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GEMS > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

IBD

A

Conditions w/ chronic or recurring inflammation of the GI tract

Aberrant immune response to gut bacteria in a genetically susceptible host

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2
Q

Types of IBD

A

Ulcerative Colitis
Crohn’s Disease

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3
Q

Signs of ulcerative colitis

A

Friable mucosa
Loss of haustra/Lead-pipe sign

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4
Q

Imaging sign of Crohn’s Disease

A

String Sign

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5
Q

Location of Crohn’s Disease

A

Any portion of the GI tract, usually terminal ileum and colon

Skip lesions+++
Rectal Sparing

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6
Q

Location of Ulcerative Colitis

A

Colon inflammation
Continuous colonic lesion ++
ALWAYS with RECTAL involvement ++

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7
Q

Crohn Dx Gross Morphology signs

A

Transmural Inflammation –> fistulas

Cobblestone Mucosa
Creeping fat
Bowel wall thickening (string sign on Barium swallow XR)

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8
Q

Ulcerative Colitis Gross Morphology

A

Mucosal & Submucosal inflammation ONLY

Friable mucosa with superficial and/or deep ulcerations (compare normal with diseased)

Loss of hausta–> lead pipe on imaging

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9
Q

Crohn Dx Micro

A

Noncaseating granulomas +++ & lymphoid aggregates

Th1 mediated

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10
Q

Ulcerative colitis micro

A

Crypt abscesses and ulcers, bleeding, no granulomas

Th2 mediated

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11
Q

Crohn’s Dx is ….. mediated

A

Th1

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12
Q

Ulcerative colitis is ….. mediated

A

Th2

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13
Q

Malabsorption + malnutrition
Colorectal cancer are complications of ….

A

Both Crohn’s disease & Ulcerative Colitis

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14
Q

Fistulas (recurrent UTI & pneumaturia), phlegmon/abscess, strictures, perianal disease are all complications of ….

A

Crohn’s Disease

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15
Q

Fulminant colitis
Toxic megacolon ++
Perforation

are all complications of ….

A

Ulcerative Colitis

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16
Q

Diarrhea may or may not be bloody in ….

A

Crohn’s Disease

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17
Q

Only diarrhea that is BLOODY is a sign of …

A

Ulcerative Colitis

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18
Q

Rash (pyoderma gangrenosum, erythema nodosum) are manifestations of…

A

Both Crohn’s and UC

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19
Q

Eye inflammation (episcleritis, uveitis) are manifestations of…

A

Both Crohn’s dx and UC

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20
Q

Oral ulceration (aphthous stomatitis) are manifestations of…

A

Crohn’s dx and UC

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21
Q

Arthritis (peripheral, spondylitis) are manifestations of …

A

Crohn’s dx and UC

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22
Q

Fever is a manifestation of…

A

Crohn’s dx & UC

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23
Q

Kidney Stones (usually Ca Oxalate) are a manifestation of ….

A

Crohn’s dx

24
Q

Gallstones are a sign of …

A

Crohn’s disease

25
May be POSITIVE for anti-Saccharomyces cerevisiae antibodies (ASCA)…
Crohn’s disease
26
1* sclerosing cholangitis is manifestation of…
Ulcerative Colitis
27
Is associated with p-ANCA…
Ulcerative Colitis
28
Associated with autoimmune hemolytic anemia, venous/arterial thromboembolism
Ulcerative Colitis
29
Treatment with corticosteroids, azathioprine, ANTIBIOTICS, infliximab, adalimumab are effective for…
Crohns Disease
30
Treatment with 5-aminocalicylic preparations (eg, mesalamine), 6-mercaptopurine, infliximab, colectomy are effective for…
Ulcerative Colitis
31
A FAT GRANny and an old CRONE SKIPping downa COBBLESTONE road away from the WRECK (rectal sparing)
Crohn’s Disease
32
ULCCCERS
Ulcers Large intestine Continuous Colorectal carcinoma Crypt Extends proximally Red diarrhea (blood) Sclerosing cholangitis
33
Nonsmokers/former smokers Severity may worsen in those who stop smoking
Ulcerative Colitis
34
Diarrhea infrequent, rectal bleeding & mucus intermittent, LLQ cramps, relieved by defecation
MILD Ulcerative Colitis
35
Diarrhea more severe/frequent bleeding, mild fever, anemia, hypoalbuminemia
Moderate Ulcerative Colitis
36
>>6 bloody bowel movements/day, hypovolemia, impaired nutrition
Severe Ulcerative Colitis
37
Consequence assessments for Ulcerative Colitis
Hematocrit Sed Rate Albumin
38
Dx r/o testing for ulcerative colitis
Stools for bacteria, culture, O&P
39
Sigmoidoscopy
Diagnostic for Ulcerative Collitis Barium enema of little use -- precipitate toxic megacolon
40
Smokers at increased risk
Crohn’s Disease
41
Locations of Crohn’s Disease
Small bowel only – terminal ileum – 33% Small bowel + colon – (terminal ileum) – 50% Colon alone – 20% Upper intestinal tract – 5%
42
Intestinal obstruction 2/2 narrowing of small bowel in context of inflammation, spasm, fibrotic stenosis
Complication of Crohn’s Disease
43
Postprandial bloating, cramping pains, loud borborygmi
Accompany intestinal obstruction as a complication of Crohn’s Disease
44
Sinus tracts & fistulas -- intra-abdominal or retroperitoneal abscesses (fever, chills, tender abdominal mass, leukocytosis)
Fistualization
45
Fistualization between small intestine & colon commonly asymptomatic but
diarrhea, WT loss, bacterial overgrowth, malnutrition Crohn’s Disease
46
Extraintestinal manifestations in Crohn’s Disease
Like w/ UC but NO THROMBOSIS, HA, sclerosing cholangitis BUT WITH gallstones, nephrolithiasis
47
Consequence assessment for Crohn’s Disease
CBC: anemia may be 2/2 chronic inflammation, blood loss, iron deficiency, B12 malabsorption (ileum) ++Leukocytosis w/ abscesses
48
Rule out assessment for Crohn’s Disease
Stool: Pathogens, O&P C. diff toxin
49
Imaging for Crohn’s disease
Barium Upper GI series w/ small bowel follow-through CT, video imaging
50
Procedures for Crohn’s disease
Colonoscopy Biopsy (may reveal granulomas) Surgery >50% pts
51
Indications for surgery in Crohn’s disease pts
Intractability to med therapy Intra-ab abscesses Massive bleeding Obstruction w/ stricture I&D abscess Surgical resection of tensotic area or stricturoplasty in small bowel
52
Regular diet Limit caffeine, gas-producing veggies Avoid opioid/anticholinergics
Diet for Ulcerative Collitis
53
Avoid lactose Fiber supplementation -- soaks up fluid & reduces diarrhea Low roughage diet w/ obstructive sx Low-fat diet for fat malabsorption B12 if terminal ileal
Diet for Crohn’s Disease
54
Toxic megacolon Colon cancer -- mucosal biopsies every 1-2 yrs, beginning 8-10 years after dx
Complications of Ulcerative Colitis
55
Prognosis for Crohn’s Disease
Most able to cope, few die
56
Preventative measures for pt’s with Crohn’s
Annual colonoscopy to detect dysplasia or cancer pts w/ 8+ years of Crohn colitis
57
Oral Ulcers Episclerotisi or uveitis Erythema nodosum, pyoderma gangrenosum Spondylitis or sacroiliitis Oligoarticular or polyarticular non-deforming arthritis
Extracolonic manifestations of both Crohn’s & Ulcerative Colitis

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