IBS and IBD Flashcards
Inflammatory Bowel Dz
- MC in who?
- Etiologies
- pathophysiology
- encompases what two dzs?
MC in jews in the US, developed world, females=males, 20YO.
Etiologies:
- autoimmune***
- genetic***
- infectious
- immunologic
- dietary
- environmental
- vascular
- neuromotor
- allergic
- psychogenic
Pathophys:
- defect in the function of the intestinal lumen
- breakdown of the defense barrier of the gut
- exposure of mucosa to microorganisms or their products resulting in chronic inflamm mediated by T cells.
Encompases Ulcerative Colitis and Crohns
What are some related disorders that are commonly seen with IBD? (systemic and small bowel)
- Aphthous Stomatitis
- episcleritis & uveitis
- arthritis
- vascular complications
- erythema nodosum
- P. gangrenosum
- sclerosing cholangitis
Small bowel:
- gallstones
- malabsorption
- renal stones, fistulas, hydronephrosis, amyloidosis
Ulcerative Colitis:
- how and where does this affect the GI?
- describe the extent of ulcer spread that occurs most commonly.
- describe clinical course.
- Is smoking protective?
- high risk of developing what?
Involves the mucosal surface* of the colon w/ the formation of crypt abscesses. Always includes the rectum* and spreads uniformly continuous & proximally.***
50% rectosigmoid**
Clinical Course: flare-ups and remissions.
Smoking is protective for UC. Dz may be lower in active smokers and may worsen in pts who stop smoking.
high risk for development of CANCER!!!
Ulcerative Colitis:
- signs and sx of mild to moderate and severe dz
- labs
Mild to moderate:
- bloody diarrhea***
- lower abd cramps (relieved with defication)
- fecal urgency
Severe:
- rectal bleeding
- LLQ cramps
- severe diarrhea
- fever
- anemia (Fe deficiency)
- hypoalbuminemia (malabsorption)
- hypovolemia (diarrhea)
Labs:
- CBC: anemia, leukocytosis
- ESR & CRP: only elevated during attack
- CMP: electrolyte disturbances, decreasaed serum albumin, prolonged clotting time
- perinuclear antineutrophil cytoplasmic abys (pANCA)
What are the following values in mild, mod, severe Ulcerative colitis for the following studies:
- stools
- pulse
- hct
- wt loss
- temp
- esr
- albumin
Mild:
- stools; less than 4/day
- pulse: less than 90
- hct: normal
- wt loss: none
- temp: normal
- esr: less than 20
- albumin: normal
Moderate:
- stools: 4-6/day
- pulse: 90-100
- hct: 30-40%
- wt loss: 1-10%
- temp: 99-100
- esr: 20-30
- albumin: 3-3.5
Severe:
- stools: greater than 6/day and bloody
- pulse: greater than 100
- hct: less than 30%
- wt loss: greater than 10%
- temp: greater than 100
- esr: greater than 30
- albumin: less than 3
Ulcerative Colitis:
-dx
Dx:
based upon clinical presentation, sigmoidoscopic demonstration of inflammation and exclusion of bacterial and parasitic infection.
-bloody diarrhea (differntiates from crohns)
-plain abd xray
-sigmoidoscopy***
-CT scan (complications)
Ulcerative Colitis:
- tx general
- tx mild-mod
- tx mod-severe
reduce dietary fiber during an exacerbation
- prescribe folic acid supplements with Sulfasalazine
- oral iron may be needed with rectal bleeding
- short course of loperamide(immodium) for troublesome diarrhea.
- periodic colonoscopy and bx in pts with pancolitis lasting more than 8 years.
- *DONT GIVE FIBER!!! this will just cause more bowel irritation.
Mild/mod:
- sulfasalzine (anti-inflamm)
- olsalazine (ok for sulfa allergies)
- Mesalamine
- may have to add prednisone
Mod/Severe:
- sulfasalzine
- olsalazine
- predniose
- may need to consider immunosuppressive therapy for pts who need constant high dose of steroids.
SE of sulfasalzine?
folate deficiency
azospermia
severe depression in young males
Ulcerative Colitis:
- tx of proctocolitis
- indications for surgery
Tx: (limited to rectosigmoid)
- oral or topical (enema, suppository)
- hydrocortisone: enema, suppositories, foam
Indications for surgery in UC:
- exsanguinating hemorrhage
- toxicity or/and perforation
- suspected CA
- significant dysplasia
- growth retardation
- systemic complication s
- intratability
What are the surgical options for UC?
Conventional Ileostomy (brooke)
Continent Illeostomy (kock pouch)
Illeo-anal anastomosis w/ reservoir
Chrons:
- how and where does this affect the GI?
- describe the extent of ulcer spread that occurs most commonly.
- Is smoking protective?
- clinical manifestations
How and where:
-transmural* involvment with formation of fistulas, narrowing of lumen, obstruction. Can involve any segment of the GI tract but is usually rectal sparing!* Skip lesions*
MC extent of spread is ileocolitis 45%
SMoking is not protective, it is strongly associated with development of Crohns dz, resistance to medical therapy and early dz relapsee.
Clinical manifestations:
- insidious onset
- intermittent bouts of low grade fever, diarrhea, and RLQ pain
- post prandial pain is common
- RLQ mass
- Perianal dz (abscess, fistula, skin tags(yellow and look lipomatous)
- intestinal obstruction
- nocturnal BM, night sweats, weight loss*
- erythema nodosum
- pallor (anemia)
Crohns dz:
- PE findings
- Labs
- imaging
PE findings;
- abd distension
- abnormal bowel sounds
- tenderness in area of involvement
- perianal region:
- -abscess, fistula, skin tag, anal stricture
Labs: (Same is UC)
CBC: anemia, leukocytosis
-ESR and CRP
-CMP: electrolyte disturbances, decreased albumin, prolonged clotting time
-serum anti-saccharomyces cerevisiae aby (ASCA) *** highly specific!!!
….heather would also check B12, folate, and iron.
Imaging:
- upper GI series: only done for someone who has crohns dz and you need to see whats going on during their acute exacerbation, this is NOT used for dx.
- -will see cobble stoning and skip lesions.
What is seen on upper GI series in a pt with Crohns?
may see string sign = horrible stricture: give radio-opaque dye.
Crohns:
-tx
Tx:
- 5-aminosalicylic acid agents
- -sulfasazine
- -mesalamin
- -pantasa
- abx only if there is an infection.
- corticosteroids
- anti-TNF therapy; Infliximab (Remicade)
- Immunomodulating drugs:
- -azathioprine
- -mercaptopurine
- -methotrexate
- require folic acid supplementation
-immodium if they need it.
Irritable Bowel Syndrome:
- older terms
- what is this?
- MC what age, gender, and geographic location?
- symptomologic dx
Older:
- spastic colon
- spastic colitis
- mucous colitis
- functional bowel dz
What:
-a functional GI disorder that is a variable combination of chronic or recurrent GI sx not explained by structural or biochemical abnormalities
MC in 15-34YO and in the US, females greater than males
Sx:
-continuous or recurrent sx for at least 3 mos of:
–abd pain or discomfort
–pain relieved by defecation
–pain with a change in frequency or form of stools
AND… a varying pattern of defication with 3 or more of the following:
–altered stool frequency
–altered stool form
–altered stool passage
–abd distention and bloating
–passage of mucous (other two dont have mucus)
