IBS Flashcards
Chronic state of physiologic inflammation ready to be activated, and dampened by tissue repair and immune modulation
Inflammatory bowel disease
Inflammatory response id activated by?
T-cell activation
Diarrhea, rectal bleeding, tenesmus, passage of mucus, fever
Ulcerative colitis
Collar-button ulcers
Ulcerative colitis
Most feared complication of ulcerative colitis
Perforation / Toxic megacolon
Transverse colon >5 - 6cm
Toxic megacolon
Mucosal disease that usually involves the RECTUM and extends to ALL or PART of colon
Ulcerative colitis
Rectal sparing
Crohn’s disease
Major symptoms of ulcerative colitis
Diarrhea, rectal bleeding, tenesmus, passage of mucus, crampy abdominal pain
Physical signs of proctitis
DRE: tender anal canal and blood
Abdominal exam: direct tenderness on palpation over colon; hepatic tympany with magacolon; signs of peritonitis
Long-standing disease
Presence of inflammatory polyps (pseudopolyps)
Atrophic featureless mucosa with narrowed and shortened colon
Remission
Fulminant disease
Toxic colitis or megacolon perforation
Two major histologic features suggesting chronicity
Distortion of colon crypt architecture
Basal plasma cells and multiple basal lymphoid aggregates
Villous atrophy and crypt regeneration with increase inflammation
Backwash ileitis
Any part of the mouth to colon, rectum is spared and segmental; stricture and fibrosis
Crohn’s disease
Granulomas, transmural inflammation, subserosal and submucosal lymphoid aggregates
Cobblestoning
Crohn’s disease
Crypt abscess
Ulcerative colitis
Dermatologic extraintestinal manifestations of IBD
Erythema nodosum Pyoderma gangrenosum Pyoderma vegetans Pyostomatitis vegetans Sweet’s syndrome
Rheumatologic
Arthritis
Ankylosing spondylitis
Sacroiliitis
Ocular
Conjuntivitis
Uveitis
Conjunctivitis Uveitis Arthritis Urethritis Sacroiliitis
Reiter’s syndrome
Gross blood and mucus
ANCA +
Ulcerative colitis
Sysytemic symptoms, painful, fistula
ASCA +
Recurrence after surgery
Crohn’s disease
Highly sensitive and specific marker for intestinal inflammation
Fecal lactoferrin
Histologic inflammation
Predict relapses
Detect pouchitis
Fecal calprotectin
Used to assess disease activity and is performed before treatment
Sigmoidoscopy
Assess disease extent and activity
Colonoscopy
Earliest radiologic change of ulcerative colitis seen on single-contrast barium enema
Fine mucusal granularity
Deep ulcerations which indicate ulceration has penetrated mucosa
Collar button lesions
Massive hemorrhage
Treat disease or do colectomy if pt requires 6-8 units of blood within 24-48 H
Transverse or right colon with diameter of >6 cm with loss of haustration
Toxic megacolon
Most dangerous complication
Perforation
Presumed malignant until proven otherwise when impassable with colonoscope
Strictures
Mainstay tx mild-mod UC and Crohn’s
Sulfasalazine
