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Clin Med II - GI > IBD Dettmann > Flashcards

IBD Dettmann Flashcards

1
Q

When does ulcerative colitis usually begin?

A

Adolescence or young adulthood

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2
Q

What populations are MC affected by ulcerative colitis?

A
  • Whites
  • Jews of E. European descent
  • Genetics
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3
Q

What is the suspected pathogenesis of ulcerative colitis?

A

Primary immune mechanism

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4
Q

How does ulcerative colitis present?

A
  • Bloody diarrhea
  • Abdominal pain relieved by BM
  • Extracolonic manifestations (arthritis, uveitis, jaundice, skin lesions)
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5
Q

What portions of the GI tract does ulcerative colitis affect?

A

Almost always distal colon and rectum

starts distally

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6
Q

What is the disease course of ulcerative colitis?

A

Nearly 90% go into complete remission after first attack

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7
Q

Where does chronic ulcerative colitis manifest in the GI tract?

A

Limited to distal bowel

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8
Q

How are the mortality rates of ulcerative colitis compared to general population?

A

No different EXCEPT in extensive disease

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9
Q

What is considered “mild” ulcerative colitis?

A
  • Less than 4 BMs/day
  • Intermittent bleeding
  • NORMAL crit and ESR
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10
Q

What is considered “moderate” ulcerative colitis?

A
  • 4 to 6 BMs/day
  • Frequent bleeding
  • HCT drop and ESR 20-30 mm/h
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11
Q

What is considered “severe” ulcerative colitis?

A
  • 6+ BMs/day
  • HCT drop
  • Wt loss greater than 10%
  • ESR greater than 30 mm/h
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12
Q

Describe ulcerative proctitis

A
  • Variant of ulcerative colitis
  • Limited extent of inflammation
  • Good prognosis and lack of serious complications
  • Relapses are MC
  • Less than 15% progress to generalized UC
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13
Q

Are relapses MC in ulcerative colitis or proctitis?

A

Ulcerative proctitis

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14
Q

How does inflammation present in Crohn’s disease?

A

Discontinuous - diseased segments separated by normal bowel

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15
Q

What layers of the GI tract does ulcerative colitis affect?

A

Superficial only

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16
Q

What layers of the GI tract does Crohn’s disease affect?

A

May extend through ALL layers

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17
Q

What part of the GI tract is MC affected by Crohn’s?

A
  • Distal ileum
  • Right colon
  • But truly can happen anywhere along GI tract
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18
Q

When is the onset of Crohn’s?

A

20s through 40s

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19
Q

How does Crohn’s present?

A
  • Abdominal pain (SOMETIMES relieved by BM)
  • Diarrhea (MAY be bloody)
  • Extraintestinal findings
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20
Q

What does constipation in a known Crohn’s pt suggest?

A

Possible early obstruction (d/t inflammation causing strictures)

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21
Q

How is mild-moderate Crohn’s defined?

A
  • Wt loss less than 10%

- NO dehydration

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22
Q

How is moderate-severe Crohn’s defined?

A
  • Fever
  • Anemia
  • Wt loss 10+%
23
Q

How is severe Crohn’s defined?

A
  • Fever
  • Obstruction
  • Abscess
24
Q

How is ulcerative colitis definitively diagnosed?

A

Sigmoid/colonoscopy w/rectal biopsy

25
Q

Possible serology findings in diagnosing ulcerative colitis and Crohn’s?

A
  • High CRP, leuks, ESR, platelets

- Low Hgb and albumin

26
Q

How is Crohn’s definitively diagnosed?

A

Endoscopy w/biopsy

27
Q

What is the initial treatment of mild-moderate ulcerative colitis?

A

Sulfasalazine

-80% pt response

28
Q

What can Sulfasalazine be combined with for more severe cases of ulcerative colitis?

A

Steroids

29
Q

Describe 5-ASA

A
  • Treatment of ulcerative colitis
  • Can deliver without many side effects a/w sulfasalazine
  • More expensive than sulfasalazine
30
Q

Describe topical 5-ASA enemas

A
  • Another alternate to sulfasalazine
  • Good option for those w/distal colitis
  • Can be used for maintenance
  • Excellent safety profile
31
Q

When are steroids used for ulcerative colitis treatment?

A

Moderately severe to severe cases

32
Q

When are immunomodulator agents used in ulcerative colitis treatment?

A
  • For those who require chronic high dose steroid therapy or inadequate response to other drugs
  • Many side effects
  • Given as infusion
33
Q

How are opiates/opioids used in ulcerative colitis treatment?

A
  • Provide symptomatic relief of diarrhea
  • Very very severe disease
  • Watch for addiction!
34
Q

Surgical treatment of ulcerative colitis

A
  • Last resort!

- Total colectomy (complete cure)

35
Q

What are the indications for a UC patient to have total colectomy?

A
  • High grade dysplasia
  • Toxic megacolon
  • Hemorrhage
  • Obstruction
36
Q

Patients with IBD are at increased risk for:

A

Colorectal cancer

37
Q

Is UC or Crohn’s a bigger risk for colorectal cancer?

A

UC

38
Q

What is the best method of cancer screening in IBD pts?

A

Colonoscopy w/multiple biopsies

39
Q

When should pts w/pancolitis (more than one section of bowel - e.g. Crohn’s) be screened for cancer?

A

-Pancolitis for 7+ years
OR
-12 yrs after L sided colitis
-Every 2-3 yrs until 20 yr hx, then annually

40
Q

What should the diet of IBD patients be?

A
  • Adequate protein and calories
  • Reduce fiber content w/flare ups (high fiber in remissions)
  • Decrease fat intake
  • Restrict milk products
  • Partial bowel rest
  • Elemental diet preps
  • TPN
  • Vit supplements
41
Q

What is the initial treatment of Crohn’s disease?

A

Sulfasalazine

42
Q

What is the second step treatment of Crohn’s disease after sulfasalazine?

A

Metronidazole

  • Weight based dose
  • Can consider quinolones
43
Q

Define irritable bowel syndrome

A
  1. Altered BMs and pain
  2. Absence of structural abnormalities
  3. Diagnosis based on clinical presentation
44
Q

How is IBS diagnosed?

A

Using ROME criteria

45
Q

Describe the ROME criteria

A
  • Used to diagnose IBS
    1. ABD pain relieved w/BM AND
    2. 2 of the following:
  • Change in stool, difficulty passing stool, sense of incomplete evacuation, presence of mucus in stool
  • Must be at least 3 days/mo for 3 months
46
Q

What populations are affected by IBS?

A
  • Under 45 yo

- Females (80%)

47
Q

When do symptoms present in IBS?

A

Almost always during waking hours

48
Q

How to differentiate UC from IBS?

A
  • UC has symptoms during night

- IBS symptoms are almost ALWAYS during waking hours

49
Q

What is the MC pattern of bowel movements in IBS?

A

Constipation alternating w/diarrhea

50
Q

What happens w/too much constipation in IBS?

A

May become intractable and resistant to laxatives

51
Q

Why would shape of stool change in IBS patients?

A

GI spasm

52
Q

How do upper GI symptoms present in IBS?

A
  • Approx 25-50% pts
  • Dyspepsia, heartburn, N/V
  • Symptoms occur during waking hours
  • Exacerbated by food and stress
53
Q

When should an air contrast barium enema/colonoscopy be considered when working a pt up?

A

In pts over 40 being considered for IBS

54
Q

Treatments of IBS

A
  • Pt counseling/diet changes
  • Stool bulking agents/high fiber diets
  • Antispasmodics
  • Antidiarrheals
  • Antidepressants
  • Antiflatulence
  • GI motility enhancers

Clin Med II - GI (17 decks)

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