3

Can affect entire GI tract (mouth to anus)
Most C in distal ileum
Transmural (entire thickness of mucosa)
Causes ulcers, strictures, fistuals, abscesses

Question 4

Crohn’s in ileum only called?

In terminal ileum and prox ascending colon called?

In colon?

Answer 4

ileitis

Ileocolitis

Crohn’s colitis

Question 5

Crohn’s intestinal presentation? (5)

Answer 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

Question 6

Crohn’s extra-intestinal presentation? (6)

Answer 6

Arthralgia/itis (U) large joints
Aphthous (mouth) ulcers
Erythem nodosum
Episcleritis/iritis/uvitis
Gallstones
Sclerosing cholangitis (inflamm of bile duct)

Question 7

Crohn’s rectal exam (P) results? (3)

Answer 7

skin tags, abscess, fistual

Question 8

Crohn’s DDX?

Answer 8

Infection (c diff, salmonella, e coli, etc)
Ulcerative colitis
Colon CA
IBS
Diverticulitis
Lactose intolerance
Celiac
Lymphoma
Endometriosis
Ischemia

Question 9

Crohn’s diagnostics?

Answer 9

Colonoscopy (test of choice)
CT w/ contrast of abd/pelvis
ESR/CRP (high)
IBD Ab’s

Question 10

Crohn’s colonoscopy findings? (3)

Answer 10

Skip lesions (area w/o dz)
Cobblestone mucosa
(P) abscess, strictures, fistulas

Question 11

Crohn’s management? (7)

Answer 11

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)

Question 12

Crohn’s mgmt: Salicylate meds?

S/E?

Answer 12

sulfasalazine w/ folic acid
mesalamine

nephrotox, GI upset

Question 13

Crohn’s mgmt: Immunosupp meds?

S/E?

Answer 13

(2nd step)
Mercaptopurine, Imuran

(closely monitor)
pancreatitis, hepatotox, leukopenia, infection
(if get pancreatitis, NEVER use these meds again)

Question 14

Crohn’s mgmt: Abx meds?

Use when?

Answer 14

Cipro, Metronidazole

Acute flair of sxs

Question 15

Crohn’s mgmt: Corticosteroid meds?

Used when?

Answer 15

Budesonide, prednisone

Acute flair

Question 16

Crohn’s mgmt: Tumor Necrosis Factor (TNF) blocker meds?

Used?

S/E?

Answer 16

(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

Question 17

Crohn’s sxs exacerbated by?

Increases risk of?

Answer 17

smoking
NSAIDs

Colon CA

Question 18

Ulcerative Colitis details?

Answer 18

Colon only (U) rectum
Mucosa surface only
Causes friability, erosions, bleeding

Question 19

Ulcerative Colitis in rectum only called?

In rectosigmoid?

To but not beyond splenic flexure?

Beyond splenic flex but not into cecum?

Into cecum?

Answer 19

proctitis

proctosigmoiditis

left-sided colitis

extensive

pancolitis

Question 20

Ulcerative Colitis intestinal presentation? (6)

Answer 20

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

Question 21

Ulcerative Colitis extra-intestinal presentation? (4)

Answer 21

Arthralgia/itis (U) large joints
Erythem nodosum
Episcleritis/iritis/uvitis
Sclerosing cholangitis (inflamm of bile duct)

Question 22

Ulcerative Colitis (P) exam findings? (3)

Answer 22

anemia
abd tenderness,
+ guaiac (blood present)

Question 23

Ulcerative Colitis diagnostics?

Answer 23

same as Crohn’s

Question 24

Ulcerative Colitis colonoscopy findings? (8)

Answer 24

No small bowel involvement
No skip lesions
Inflamm starts distal
Loss of haustra
Petechiae/exudate/friability
Frank hemorr
Crypt abscess
Rarely see strictures

Question 25

Ulcerative Colitis management? (5)

Answer 25

Base on severity/frequency 1) salicylates 2) immunosuppressants 3) Corticsteroids 4) TNF block 5) Surgery (if perf, hemorr, refractory)

Question 26

Ulcerative Colitis complications? (2) Sxs exacerbated by? Increases risk of what?

Answer 26

``` Toxic Megacolon (dilated > 6cm w/ toxicity) Hemorr ``` NSAIDs Colon CA

Question 27

SUMMARY: | Differences of Crohn's and Colitis

Answer 27

``` 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 ```

Question 28

Celiac Disease is?

Answer 28

NOT IBD Immune d/o triggered by environment Gluten toxic to sm intest

Question 29

Celiac Disease: Gluten causes what rxns in sm intest?

Answer 29

Mucosal inflamm Crypt hyperplasia Villous atrophy

Question 30

Celiac Disease: epidemiology? A/W? (5)

Answer 30

Whites from N Europe ``` + Family Hx Autoimm dz DM I Thyroid dz Down's ```

Question 31

Celiac Disease intestinal presentation?

Answer 31

Signs of malabsorption: Diarr w/ bulky, smelly, steatorrhea Gas/bloating

Question 32

Celiac Disease non-intestinal findings?

Answer 32

``` Dermatitis herpetiformis (burn/itch pap/pust) Fe def anemia Osteopenia Vit B defic caused neruo disorders High LFT Weight loss Kids = failure to thrive ```

Question 33

Celiac Disease diagnostics?

Answer 33

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)

Question 34

Celiac Disease tx?

Answer 34

avoid gluent

Question 35

Celiac Disease complications?

Answer 35

Malabsorb issues (Fe def, B def, osteoporo) (P) increase in malignancy

Question 36

Celiac Disease AEIOU?

Answer 36

``` Anemia Elevated LFT Iron def Osteopenia Uncomfortable digestion ```

Question 37

Erythema Nodosum is?

Answer 37

Inflamm of fatty layer of skin, Painful nodules, U on shins