IBD - Crohn's Flashcards
characterized by
transmural (across wall) inflammation and skip lesions
involves ANY part of GI tract (mouth to perianal area)
MC affected areas
Ileum and proximal colon (cecum and ascending)
s/s
insidious onset
intermittent diarrhea (NON bloody)
abdominal pain, colicky, per umbilical
+/- B12 deficient anemia
GI imaging (CT)
ulcerations, strictures, fibulas
small bowel follow thru shows
string sign
due to inflammation and structure
tx of mild-mod
5 ASA drugs
ABX
Corticosteroids (Budesonide)
steroid dependent = Mercaptourine, Azathioprine (if works, wean off, if not ANTI-TNF
mod-severe dz tx
methylprednisone/prednisone
maintain remission with immunomodulators or Anti-TNF tx
prednisone in tx
best in small bowel, naive pt, relapses or major symptoms
not effective in maintaining remission
should start 5-ASA at same time
surgical intervention in Crohn’s (intent +freq)
PALLATIVE (not curative)
50% req intervention
indications of surgery
abscess excessive bleeding refractory fistulas refractory dz recurrent obstruction perforation inability to thrive CA
complications
- abscess
- obstruction and fibrosis
- fistula
- perianal disease
- colon cancer
- hemorrhage
- malabsorption
- renal stones
fistula
between mesentery or across bowel walls
may be asymptomatic or req. surgical tx
colon cancer and IBD
INCREASED in both UC and IBD
MC in UC
CRC screening recommendation
UC 7-8yrs, colonoscopy req 1-2 yrs
low grade dysplasia = evaluation every 3-6 mo (if mass, consider colectomy)
extra intestinal manifestations
found in both UC and Crohn’s
occur at any point
- inflammatory arthritis
- sacroillitis
- uveitis
- erythema nodosum
- pyoderma gangrenous
- sclerosinG colangitis (UC)
- thromboembolic
- hemolytic anemia
