Inflammatory Bowel Disease Flashcards
What is IBD?
loss of tolerance against indigenous enteric flora believed to be central event in pathogenesis of IBD
What 2 things can IBD be triggered by? What makes it worse?
- increased intestinal permeabililty
- imbalanced microflora
- psychological stress exacerbates the condition
What Crohn’s dz? What type of destruction is there? What kind of appearance does this lead to? What develops with progression? Typical pattern?
chronic transmural inflam of colon involving mesentery as well as regional LNs, may involve the entire GI tract w/”skip lesions”
early mucosal involvement= aphthous ulcerations which is responsible for cobblestone appearance
with progression get deep fissures, sinuses & fistulas
typical pattern= intermittent exacerbations & periods of remission, worse w/stress
Etiology & RFs of Crohn’s?
UNKNOWN
mb genetic, infectious, immunologic, psychological factors possible
smoking
use of oral contraceptives
diet of dairy, refined sugar, low fiber, high animal fat
dysbiosis, dt abx
removal of inflamed appendix early in life
Epidemiology of Crohn’s?
bimodal distribution, early peak 15-25 yo, smaller peak 55-65 yo
pts 40
jewish pop 2-4x’s more likely, high in caucasians
increased in higher socioeco groups & type A personality
slight predominance in females
Pathophys of Crohn’s?
inflam involves all layers of intestinal wall which becomes thick patchy distribution w/areas of normal bowel (“skip lesions”)
can occur from mouth to anus
rarely affects stomach, duodenum & esophagus
Ssxs of Crohn’s? what is perianal dz?
abd pain, stead, RLQ, fatigue
occult blood, blood in stool if colon involvement
stool usu formed but can be lose with colonic involvement or terminal ileum, steatorrhea, 1/3 have perianal dz (fissures, fistulas, perianal abscesses)
What are the 4 patterns of Crohn’s that can present?
- inflammation: RLQ pain, tender
- obstruction: severe colic, abd distention, constipation, vomiting
- diffuse jejunoileitis: inflam & obstruction which leads to chronic debility
- abd fistulas & abscesses: usu late w/fever, painful masses & wasting
PE of Crohn’s?
RLQ tenderness w/assoc fullness or mass
abd distention, fever, wt loss
4 complications of Crohn’s? what can they all lead to?
- intestinal obstruction, reversible early, as progresses though can lead to constipation & intractable obstruction from fixed luminal narrowing
- fistula formation is common and can cause abscesses, malabsorption, cutaneous fistula, persistent UTIs, pneumaturia
- perforation
- hemorrhage
3&4 dt thickened mucosa
*increase risk of SCC
Labs for Crohn’s?
CBC: mild anemia, leukocytosis increased ESR, elevated CRP low serum iron, low vit B12 positive fecal lysozyme ASCA (higher in Crohn's), ANCA (higher in UC)
Imaging for Crohn’s? What do you see in advanced cases?
xray, double-contrast barium enema exam
single-contrast upper GI series w/small-bowel follow through barium xray= irregularity, nodularity, stiffness, thickening of terminal ileum, narrowed ileum lumen
advanced cases: string sign= marked stricture of the ileum
What will a colonoscopy show?
“skip areas” “cobblestone appearance,” longituidinal ulcers, rectal sparing, narrowing & fistulas
1/2 of pts have what pathognomonic sign?
sarcoid-type epitheloid granulomas in the intestinal wall & occ in involved mesenteric nodes
DDX of Crohn’s?
lactose intolerance, IBS, infectious colitis, UC, appendicitis, diverticulitis, carcinoma
What is ulcerative colitis? what is ulcerative proctitis?
chronic, recurrent inflam dz of the colon or rectal mucosal layer w/superficial ulcertion
almost always involves the colon (NO skip areas)
ulcerative proctitis= UC localized to the rectum, common
Etiology & RFs of UC? What chromosomes? what is negatively assoc?
immune-mediate (abn humoral & cell-mediated immunity &/or enhanced reactivity against bac antigens
chromosomes 12 & 16 are factors & genetic susceptibility, FHx may play a role
smoking is negatively assoc w/UC (opposite in Crohn’s)
mb environmental factors
dietary factors: dairy, refined sugar, low fiber, high animal fat
Epidemiology/incidence of UC?
2-4 x’s higher in Jewish pop & higher in whites
slight predominance in males
peaks 15-25 yo & 55-65 yo (but any age can have it)
Ssxs of UC? if only in recto-sigmoid area? if extends proximally? systemic sxs?
ranges from mild to severe
cramping abd pain
series of attacks of bloody diarrhea w/asx intervals
begins insidiously w/increased urgency, lower abd cramps, blood & mucosa
if in recto-sigmoid only stool mb normal, hard or dry w/rectal d/c of WBCs & RBCs
if extends proximally stools are looser, 10-20/d w/severe cramps, rectal tenesmus, watery stools w/pus, blood & mucus
systems sxs: malaise, fever, anemia, wt loss
3 complications of UC? most common? most serious? most progressing?
hemorrhage most common!
TOXIC MEGACOLON- distended colon w/attenuated walls & immediate danger of perforation!!! may occur in severe colitis (>40% mortality)
cells can become dysplastic w/increased risk of colon CA, 0.5-1% increase each year
Labs for UC?
CBC- anemia, plts >350,000/mL
elevated ESR & CRP
CMP- hypoalbuminemia, hypokalemia, hypomagnesemia, elevated alk phos
stool analysis for organisms (salmonella, shigella, E. coli, etc)
Imaging for UC? xray? barium enema? what 2 can provide a dx?
xray might show colonic dilation in severe cases suggesting TOXIC MEGACOLON, also evidence of perforation, obstruction or ileus
barium enemas for mild cases, narrow, tubular, shortened colon w/loss of haustral folds, pseudopolyps & small ulcers
flexible sigmoidoscopy can provide diagnosis!!!
colonoscopy w/bx confirms dx also useful for documenting extend of dz but do with caution b/c of risk of perforation
Prognosis of UC?
controlled w/tx, usu lifelong exacerbations & remissions, severe cases need surgery
Extra-intestinal manifestations of IBD?
peripheral arthritis, erythema nodosum, conjunctivitis, fatty liver, pyelonephritis, amyloidosis
Crohn’s specific extra-intestinal manifestations of IBD?
cholelithiasis, renal oxalate stones, vit B12 deficiency, obstructive hydronephrosis, aphthous ulcers
