IBD popcorn Flashcards
Smoking ↑ risk
Crohn’s Disease
Smoking ↓ risk
Ulcerative Colitis
Condition?
- Mouth –> Anus
- Transmural
- Causes fistulas
- MC site : Distal Ileum
- 1/3 w/ perianal dz (fistula/fissure/abscess)
- Aphthous ulcer
Crohn’s
Condition?
- Chronic, int, NOCTURNAL NON-bloody diarrhea
- “Colicky” RLQ pain / mass
Crohn’s
Condition?
- Skip lesions
- Rectal sparing!!
- “string sign” on small bowel follow thru
1st line Tx?
Crohn’s
1st line Tx:
- Step up (5-ASA- Salicylates) = Mesalamine or Sulfalazine
- Immunomodulator= Azathioprine
- Bio/TNF blockers = Infliximab, Adalimumab
Tx for Flares of Crohn’s?
Corticosteroids
- Budesonide (less systemic effects)
- Prednisone (oral = systemic effects)
- SLOW taper!! Avoid dependence
Antibiotics
- Cipro + Metro
- Cipro: tendinitis, photosens, QT prolong
- Metro: Disulfuram rxn (avoid ETOH), metallic taste
Condition?
- Colon only
- Rectum almost always
- Mucosal surface of colon
- Proctitis (rectum) is MC site!
UC
Condition?
- Rectal bleeding
- BLOODY/MUCOUS NOCTURNAL diarrhea
- “crampy” abd pain
- Tenesmus (rectal urgency)
- Anemia if dz is severe
UC
Condition?
- ↑ ESR & CRP if dz active
- Colonoscopy (choice dx study)
-
Complications:
- Pyoderma Gangrenosum
- Nutrient deficiency (Fe, B12)
Crohn’s
Condition?
-
On flex sig / colonoscopy
- inflammation distal –> proximal
- Continous involvement
- Loss of haustral folds
- Petechia, exudate, friability
UC
Complications of which dz?
- Hemorrhage
- TOXIC MEGACOLON (very serious)
- colonic dilation >6cm
UC
Tx for UC?
Step up therapy
- 1st line: 5-ASA-Salicylate (Mesalamine/Sulfalazine)
- Immunomodulators (6MP, Azathioprine)
- TNF blocker (Remicade)
Tx for flares of UC?
Corticosteroids
- Budesonide: less systemic SE. Used for ileal or Right sided colonic dz
- Prednisone: oral. Systemic SE (osteoporosis, insomnia, weight gain, psychosis)
- (SLOW taper!!) & avoid dependence
What is the surgery for UC?
What are 3 indications for this surgery?
Complete Proctolectomy
- Perforation / Severe hemorrhage
- Dysplasia / Cancer
- Refractory dz to medical management
What are the 6 RED FLAGS of IBD (Crohn’s & UC)
- Anemia from severe bleeding
- Peritoneal signs (Severe abd pain)
- Weight loss d/t not tolerating POs
- Dehydration (↑ creatinine, tachycardia, hypotension)
- Obstruction
- Failure of therapy
PAWD-OF
Condition?
- Gluten toxic to small intestine
- Exposure –> mucosal inflammation, crypt hyperplasia, villous atrophy
- White Northern Europeans
Celiac
Complications of Celiac?
- Fe deficiency anemia
- B vitamin deficiency
- Osteoporosis
- Slight incr. risk of malignancy (Non-hodgkin’s lymphoma or GI)
Celiac associated with what 4 things?
Previously dz of infants, now what age group?
- Autoimmune
- DM 1
- Thyroid dz
- Trisomy 21/Down’s
- 10 - 40 yrs
Condition?
- Diarrhea, bloating, flatulance
- Dermatitis herpetiformis
- Lactose intolerant
- Neuro disorders from B vit deficiency
- FTT (children)
Tx?
Celiac
Tx: avoid gluten, supplement PRN
GOLD STANDARD dx for Celiac?
Small bowel biopsy (via EGD) –> will show villous atrophy
MUST be done while pt eating gluten
Serologic Blood Testing for Celiac
- What level must be NORMAL for test to be valid?
- 3 other diagnostic findings?
IgA must be normal
- Fe deficiency anemia
- Osteopenia
- Elevated LFTs
What is seen on PE of Celiac dz?
Dermatitis Herpetiformis
Close-up of dermatitis herpetiformis lesions. Dermatitis herpetiformis is a chronic inflammatory disease that produces lesions that burn and itch intensely. The lesions are erythematous and may be slightly papular, form small pustules, or there may be vesicles.
