Inflammatory Bowel Disease

Question 1

What 2 conditions are included in Inflammatory Bowel Disease?

Answer 1

UC and Crohn’s

Question 2

Inflammatory bowel disease is a lifelong illness found to have what impacts on an individual?

Answer 2

Emotional and social impacts

Question 3

In Ulcerative Colitis(UC), where is inflammation limited to?

Answer 3

Colonic mucosa: mucosal inflammation
Can also have pseudo-polyps

Question 4

Where in the GI tract can Crohn’s manifest and what kind of lesions does it have?

Answer 4

Anywhere in the GI tract from mouth to anus
“Skip Lesions”

Question 5

Crohn’s disease and UC is associated with what percentage of patients with a number of extra-intestinal manifestations?

Answer 5

50%, especially Crohn’s

Question 6

What extra intestinal manifestations do Crohn’s and UC share?

Answer 6

Erythema nodosum, pyoderma gangrenosum, thromboembolic events

Question 7

What extra- intestinal manifestations are specific to Crohn’s?

Answer 7

Oral Ulcers, anorectal disease

Question 8

What extra- intestinal manifestations are specific to UC?

Answer 8

Peripheral arthritis, spondylitis or sacroiliitis, episcleritis or uveitis, hepatitis and sclerosing cholangitis

Question 9

UC has inflammation of which layer of bowel wall?

Answer 9

Mucosal layer

Question 10

Crohn’s disease has inflammation which layer of bowel wall?

Answer 10

Transmural inflammation, complete inflammation of all layers

Question 11

What is the most common portion of the GI tract Crohn’s affects?

Answer 11

Terminal ileum which results in malabsorption of food, B12, bile salts and calcium

Question 12

Physical findings of Crohn’s?

Answer 12

Ileitis or ileo-colitis
Non bloody, intermittent diarrhea
Weight loss (evidence of malnutrition)

Question 13

What is a complication of Crohn’s Disease?

Answer 13

Small Bowel obstruction

Question 14

One third of patients with large or small bowel involvement with Crohn’s disease develop what?

Answer 14

Perianal disease such as:
Anal fissures, abscesses, skin tags, fistulas

Question 15

What lesions are common with Crohn’s disease?

Answer 15

Oral Aphthous ulcers

Question 16

Crohn’s disease increases the prevalence of what due to malabsorption of bile salts?

Answer 16

Gallstones (cholelithiasis)

Question 17

What other stones may form due to Crohn’s?

Answer 17

Kidney stones (nephrolithiasis)

Question 18

What kind of onset does Crohn’s have?

Answer 18

Insidious with bouts of fever, diarrhea and RLQ pain

Question 19

How many cases of Crohn’s involve small bowel only, usually the terminal ileum (ileitis)?

Answer 19

1/3 of cases

Question 20

How many cases of Crohn’s involve small bowel and colon (ileocolitis)?

Answer 20

Half of all cases

Question 21

What social action is strongly associated with the development of Crohn’s disease?

Answer 21

Cigarette smoking

Question 22

What labs should be done for patients with Crohn’s?

Answer 22

CBC w/ serum albumin

Question 23

What is the treatment directed towards in Crohn’s?

Answer 23

Symptomatic relief

Question 24

What therapies are available for Crohn’s?

Answer 24

5- aminosalicylic acid derivatives (5-ASA)
Corticosteroids
Immuno-modulating and biologic agents

Question 25

Acute flairs of Cron’s may require what intervention?

Answer 25

Surgical intervention (i.e. bowel perforation)

Question 26

What products should you counsel Crohn’s patients to discontinue?

Answer 26

Tobacco products

Question 27

Who should you consult for Crohn’s patients?

Answer 27

GI/Gen surg

Question 28

Is bleeding/severe hemorrhage common in patients with Crohn’s?

Answer 28

No, it is unusual

Question 29

When should patients with Crohn’s begin screening colonoscopy?

Answer 29

8 or more years after initial flare/dx

Question 30

How much more likely are patients with Crohn’s likely to develop colon cancer than the rest of the population?

Answer 30

20x more likely

Question 31

UC or Crohn’s have a higher risk of development of carcinoma?

Answer 31

UC

Question 32

What is thought to cause UC?

Answer 32

Abnormal activation of immune system resulting in diffuse inflammation of colonic mucosa (mucosa of large intestine)

Question 33

UC involves what structures?

Answer 33

Only mucosa of large intestine Can involve the rectum (begins distally and migrates proximally)

Question 34

UC commonly extends to which parts of the large intestine?

Answer 34

Proximal portion to involve part or all of large intestine

Question 35

What is common in UC that is not common in Crohn’s?

Answer 35

Bleeding

Question 36

What percentage of patients have UC confined to recto-sigmoid colon, splenic flexture (left sided colitis) and extensive colitis (proximal)

Answer 36

33% each

Question 37

UC is more common in what population?

Answer 37

Non smokers and former smokers

Question 38

What procedure before the age of 20 is associated with a lower risk of developing UC?

Answer 38

Appendectomy

Question 39

What signs and sx of infectious colitis, such as diverticulitis, mimic UC?

Answer 39

Bloody diarrhea Fecal urgency

Question 40

What hx should be collected from patients with suspected UC?

Answer 40

Stool frequency/character Prescence and amount of rectal bleeding Diffuse crampy abdominal pain Fecal Urgency Tenesmus (needing to poopoo)

Question 41

What is the hallmark sx of UC?

Answer 41

Bloody diarrhea

Question 42

How do you classify patients with UC?

Answer 42

Mild, Moderate, Severe

Question 43

What are sx of mild UC?

Answer 43

Gradual onset infrequent diarrhea (less than 5 movements per day) LLQ cramps relieved by defecation

Question 44

What are sx of moderate UC?

Answer 44

More severe diarrhea with frequent bleeding Systemic sx

Question 45

What are sx of severe UC?

Answer 45

More than 6-10 blood bowel movements per day Severe anemia, hypovolemia and impaired nutrition with hypoalbuminemia

Question 46

What labs should be done for patients with UC?

Answer 46

CBC, ESR, CRP, stool bacterial culture, C Diff, Ova and Parasites, serum albumin and electrolytes

Question 47

When should patients with UC begin colonoscopy screenings?

Answer 47

8 years after initial dx or initial flare

Question 48

What are the 2 main treatment objectives when treating UC?

Answer 48

Terminate acute, symptomatic attack Prevent recurrence of attacks

Question 49

What medications are available for UC?

Answer 49

Mesalamine Corticosteroid Aminosalicylates Antidiarrheals

Question 50

What surgical intervention may be required in severe case of UC?

Answer 50

Total proctocolectomy