IBS Flashcards
two main types of Inflammatory bowel disease
Ulcerative colitis (UC) and Crohn’s disease (CD)
Ulcerative colitis vs Crohns’ disease
ulcerative colitis: continuous inflammation of the colon and rectum
Crohns disease: patchy inflammation everywhere in the GI tract
Ulcerative colitis and Crohns’ disease both cause alterations of
Alterations of epithelial barrier functions
Altered immune reactions to intestinal flora
ulcerative colitis diagnosis
gold standard: colonoscopy with biopsy
ulcerative colitis symptoms
Diarrhea (10 to 20/day) *
Urgency
* Bloody stools
* Cramping
treatment of ulcerative colitis
Mild to moderate disease treated with 5 aminosalicyclate therapy followed by steroids
Thioprine and immunomodulatory agents, or TNF-blocking agents or vedolizumab used for serious disease
surgery for severe diseae
Crohn’s disease manifestations
Causes “skip lesions”
One side of the intestinal wall may be affected and not the other
Ulcerations can produce fissures that extend into the lymphoid tissue
Symptoms similar to ulcerative colitis
Anemia may result from malabsorption of vitamin B12 and folic acid
Treatment similar to ulcerative colitis
Crohn’s disease risk factors
Smoking,
higher socioeconomic status,
family history
Crohn’s disease more common in ___ gender
age
Incidence increasing in young females.
* Onset before 30 yrs, second peak age 60
Crohn’s disease symptoms
Abd pain, wt loss, diarrhea, bld in stool, perianal lesions, fever.
* Intermittent, crampy/steady RLQ or periumbilical pain precedes and partially relieved by a BM.
* More diffuse abd pain with mucus, blood, and pus in the stool for colonic Crohn’s.
diagnostics tests for Crohn’s disease
Lab panels
* CBC -anemia of chronic disease or iron deficiency
* ESR & CRP – elevated but not specific
* Nutritional markers related to poor absorption – B12, folate, albumin
* Stool: Ova & parasites, clostridium difficile – R/O
* Colonoscopy with biopsy is definitive diagnostic study
* Barium studies if required
treatment of Crohn’s disease
Referral to gastroenterology
* Symptom control – antidiarrheals, antispasmotics, PPIs
* Mucosal healing: Step wise therapies
* Aminosalicylates (salicylates,mesalamine)
* Corticosteroids (prednisone10–60mgdaily)
* Immune modifying agents (methotrexate) Biological therapies – Anti-TNF therapies (infliximab)
* Surgery may be necessary
* Education – increased risk of colorectal malignancies, extra- intestinal manifestations (arthralgias, ocular symptoms – uveitis, liver disease, thromboembolic events), support groups
Aminosalicylates
compounds that contain 5-aminosalicylicacid (5-ASA) and reduce inflammation in the lining of the intestine
Generally considered safe in pregnancy and breastfeeding
can cause kidney diseases, renal function should be checked
Irritable Bowel Syndrome (IBS) more common in
females
Rome III Diagnostic Criteria for IBS
(at least 3 days per month in the last 3 months associated with 2 or more of the following)
1 Improvement with defecation
2 Onset associated with change in frequency of stool
3 Onset associated with change in form (appearance) of stool
4 Onset of symptoms more than 6 before diagnosis
symptoms and treatment of IBS
Manifestations
Lower abdominal pain or discomfort and bloating
Symptoms are usually relieved with defecation and do not interfere with sleep
No cure, and treatment is individualized
