IBD, Diverticulitis Tieman CIS Flashcards
Differences between Crohn’s and Ulcerative Colitis
lower GI cramping, tenesmus, bloody/ mucousy stools more typical of ulcerative colitis. Starts in rectum and moves proximally. Usually found in the 20s and 30s. small ulcerated regions surrounded by inflammation, continuous, sometimes with pseudopolyps Superficial, ulcers, exudate.
Crohn’s- (midgut/ small intestine) - usually in distal ileum. abdominal pain, crampy, weight loss over time, sometimes associated with diarrhea. Found anywhere from throat to anus. Bimodal age distribution. Skip lesions (cobblestoning). Histology: transmural, usually granulomas. Fistulae. Creeping Fat.
IBD epidemiology
disease of developed countries.
UC slightly more prevalent than Crohn’s Disease. Both distributed pretty equally between men and women
positive family history of UC or Crohn’s
means higher risk of either one
aphthous ulcers associated with
Crohn’s
erythema nodosum and pyoderma nodosum
both associated with Crohn’s
more common area to find Crohn’s
terminal ileum
what does CRP indicate?
C-reactive protein indicates some inflammation
ASCA is what?
an antibody to yeast
IgA and IgG elevated, ASCA up, CRP up, normal pANCA means what?
90% chance of Crohn’s disease
hyperemia of ascending colon means what?
inflammation of the terminal ileum would cause this because it lives right next door.
how do we treat acute episode of Crohn’s?
bowel rest, IV corticosteroids
for outpatient– could use oral prednisone, or 5ASA (a topical anti-inflammatory)
biologics: anti-TNF drugs
CT ENTEROGRAPHY on our Crohn’s disease patient
Three areas of thickened bowel wall, hyperemia and prominence of the vasa recti in the distal ileum. These areas show narrowing of the bowel lumen with areas of dilatation between each area of narrowing. Suggestive of moderately severe active Crohn’s Disease. No fistulae or abscesses are identified.
Surgery is a last resort; tends to come back.
ESR, CRP elevated, p-ANCA elevated
more like ulcerative colitis
arthralgias
go along with IBD of either kind
Endoscopy of ulcerative colitis patient
Proctosigmoidoscopy: Edematous, friable mucosa in rectal vault extending continuously into the proximal left colon beyond the level of the scope
Colonoscopy: Edematous, friable mucosa which bleeds when touched. Scattered polypoid formations. This pattern extends beyond the splenic flexure into the distal transverse colon. Beyond that point the colon is normal. Polyps removed and numerous random biopsies taken throughout the diseased areas.
toxic megacolon
ulcerative colitis patients are prone to it; be very careful when sticking stuff up their butts (-scopy)
biopsy in ulcerative colitis
elongated mucosa, inflammation
treatment modalities for ulcerative colitis
5ASA products via suppository or enema, rectal preparation of prednisone, Budesonid MMX for induction
more severe case- deliver drugs intravenously or steroids that are not released until you get to the colon
Immunomodulator
Anti-TNF therapy
Infliximab, adalimumab or golimumab, vedolizumab, cyclosporine for induction
Disease refractory to medical therapy, colonic dysplasia or cancer: Proctocolectomy
associated disease with ulcerative colitis
primary sclerosing cholangitis
what age group does volvulus usually happen in?
80s, 90s- nursing home, stool backing up, flips on mesentery
dirty fat on radiography
edema and fat, signifies sigmoid diverticulitis
treat with bowel rest, IV fluids, IV imipenem
then good to follow up with colonoscopy
when do we start doing yearly colonoscopies on U/C patients?
after 8 years or maybe earlier due to the risk of colon cancer.
feeling of fullness in buttock suggests what?
rectal fistula
can arise from Crohn’s disease
Good-Sol’s line is from 3-9 o’clock across anus in supine position. If fistula is anterior to that line, it’s likely a direct fistula; posterior is much more likely to be complex.
If direct, a probe and fistulotomy will do the trick and heal it. (won’t damage anal sphincter and cause incontinence)
posterior can be all complex and just trying to open it up would –> cut sphincter, incontinence (treat with setons– heavy sutures to tighten down slowly over time)
fistulae with Crohn’s disease, how to treat?
don’t operate!
Use an anti-metabolite.
anal fissures don’t heal because why?
constant trauma of bowel movements PLUS spasm of the internal sphincter (autonomic control; pain –> involuntary contraction, increased pressures)
trick with these– treat internal sphincter
Sitz baths, etc.
If they come back no better, do surgery– lateral internal sphincterotomy (stretch out the anal canal, make a little incision at 3 or 9 o’clock). Incidence of incontinence is almost zero.
4 grades of internal hemorrhoids
1- do not prolapse
2- prolapse and go back in spontaneously
3- prolapse and must be manually reduced
4- prolapse and don’t go in no matter what you do
internal tend to bleed. can usually treat with rubber bands.
external cause pain
