IBD Dettmann Flashcards
When does ulcerative colitis usually begin?
Adolescence or young adulthood
What populations are MC affected by ulcerative colitis?
- Whites
- Jews of E. European descent
- Genetics
What is the suspected pathogenesis of ulcerative colitis?
Primary immune mechanism
How does ulcerative colitis present?
- Bloody diarrhea
- Abdominal pain relieved by BM
- Extracolonic manifestations (arthritis, uveitis, jaundice, skin lesions)
What portions of the GI tract does ulcerative colitis affect?
Almost always distal colon and rectum
starts distally
What is the disease course of ulcerative colitis?
Nearly 90% go into complete remission after first attack
Where does chronic ulcerative colitis manifest in the GI tract?
Limited to distal bowel
How are the mortality rates of ulcerative colitis compared to general population?
No different EXCEPT in extensive disease
What is considered “mild” ulcerative colitis?
- Less than 4 BMs/day
- Intermittent bleeding
- NORMAL crit and ESR
What is considered “moderate” ulcerative colitis?
- 4 to 6 BMs/day
- Frequent bleeding
- HCT drop and ESR 20-30 mm/h
What is considered “severe” ulcerative colitis?
- 6+ BMs/day
- HCT drop
- Wt loss greater than 10%
- ESR greater than 30 mm/h
Describe ulcerative proctitis
- 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
Are relapses MC in ulcerative colitis or proctitis?
Ulcerative proctitis
How does inflammation present in Crohn’s disease?
Discontinuous - diseased segments separated by normal bowel
What layers of the GI tract does ulcerative colitis affect?
Superficial only
What layers of the GI tract does Crohn’s disease affect?
May extend through ALL layers
What part of the GI tract is MC affected by Crohn’s?
- Distal ileum
- Right colon
- But truly can happen anywhere along GI tract
When is the onset of Crohn’s?
20s through 40s
How does Crohn’s present?
- Abdominal pain (SOMETIMES relieved by BM)
- Diarrhea (MAY be bloody)
- Extraintestinal findings
What does constipation in a known Crohn’s pt suggest?
Possible early obstruction (d/t inflammation causing strictures)
How is mild-moderate Crohn’s defined?
- Wt loss less than 10%
- NO dehydration
How is moderate-severe Crohn’s defined?
- Fever
- Anemia
- Wt loss 10+%
How is severe Crohn’s defined?
- Fever
- Obstruction
- Abscess
How is ulcerative colitis definitively diagnosed?
Sigmoid/colonoscopy w/rectal biopsy
Possible serology findings in diagnosing ulcerative colitis and Crohn’s?
- High CRP, leuks, ESR, platelets
- Low Hgb and albumin
How is Crohn’s definitively diagnosed?
Endoscopy w/biopsy
What is the initial treatment of mild-moderate ulcerative colitis?
Sulfasalazine
-80% pt response
What can Sulfasalazine be combined with for more severe cases of ulcerative colitis?
Steroids
Describe 5-ASA
- Treatment of ulcerative colitis
- Can deliver without many side effects a/w sulfasalazine
- More expensive than sulfasalazine
Describe topical 5-ASA enemas
- Another alternate to sulfasalazine
- Good option for those w/distal colitis
- Can be used for maintenance
- Excellent safety profile
When are steroids used for ulcerative colitis treatment?
Moderately severe to severe cases
When are immunomodulator agents used in ulcerative colitis treatment?
- For those who require chronic high dose steroid therapy or inadequate response to other drugs
- Many side effects
- Given as infusion
How are opiates/opioids used in ulcerative colitis treatment?
- Provide symptomatic relief of diarrhea
- Very very severe disease
- Watch for addiction!
Surgical treatment of ulcerative colitis
- Last resort!
- Total colectomy (complete cure)
What are the indications for a UC patient to have total colectomy?
- High grade dysplasia
- Toxic megacolon
- Hemorrhage
- Obstruction
Patients with IBD are at increased risk for:
Colorectal cancer
Is UC or Crohn’s a bigger risk for colorectal cancer?
UC
What is the best method of cancer screening in IBD pts?
Colonoscopy w/multiple biopsies
When should pts w/pancolitis (more than one section of bowel - e.g. Crohn’s) be screened for cancer?
-Pancolitis for 7+ years
OR
-12 yrs after L sided colitis
-Every 2-3 yrs until 20 yr hx, then annually
What should the diet of IBD patients be?
- 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
What is the initial treatment of Crohn’s disease?
Sulfasalazine
What is the second step treatment of Crohn’s disease after sulfasalazine?
Metronidazole
- Weight based dose
- Can consider quinolones
Define irritable bowel syndrome
- Altered BMs and pain
- Absence of structural abnormalities
- Diagnosis based on clinical presentation
How is IBS diagnosed?
Using ROME criteria
Describe the ROME criteria
- 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
What populations are affected by IBS?
- Under 45 yo
- Females (80%)
When do symptoms present in IBS?
Almost always during waking hours
How to differentiate UC from IBS?
- UC has symptoms during night
- IBS symptoms are almost ALWAYS during waking hours
What is the MC pattern of bowel movements in IBS?
Constipation alternating w/diarrhea
What happens w/too much constipation in IBS?
May become intractable and resistant to laxatives
Why would shape of stool change in IBS patients?
GI spasm
How do upper GI symptoms present in IBS?
- Approx 25-50% pts
- Dyspepsia, heartburn, N/V
- Symptoms occur during waking hours
- Exacerbated by food and stress
When should an air contrast barium enema/colonoscopy be considered when working a pt up?
In pts over 40 being considered for IBS
Treatments of IBS
- Pt counseling/diet changes
- Stool bulking agents/high fiber diets
- Antispasmodics
- Antidiarrheals
- Antidepressants
- Antiflatulence
- GI motility enhancers
