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IBD & IBS Flashcards

1
Q

Main Diseases of IBD

A

Crohn’s Disease

Ulcerative Colitis

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2
Q

Difference between Ulcerative Colitis & Crohn’s Disease

A

UC: mucosal colitis, recurring episodes

Crohn’s: transmural inflammation, skip lesions

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3
Q

Epidemiology of IBD

A

Males = females

Infrequent in countries with poor sanitation

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4
Q

Etiology Theories of IBD

A 
Infectious
Immunologic
Genetic
Dietary
Environmental
Vascular
Neuromotor
Allergic
Psychogenic
Autoimmune
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5
Q

Pathophysiology of IBD

A

Defect in function of intestinal lumen
Breakdown defense barrier
Results in chronic inflammatory process

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6
Q

Systemic Complications of IBD

A 
Aphthous stomatitis
Episcleritis & uveitis
Arthritis
Vascular complications
E. Nodosum
P. Gangrenosum
Gallstones
Malabsorption
Renal stone, fistulae, hydronephrosis, amyloidosis
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7
Q

Define Ulcerative Colitis

A

Involves mucosal surface of colon with the formation of crypt abscess

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8
Q

Where is the initial point of ulcerative colitis?

A

Rectum

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9
Q

Clinical Course of Ulcerative Colitis

A

Flare-ups

Remission

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10
Q

What can cause a flare-up in ulcerative colitis?

A

Stress
Lack of sleep
Illness

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11
Q

What is protective in the case of ulcerative colitis?

A

Smoking

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12
Q

Signs/Symptoms of Mild to Moderate Ulcerative Colitis

A

Bloody diarrhea
Lower abdominal cramps- relieved with defecation
Fecal urgency

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13
Q

Signs/Symptoms of Severe Ulcerative Colitis

A 
Rectal bleeding
LLQ cramps
Severe diarrhea
Low-grade fever
Anemia
Hypoalbuminemia
Hypovolemia
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14
Q

Systemic Associations of Ulcerative Colitis

A 
Peripheral arthritis
Central arthritis
Erythema nudism
Uveitis
Sclerosing cholangitis
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15
Q

Labs for Ulcerative Colitis

A

CBC: anemia, leukocytosis
ESR & CRP: elevated
CMP: electrolyte disturbances, decreased albumin, prolonged clotting time
pANCA: Perinuclear antineutrophil cytoplasmic antibodies

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16
Q

Mild Ulcerative Colitis

A

Stools:

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17
Q

Moderate Ulcerative Colitis

A 
Stools: 4-6/day
Pulse: 90-100
Hematocrit: 30-40
Weight loss: 1-10%
Temp: 99-100
ESR: 20-30
Albumin: 3-3.5
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18
Q

Severe Ulcerative Colitis

A 
Stools: >6/day (bloody)
Pulse: >100
Hematocrit: 10%
Temp: >100
ESR: >30
Albumin:
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19
Q

Diagnostics of Ulcerative Colitis

A

Bloody diarrhea
Plain abdominal X-rays
Sigmoidoscopy or colonoscopy
CT

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20
Q

Differential Diagnosis of Ulcerative Colitis

A 
Infectious colitis
CMV colitis
Rectal CA
 Crohn's
GI bleed
Mesenteric ischemia
Diverticulitis
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21
Q

Intestinal Complications of Ulcerative Colitis

A 
Bleeding
Toxic megacolon
Perforation
Benign stricture
Malgnant stricture
Colorectal CA
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22
Q

Treatment of Ulcerative Colitis

A 
Reduce fiber during exacerbation 
Folic acid supplements with sulfasalazine
Oral iron with bleeding
Frequent follow-up
Short course loperamide
Yearly colonoscopy
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23
Q

Treatment of Mild to Moderate Ulcerative Colitis

A

Sulfasalazine
Olsalazine
Mesalamine
+/- prednisone

24
Q

Treatment of Moderate to Severe Ulcerative Colitis

A

Sulfasalazine
Olsalazine
+/- prednisone

25
Q

Sulfasalazine

A

Mild anti-inflammatory compared to steroids
Azospermia
Severe depression in males

26
Q

Types of Sulfasalazine

A

Oral
Topical
Hydrocortisone (enema, suppositories, foam)

27
Q

Indications for Surgery in Ulcerative Colitis

A 
Exsanguinating hemorrhage
Toxicity/perforation
Suspected CA
Significant dysplasia
Growth retardation
Systemic complications
Intractability
28
Q

Define Crohn’s Disease

A

Transmural involvement with formation of fistulas, narrowing of lumen, obstruction

29
Q

Main Areas where Crohn’s is Located

A 
Ileocolitis
Ileitis
Colitis
Gastroduodenitis
Jejunoileitis
30
Q

What is smoking strongly associated with?

A

Development of Crohn’s
Resistance to medical therapy
Early disease relapse

31
Q

Clinical Manifestations of Crohn’s Disease

A 
Depends on site/severity
Insidious onset
Intermittent bouts of low-grade fever, diarrhea, & RLQ pain
Postprandial pain
RLQ mass
Perianal disease
Nocturnal BM's, sweats, weight loss
Skin lesions
Chronically ill: weight loss, pallor
32
Q

Children & Adolescent Clinical Manifestations of Crohn’s Disease

A 
Insidious onset
Weight loss
Failure to grow or develop secondary sex characteristics
Arthritis
Fever of unknown origin
33
Q

Distinguishing Features of Crohn’s Disease

A 
Small bowel involvement
Rectal sparing
25-30% without gross bleeding
Perianal disease
Focal lesions
Skip lesions
Asymmetric involvement
Fistulization
Granulomas
Endoscopic features
34
Q

PE Findings in Crohn’s Disease

A

Abdominal distention
Abnormal bowel sounds
Tenderness in involved area
Perianal abscess, fistula, skin tag, anal stricture

35
Q

Crohn’s Disease Labs

A

CBC: anemia, leukocytosis
ESR & CRP: elevated
B12, folate, & iron levels
CMP: electrolyte disturbances, decreased albumin, prolonged clotting time
ASCA: anti-saccharomyces cerevisiae antibody

36
Q

Radiography for Crohn’s Disease

A

Barium contrast studies

37
Q

What will you see on barium contrast studies?

A 
Cobble stoning
Skip lesions
Pseudodiverticula
Dilated bowel
Fistulas communicating to adjacent bowel/ mesentery/bladder/ vagina
38
Q

Treatment of Crohn’s Disease

A 
5-Aminosalicylic acid agents
Antibiotics: acute infections
Steroids: acute infections
Anti-TNF therapy (Infliximab)
Immunomodulating drugs
39
Q

Examples of 5-Aminosalicylic Acid Agents

A

Sulfasazine
Mesalamine
Pentasa

40
Q

Examples of Immunomodulating Drugs

A

Azathioprine
Mercaptopurine
Methotrexate

41
Q

Define IBS

A

Functional gastrointestinal disorder that is a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities

42
Q

Characteristics of IBS

A

Continuous or recurrent symptoms for at least 3 months of: abdominal pain or discomfort, pain relieved by defecations, pain with a change in frequency or form
And a varying pattern of defecation with 3 or more of the following: altered stool frequency, form, stool passage, abdominal dissension & bloating, passage of mucus

43
Q

Epidemiology of IBS

A

Females > males

Younger > older

44
Q

Associated symptoms of IBS

A 
Fatigue
Back ache
Early satiety
Nausea
Headache
Irritable bladder
Functional dyspepsia
45
Q

Rome II Criteria for IBS

A

Abdominal discomfort/pain with 2 of the follow 3 features for at least 12 weeks not necessarily consecutive: relief with defecation, onset associated with change in stool frequency or formation

46
Q

Manning Criteria for IBS

A

Pain relieved by defecation
More frequent stools associated with pain onset
Looser stools associated with onset of pain
Abdominal distention
Passage of mucus
Feeling of incomplete evacuation

47
Q

Important History for IBS

A 
Dietary habits
Travel history
Medication use
Recent gastro-enteritis
Recent food-born illness
Lactose intolerance
Gender, age
Family Hx
Night time defecation
48
Q

PE Findings of IBS

A 
Full findings
Won't have abdominal guarding
Rebound tenderness
Abdominal distension
EBM: no tests can be justified
49
Q

Labs for an IBS Work-up

A 
CBC
ESR
Serum electrolytes
Liver enzymes
Stool occult blood x3
Stool cultures x3
Stool O & P
UA
50
Q

Imagining for an IBS Work-up

A

Flex sigmoidoscopy
Upper GI series with small bowel follow through
Plain abdominal radiograph
Air contrast barium enema

51
Q

Warning Signs & Red Flags for IBS

A 
Any abnormality of PE
Anemia
Clinical/biochemical evidence of malnutrition
Family Hx of GI CA, IBD, or sprue
Fever
Hematochezia
Nocturnal symptoms
Symptoms >50
52
Q

Alarm Symptoms for IBS

A 
Constant abdominal pain
Constant diarrhea
Constant abdominal distension
Nocturnal disturbance
Passage of blood with stool
Weight loss
53
Q

Management of IBS

A

Make a positive diagnosis
Consider patients agenda
Make management classification
Plan a management strategy

54
Q

Make a Positive Diagnosis of IBS

A

Usually from Hx alone
Symptoms begin late teens to 20s
Pain intermittent & crampy
Pain doesn’t occur at night/interfere with sleep
Full PE
Normal Hgb & ESR
Sigmoidoscopy and/or barium enema may help to reassure

55
Q

Consider Patients Agenda for IBS

A

Complete H&P

56
Q

Make a Management Classification of the IBS Disease

A 
Bloating & pain predominant
Constipation predominant
Diarrhea predominant
Anxiety associated
Depression associated
57
Q

Plan a Management Strategy

A

Establish a therapeutic provider-patient relationship: focus symptom relief, shift responsibility to patient, commitment to patient well-being
Patient education: validate patient’s illness, set realistic goals, teach symptom monitoring, reassure benign nature of IBS, address psychosocial issues

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