Inflammatory Bowel Disease Flashcards
The term “inflammatory bowel disease” includes what?
ulcerative colitis and Crohn’s disease
Inflammatory bowel disease is a _____ that can have profound emotional and social impacts on the individual.
lifelong illness
The ________ disrupts the intestinal mucosa and leads to a chronic inflammatory process
immune response
What one?
Ulcerative Colitis vs Crohn’s Disease
1) Inflammation is limited to the colonic muscosa: Mucosal inflammation
2) Can have pseudo-polyps
a) An inflammatory pseudo-polyp is an island of normal colonic muscosa which only appears raised because it is surrounded by atrophic tissue
Ulcerative colitis (UC)
What one? Ulcerative Colitis vs Crohn’s Disease 1) Can affect ANY segment of the gastrointestinal tract from the mouth to the anus 2) “Skip Lesions” 3) Transmural Inflammation
Crohn’s Disease (CD)
Crohn’s disease and ulcerative colitis may be associated in ___% of patients with a number of extra-intestinal manifestations. ESPECIALLY ____
50%
ESPECIALLY CROHN’S
Extra-intestinal Manifestation in UC and Crohn’s Disease
What one?
peripheral arthritis, spondylitis or sacroiliitis, episcleritis or uveitis, hepatitis and sclerosing cholangitis
Ulcerative Colitis (UC)
Extra-intestinal Manifestation in UC and Crohn’s Disease
What one?
oral ulcers, anorectal disease
Crohn’s
Extra-intestinal Manifestation in UC and Crohn’s Disease
What one?
erythema nodosum, pyoderma gangrenosum,
thromboembolic events.
BOTH…..
Mucosal vs Transmural Inflammation
Involves only the mucosal layer of bowel wall is characteristic of ______
Ulcerative Colitis
CD vs UC
Mucosal vs Transmural Inflammation
1) “Complete” inflammation of all layers of a structure
2) Inflmmatory changes/ulceration of all layers of the bowel wall.
Crohn’s Disease
The most common portion of the GI tract that Crohn’s affects is the ______.
terminal ilium (near the appendix)
When Crohn’s involves the terminal ileum it can result in ……
malabsorption of digested foods,
Vitamin B12, Bile Salts and Calcium.
Deficiency of _______ causes a macrocytic anemia with neurologic symptoms. Some common symptoms include numbness and tingling in the distal aspects of the upper and lower extremities and disequilibrium.
vitamin B12
______ is a chronic and recurrent disease, which can affect any segment of the
gastrointestinal tract from the mouth to the anus, involves “skip lesions.” This is transmural.
Crohn’s
What disease commonly presents with one or a combination of the following symptoms?
1) Ileitis or ileo-colitis (Most Common)
2) Diarrhea, which is usually non-bloody and often intermittent
3) Low-grade fever
4) Malaise / Loss of energy
5) Weight loss (evidence of malnutrition)
6) Cramping abdominal pain:
a) Can be diffuse, Right Lower Quadrant (RLQ) or peri-umbilical pain)
7) Diffuse abdominal pain/discomfort and bloating
a) Possible to find a palpable, tender mass:
(1 May represent matted (inflamed loops of inflamed intestine or possible intra-abdominal abscess.
8) Small Bowel Obstruction (SBO) is a possible complication
Crohn’s Disease
What lifestyle habit is strongly associated with the development of Crohn’s disease, resistance to medical therapy, and early disease relapse
Cigarette smoking
PT with recurrent UTI’s and complaining of peeing air is indicative of what?
Fistula to the bladder
What issue?
One-third of patients with either large or small bowel involvement develop
perianal disease:
a) Large painful skin tags
b) Anal fissures
c) Perianal abscesses
d) Peri-anal fistulas
10) Oral aphthous lesions are common.
11) There is an increased prevalence of cholesterol gallstones (cholelithiasis) due to malabsorption of bile salts from the terminal ileum, creating an imbalance of cholesterol to bile salts resulting in precipitation of cholesterol in the biliary system.
12) Nephrolithiasis (kidney Stones) may also occur.
CD
True/False
Crohn’s
There is a poor correlation between laboratory studies and the patient’s clinical picture.
True
Laboratory values for CD may reflect what?
inflammatory activity or nutritional complications of disease.
LABS for CD
________ should be obtained in all patients to assess immune
response and nutritional status respectively.
CBC and serum albumin
Imaging / Radiology for CD
Endoscopy
Colonoscopy
CT scan of the abdomen
Imaging / Radiology for CD
What is recommended for acute exacerbations
-should be done to assess for abscess/fistula formation or even perforation
CT scan
Crohn’s disease is a chronic lifelong illness characterized by exacerbations and periods of remission. As no specific therapy exists, current treatment is directed toward………
symptomatic improvement and controlling the disease process
Available therapies for CD:
1) 5-aminosalicylic acid derivatives (5-ASA)
2) Corticosteroids
3) Immuno-modulating and biologic agents
a) Monoclonal antibodies
b) Methotrexate
Management for CD
1) Acute flairs may require _______ (i.e. bowel perforation).
2) Counsel patient to discontinue ________.
3) Consult to _______
4) MEDEVAC
1) surgical intervention
2) tobacco products
3) GI/General Surgery
True/False
Bleeding/severe hemorrhage is usual in patients with Crohn’s disease.
FALSE
Unusual
True/False
CD
Increased risk for developing colon carcinoma relative to normal population
TRUE
What is a chronic, recurrent disease, limited to the colonic mucosa
- It is thought to be caused by abnormal activation of the immune system resulting in diffuse inflammation of the colonic mucosa (mucosa of the large intestine)
- involves only the muscos of the large intestine (Colon)
- Can involve the rectum
Ulcerative Colitis (UC)
______ manifests in the inflammation of the mucosa of the colon, causing:
1) Ulceration
2) Edema
3) Bleeding (common, unlike Crohn’s disease where bleeding is less common)
4) Fluid and electrolyte loss
Ulcerative colitis
What % of UC patients have disease confined to the recto-sigmoid region
33%
What % of UC patients have disease that extends to the splenic flexure (left-sided colitis)
33%
What % of UC patients have disease that extends more proximally (extensive colitis)
33%
True/False
UC Commonly manifests in periods of symptomatic flare-ups and remissions.
True
What is
It is more common in non-smokers and former smokers. Severity may be lower in active smokers and may worsen in patients who stop smoking.
UC
For UC you should advocate your pt to not stop smoking or start smoking.
1) THIS DOES NOT MEAN YOU SHOULD NOT ADVOCATE FOR A
PATIENT TO STOP SMOKING!
2) THIS DOES NOT MEAN YOU SHOULD ADVOCATE FOR A PATIENT TO
START OR CONTINUE SMOKING!
What surgery before the age of 20 years for acute appendicitis is associated with a reduced risk of developing ulcerative colitis.
Appendectomy
What may MIMIC the signs and symptoms of Ulcerative Colitis and why?
Infectious colitis, such as diverticulitis
1) Bloody diarrhea
2) Fecal urgency, which may mimic the symptoms of ulcerative colitis.
Patients suspected to have possible UC should be asked about:
1) Stool frequency and character of stool
2) The presence and amount of rectal bleeding (color and amount, even a picture if possible)
3) Diffuse crampy abdominal pain
4) Fecal urgency
5) Tenesmus (consistent feeling of needing to defecate)
What would you suspect?
(a) Bloody diarrhea is the hallmark.
(b) Lower abdominal cramps and fecal urgency
(c) Anemia (due to inflammation and blood loss), low serum albumin (due to
inflammation)
(d) Negative stool cultures (no signs of infectious cause)
UC
True/False
“Ulcerative colitis
On the basis of several clinical and laboratory parameters, it is clinically useful to classify patients as having mild, moderate, or severe disease.
True
What severity of UC
a) Gradual onset of infrequent diarrhea (less than five movements per day)
with intermittent rectal bleeding and mucus.
b) Stools may be formed or loose in consistency.
c) Because of rectal inflammation, there is fecal urgency and tenesmus.
d) Left lower quadrant cramps relieved by defecation are common, but there
is no significant abdominal tenderness.
Mild
What severity of UC
a) Have more than six to ten bloody bowel movements per day, resulting in
severe anemia, hypovolemia, and impaired nutrition with
hypoalbuminemia.
b) Abdominal pain and tenderness are present.
Severe
What severity of UC
a) Have more severe diarrhea with frequent bleeding.
b) Abdominal pain and tenderness may be present but are not severe.
c) May be mild fever, anemia, and hypoalbuminemia.
Moderate
UC
Initial assessment of the patient experiencing a flair/exacerbation should focus on:
1) Volume status as determined by orthostatic blood pressure, heart rate, urine
output and mental status.
2) Nutritional status.
True/FAlse
Red blood may be present on digital rectal examination of CD
FALSE
UC
What labs for UC
CBC, ESR, CRP, Stool Bacterial culture, C DIF, Ova and Parasites, Serum Albumin Electrolytes.
Labs for UC
The degree of abnormality of the hematocrit, sedimentation rate, and serum
albumin reflects ______
disease severity
UC Imaging/Radiology
1) _____ scan if suspect fistula formation, abscess, perforation and during acute flares
2) Can help to assess severity of flare and guide treatments
3) __ years post initial diagnosis/flare:
4) Colonoscopy to screen for _____
1) CT
3) 8 years
4) carcinoma
Patients with UC have a substantially increased risk of _______ than that of the general population and patients with Crohn’s Disease.
colon cancer
What are two main treatment objectives when treating patients with Ulcerative Colitis
1) To terminae the acute, symptomatic attack
2) To prevent recurrence of attacks.
Medication Options for UC
1) Mesalamine
2) Corticosteroid
3) Aminosalicylates (5-ASA), immunomodulating agents and biologic agens
depending on the severity of disease.
4) Antidiarrheal agents such as Loperamide should not be given in the acute phase of illness but are safe and helpful in patients with mild chronic symptoms whom have tested negative for C. Diff.
Treatment for UC
Antidiarrheal agents such as Loperamide should not be given in the _____ phase of illness but are safe and helpful in patients with mild chronic symptoms whom have tested negative for _______.
acute
C. Diff
