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Gen Med: GI > IBS > Flashcards

IBS Flashcards

1
Q

Define IBD

A
  1. Autoimmune disease of the gastrointestinal (GI) tract characterized by
    A. Mucosal inflammation
    B. Recurrent diarrhea & abdominal pain
  2. Chronic & relapsing
  3. Idiopathic
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2
Q

What is ulcerative colitis?

A
  1. Affects colon & rectum
  2. Diffuse mucosal inflammation
  3. Involves the rectum ≈ 95% of cases
  4. Extends proximally in continuous pattern
  5. Rarely involves anus
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3
Q

What is crohn’s dz?

A
  1. Can involve any part of GI tract (mouth to anus)
  2. Transmural inflammation
  3. Most commonly affects ileum & proximal colon, extends distally
  4. Interrupted or “skip lesions”
  5. Perianal involvement
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4
Q

What asst. comorbidities may be present with IBD?

A
  1. Gallstones
  2. Malnutrition
  3. UTI
  4. Kidney stones
  5. Amyloidosis
  6. Arthritis
  7. Uveitis
  8. Episcleritis
  9. Aphthous stomatitis
  10. Erythema nodosum
  11. Pyoderma gangrenosum
    A. (red-blue pus containing sores)
  12. Ankylosing spondylitis
  13. Sacroiliitis
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5
Q

What are the ddx for IBD?

A
  1. IBS

2. Celiac dz

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6
Q

What is IBS?

A
  1. GI syndrome characterized by chronic abdominal pain & altered bowel habits w/out organic cause
  2. NOT associated w/ inflammation
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7
Q

What is celiac dz?

A
  1. Small-bowel disorder characterized by mucosal inflammation, villous atrophy & crypt hyperplasia
  2. Sx’s occur w/ingestion of dietary gluten
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8
Q

What is the etiology of Crohn’s dz?

A
  1. Idiopathic
  2. Disruption of immune homeostasis of intestine
    → overreacts to environmental, dietary, infectious agents
  3. Hereditary predisposition
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9
Q

What is the pathogenesis of crohn’s dz?

A
  1. Edema w/ linear ulcerations of mucosal surface
    A. “Cobblestoning”
  2. Noncaseating granulomas - pathognomonic
  3. Hypercoagulable state
    A. Stroke, retinal thrombus, DVT, PE
  4. Extra-intestinal manifestations
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10
Q

What are ppl with crohn’s dz at risk for?

A
  1. Scarring
  2. Obstruction
  3. Penetrating ulcers
  4. Abscesses
  5. Fistulas
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11
Q

What are the sxs of crohn’s dz?

A
  1. Chronic diarrhea
  2. (+) blood if Crohn’s colitis
  3. Crampy abdominal pain
  4. Fever
  5. Anorexia
  6. Wt loss
  7. Fatigue
  8. Anemia
  9. Sx’s wax & wane
    A. “Flares” mild/brief → severe/prolonged
  10. N/V w/ partial or complete bowel obstruction
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12
Q

What are the ddx for crohn’s dz?

A
  1. Appendicitis
  2. Diverticulitis
  3. IBS
  4. UC
  5. Bacterial/viral gastroenteritis
  6. Food poisoning
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13
Q

What are the dx studies for crohn’s dz?

A
  1. Stool guaiac
  2. CBC w/ diff
    A. Microcytic/hypochromic
  3. B12, Fe, TIBC, folate
    A. ↓ Iron
    B. ↓ B12
  4. Stool for WBC, O&P, C. diff, Cx
  5. ↑ ESR
  6. ↑ CRP
  7. CMP
    A. ↓ Albumin
  8. (+) ANCA (Anti-Saccharomyces CerevisiaeAb)
  9. (-) pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Ab)
  10. KUB
    A. Air-fluid levels (obstruction), pneumoperitoneum (perforation)
  11. CT abdomen/pelvis (procedure of choice)
    A. Dx Crohn’s (“string sign” in terminal ileum) & manage abscesses
    B. Wall thickening, abscess
  12. Barium enema
    A. Fistula, inflammation, skip lesions
  13. UGI w/SBFT
    A. Inflammation, stricture
  14. Colonoscopy
    A. Evaluate severity, location, tissue Bx
  15. Upper endoscopy
    A. Upper GI evaluation
  16. MRI
    A. Routine assessment of pelvis fistulae & sinus tracks
  17. Capsule enteroscopy
    A. Swallow encapsulated video camera w/ specific indications
    B. Avoid w/ known strictures, fistulas
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14
Q

What is string sign?

A
  1. Seen on CT w/contrast or UGI w/SBFT
  2. Narrowing & stricturing in terminal ileum
  3. Seen in Crohn’s dz
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15
Q

What is the Step 1 management in Crohn’s dz?

A
  1. Acute/maintenance

2. Aminosalicylates – Asacol/Lialda/Pentasa/Rowasa/Apriso (mesalamine), Azulfidine (sulfasalazine) PR

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16
Q

What is the Step 1-A management in Crohn’s dz?

A
  1. Antibiotics – Metronidazole (Flagyl) or Ciprofloxacin (Cipro) prn fistula/abscess as seen on CT or MRI
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17
Q

What is the Step II management in Crohn’s dz?

A
  1. Corticosteroid – Solu-Medrol/Cortef IV, Prednisone PO, Cortenema (Hz) enema PR,
  2. Entocort EC (budesonide) PO or PR prn exacerbation
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18
Q

What is the Step III management in Crohn’s dz?

A
  1. Immune modifiers – Imuran (azathioprine), methotrexate, cyclosporine
  2. Use if difficult to maintain remission w/ aminosalicylates alone
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19
Q

What is the Step III-A management in Crohn’s dz?

A

TNF inhibitors – Remicade (infliximab), Humira (adalimumab)

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20
Q

What are the meds for symptomatic treatment of crohn’s dz?

A
  1. Antidiarrheal agents – Lomotil, Imodium
  2. Bile sequestrants – Questran
  3. Antispasmodics – Bentyl, Levbid
  4. Acid suppressants – H2 blockers, PPI’s
  5. Parenteral nutrition if severe
21
Q

When are crohn’s pts hospitalized?

A
  1. Failed OP Tx
  2. Dehydration
  3. Uncontrolled diarrhea/pain
22
Q

When should a specialty consultation be ordered for a crohn’s dz pt?

A
  1. Extra-intestinal manifestations

2. Surgical indications

23
Q

When is surgery indicated for crohn’s pts?

A
  1. Not curative - high recurrence
  2. Mostly for complications (strictures, fistulas, bleeding, abscess, dysplasia/CA)
    A. CT percutaneous abscess drainage has shown great success w/↓ rate of recurrence, as compared to surgery
24
Q

What are the surgical options for crohn’s dz pts?

A
  1. Segmental resection w/ re-anastomosis
  2. Stricturoplasty
  3. Diverting ileostomy/colostomy (severe perianal disease allowing healing for 6-12 mo)
  4. Fistula resection
  5. Perirectal abscess drainage
25
Q

What are surgical emergencies in crohn’s pts?

A
  1. Toxic
  2. Obstruction
  3. Hemorrhage
  4. Peritonitis
26
Q

What is emergency treatment for crohn’s pts?

A
  1. Steroids
  2. Bowel rest
  3. NG suction
  4. IV hydration
    A. Electrolytes prn
27
Q

What diet should a crohn’s pt consider?

A
  1. Low residue

2. Lactose avoidance if intolerant

28
Q

What supplements should a crohn’s pt consider?

A
  1. Probiotics, Ca/Vit D if steroid use

2. Vit A, D, E, K, Fe, folic acid if taking sulfasalazine

29
Q

What other supportive measures can a crohn’s pt consider?

A
  1. Sitz baths/soap & water after stooling if perianal sx

2. Psych support

30
Q

What is the prognosis foe crohn’s dz?

A
  1. Prognosis
    A. 10% w/prolonged remission
    B. 75% w/chronic intermittent Dz
    C. 12% w/unremitting Dz
  2. Obstruction occurs in 20-30% of cases
  3. Intestinal perforation in 1-2% of cases
  4. Fistulas w/ abscess in 50% of cases
31
Q

What is the leading cause of mortality in Crohn’s dz?

A
  1. GI cancer (Adenocarcinoma)

2. Occurs in small & large intestine in areas of chronic Dz

32
Q

What is ulcerative colitis?

A
  1. Chronic inflammation & ulcerative disease of colonic mucosa & submucosa
  2. Main sx of active disease is usuallydiarrheamixed w/ blood
  3. Gradual onset
  4. Systemic diseaseaffecting many parts of the body
33
Q

What is the epidemiology of ulcerative coilitis?

A
  1. M = W
  2. Most people Dx’d in mid-30’s
    3.Older men > older women
  3. Tends to run in families, but no clear pattern of inheritance
  4. Inc Risk:
    A. European caucasians
    B. Jewish heritage
34
Q

What is the etiology of ulcerative coilitis?

A
  1. Undetermined etiology

2. Autoimmune inflammatory colitis

35
Q

What is the pathogenesis of ulcerative coilitis?

A
  1. Usually begins in rectum, may remain there or spread proximally
  2. Severe disease causes large ulcers & purulent exudate
  3. Pseudopolyps or hyperplastic tissue growth at sites of previous ulceration
  4. Stricture formation
36
Q

What can ulcerative coilitis develop into?

A

10-20% develop adenoCA after 10 yr

37
Q

What are the sxs of ulcerative coilitis?

A
  1. Exacerbations alt. w/remissions
  2. Bloody diarrhea
  3. Absent or minimal pain
  4. Fatigue
  5. Urgency to defecate
  6. Mild lower abdominal cramping
  7. Mucus &/or blood in stool
  8. May follow intestinal infection
  9. Loose/frequent (≥ 10) stools/day
  10. Tenesmus
    A. feeling of needing to pass stool when the rectum is empty
  11. Systemic sx’s w/ severe disease
    A. Malaise, fever, anemia, anorexia, wt loss
38
Q

What are the dx studies for ulcerative coilitis?

A
  1. (+) pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Ab) > 45% of cases
  2. (-) ANCA (Anti-Saccharomyces CerevisiaeAb)
  3. Stool guaiac
  4. CBC w/ diff
    A. Microcytic/hypochromic anemia
  5. Stool for WBC, O&P, C. diff, Cx
  6. ↑ ESR
  7. CMP
    A. ↓ Albumin , ↓ K, ↓ Mg, ↓ Ca
39
Q

what imaging studies are used for ulcertive coilits?

A
  1. Imaging generally not indicated
  2. Barium enema w/ rectal involvement, “stove-pipe” appearance due to loss of haustrae
  3. UGI w/SBFT if unable to perform complete BE due to stricture
  4. CT w/o abscesses or fistulas
40
Q

When is a colonoscopy indicated in ulcerative coilitis?

A

Colonoscopy w/ Bx when not acute

41
Q

What is the medical management for ulcerative coilitis?

A
  1. Tx acutesymptoms w/ goal to induce remission, then maintain
  2. Anemia often requires the use ofparenteral iron
  3. Low residue diet
  4. Correct nutritional deficiencies
    A. Folic acid
    B. TPN w/ bowel rest if severe
42
Q

What is the Step I management in UC?

A
  1. Aminosalicylates
    A. Acute/maintenance
    Asacol/Lialda/Pentasa/Rowasa/Apriso (mesalamine) PO or PR, Azulfidine (sulfasalazine) PR, Dipentum (olsalazine) PO, Giazo/Colazal( balsalazide) PO
43
Q

What is the Step II management in UC?

A
  1. Corticosteroid
    A. Solu-Medrol/Cortef IV, Prednisone PO, Cortenema (Hz) enema PR,
    Entocort EC (budesonide) PO or PR prn exacerbation
44
Q

What is the Step III management in UC?

A
  1. Immunosuppressive drugs

A. Mercaptopurine ( Purinethiol), Azathioprine (Imuran) ,Methotrexate (inhibitsfolic acid)

45
Q

What is the Step IV management in UC?

A
  1. TNF inhibitors

A. Infliximab (Remicade)

46
Q

When are UC pts considered for colectomy or IV cyclosporine?

A

Those with less severe disease but do not respond to IV steroids w/in 7–10 days should be considered for colectomy or IV cyclosporine

47
Q

What is the hygiene hypothesis in UC?

A
  1. Low incidence of autoimmune Dz in less developed countries
  2. ↑ autoimmune Dz in industrialized countries
  3. Suggests helminthic infections protect individuals from developing autoimmune Dz
48
Q

What is helminthic therapy in UC?

A
  1. Inoculationof pt w/ specific parasitic intestinalhelminths
  2. Experimental Tx to reduce the severity of autoimmune response in IBD
49
Q

What are the dietary recommendations for UC?

A 
1. Lactose intolerancecommon in UC
A.Lactose breath hydrogen test
B. Ca  supplement to avoid bone loss
2. If (+) cramping or diarrhea 
A. Avoid fresh fruit, caffeine, carbonated drinks, high fructose corn syrup &sorbitol
3.”Specific Carbohydrate Diet”
A. Avoid disaccharides& polysaccharides 
B. Monosaccharides allowed

Gen Med: GI (16 decks)

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