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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
Q

May be POSITIVE for anti-Saccharomyces cerevisiae antibodies (ASCA)…

A

Crohn’s disease

26
Q

1* sclerosing cholangitis is manifestation of…

A

Ulcerative Colitis

27
Q

Is associated with p-ANCA…

A

Ulcerative Colitis

28
Q

Associated with autoimmune hemolytic anemia, venous/arterial thromboembolism

A

Ulcerative Colitis

29
Q

Treatment with corticosteroids, azathioprine, ANTIBIOTICS, infliximab, adalimumab are effective for…

A

Crohns Disease

30
Q

Treatment with 5-aminocalicylic preparations (eg, mesalamine), 6-mercaptopurine, infliximab, colectomy are effective for…

A

Ulcerative Colitis

31
Q

A FAT GRANny and an old CRONE SKIPping downa COBBLESTONE road away from the WRECK (rectal sparing)

A

Crohn’s Disease

32
Q

ULCCCERS

A

Ulcers
Large intestine
Continuous
Colorectal carcinoma
Crypt
Extends proximally
Red diarrhea (blood)
Sclerosing cholangitis

33
Q

Nonsmokers/former smokers
Severity may worsen in those who stop smoking

A

Ulcerative Colitis

34
Q

Diarrhea infrequent, rectal bleeding & mucus intermittent, LLQ cramps, relieved by defecation

A

MILD Ulcerative Colitis

35
Q

Diarrhea more severe/frequent bleeding, mild fever, anemia, hypoalbuminemia

A

Moderate Ulcerative Colitis

36
Q

> > 6 bloody bowel movements/day, hypovolemia, impaired nutrition

A

Severe Ulcerative Colitis

37
Q

Consequence assessments for Ulcerative Colitis

A

Hematocrit
Sed Rate
Albumin

38
Q

Dx r/o testing for ulcerative colitis

A

Stools for bacteria, culture, O&P

39
Q

Sigmoidoscopy

A

Diagnostic for Ulcerative Collitis

Barium enema of little use – precipitate toxic megacolon

40
Q

Smokers at increased risk

A

Crohn’s Disease

41
Q

Locations of Crohn’s Disease

A

Small bowel only – terminal ileum – 33%
Small bowel + colon – (terminal ileum) – 50%
Colon alone – 20%
Upper intestinal tract – 5%

42
Q

Intestinal obstruction 2/2 narrowing of small bowel in context of inflammation, spasm, fibrotic stenosis

A

Complication of Crohn’s Disease

43
Q

Postprandial bloating, cramping pains, loud borborygmi

A

Accompany intestinal obstruction as a complication of Crohn’s Disease

44
Q

Sinus tracts & fistulas – intra-abdominal or retroperitoneal abscesses (fever, chills, tender abdominal mass, leukocytosis)

A

Fistualization

45
Q

Fistualization between small intestine & colon commonly asymptomatic but

A

diarrhea, WT loss, bacterial overgrowth, malnutrition

Crohn’s Disease

46
Q

Extraintestinal manifestations in Crohn’s Disease

A

Like w/ UC but NO THROMBOSIS, HA, sclerosing cholangitis

BUT WITH gallstones, nephrolithiasis

47
Q

Consequence assessment for Crohn’s Disease

A

CBC: anemia may be 2/2 chronic inflammation, blood loss, iron deficiency, B12 malabsorption (ileum)

++Leukocytosis w/ abscesses

48
Q

Rule out assessment for Crohn’s Disease

A

Stool: Pathogens, O&P
C. diff toxin

49
Q

Imaging for Crohn’s disease

A

Barium Upper GI series w/ small bowel follow-through
CT, video imaging

50
Q

Procedures for Crohn’s disease

A

Colonoscopy
Biopsy (may reveal granulomas)
Surgery >50% pts

51
Q

Indications for surgery in Crohn’s disease pts

A

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
Q

Regular diet
Limit caffeine, gas-producing veggies
Avoid opioid/anticholinergics

A

Diet for Ulcerative Collitis

53
Q

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

A

Diet for Crohn’s Disease

54
Q

Toxic megacolon
Colon cancer – mucosal biopsies every 1-2 yrs, beginning 8-10 years after dx

A

Complications of Ulcerative Colitis

55
Q

Prognosis for Crohn’s Disease

A

Most able to cope, few die

56
Q

Preventative measures for pt’s with Crohn’s

A

Annual colonoscopy to detect dysplasia or cancer pts w/ 8+ years of Crohn colitis

57
Q

Oral Ulcers
Episclerotisi or uveitis
Erythema nodosum, pyoderma gangrenosum
Spondylitis or sacroiliitis
Oligoarticular or polyarticular non-deforming arthritis

A

Extracolonic manifestations of both Crohn’s & Ulcerative Colitis

GEMS (20 decks)

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