Inflammatory bowel disease Flashcards
What defines a severe UC flare
> 6 bloody bowel movements per day, severe abdominal cramps, weight loss, tachycardia, fever, anemia and elevated ESR/CRP
what should we evaluate for in a pt who has a suspected UC flare up?
infectious colitis, culture, ova and parasaite and C diff and flexible sigmoidoscopy to evaluate for extent of disease
Rule out toxic megacolon and colonic perforation
Management of a severe UC flare
systemic steroids and high dose 5 aminosalicylic acid (5ASA) compounds
Do we give empiric antibiotics for UC flares
no
only meant for severe UC if the pt has signs of severe systemic toxicity
(high fever, marked WBC with left shift and bandemia) or
toxic megacolon or
peritonitis
When do do you transition someone from IV steroids to PO steroids in a UC flare up
reassess in 3-5 days and if those who fail to respond after 7 to 10 days are steroid refractory and need cyclosporine or TNF inhibitor (infliximab)
if still refractory to TNF alpha inhibitors or cyclosporine, may need colectomy
Is a CT abd helpful in UC flare up?
when do you get one?
only helpful for evaluation of toxic megacolon and perforation
but not needed if physical exam and XR abd is unremarkable.
Try to limit CT scans given the amount that patient will likely experience in their life.
Tobacco use increases risk for
Crohn’s dx
protective for UC
inflammatory bowel disease has a bimodal age presentation:
in 20’s- 40’s and then 70-80’s years
Ulcerative colitis presentation:
diarrhea abdominal discomfort, rectal bleeding and tenesmus
can be slow and insidious onset and so may present looking like a infectious colitis.
Note diarrhea may not always be present too.
most commonly affected area of GI tract with Crohn’s
ileocecal area
what is hallmark of Crohn’s disease presentation
see fistula, abscess or strictures.
two most common skin manifestations of IBD are:
erythema nodosum
and pyoderma gangrenosum.
ocular manifestations of IBD
epicleritis (infection of sclera and conjunctiva) and uveitis (can present with headache blurred vision and photophobia)
Uveitis - this is a ocular emergency and need to see eye doctor.
what does fecal calprotectin do?
helps differentiate between IBD and irritable bowel syndrome
present in IBD
What is also seen on labs with IBD:
fe deficiency anemia, see thrombocytosis, leukocytosis and ESR and CR elevation.
earliest endoscopic findings of Crohn’s dx is
aphthous ulcers which can coalesce and form stellate ulcers or cobble stone appearance on the mucosa
what is also seen in EGD findings of Crohn’s dx?
skip lesions - and see granulomatous inflammation on mucosal biopsies.
Treatment of IBD is based on four categories of drugs;
5 aminosalicylates, glucocorticoids, immunomodulators, and biologics.
Goals are to induce and maintain remission and prevent disease or treatment related complications.
startification based on clinical severity is based on guiding IBD management but there is no consensus definition of mild, moderate, severe IBD. but we look at:
Dx in the patient (quality of life, clinical symptoms, and disability)
inflammatory burden (extent, location, and severity of bowel involvement)
disease course (structural damage)
surgery is used for:
refractory symptoms and complications.
proctitis is
rectal inflammation and seen in UC pts.
Proctitis can lead to frequent defecatory urges and passage of small liquid stools containing mucus and blood.
what are IBD pts at risk for if they ever get surgery?
VTE and so if they ever go get surgery they need subcut heparin and this is only held in severe GI bleeding, severe anemia, tachycardia, or hypotension.
mainstay of treatment to mild to moderate UC (has a dose dependent response)
5 aminosalicylate - these help an anti inflammatory effect.
Better to use oral AND topical 5 ASA.
Also helpful for maintaining remission.
UC with proctitis or left sided disease should get
GIVE 5 ASA or mesalamine combined ORAL (topical) AND suppositories and enemas.
sulfasalazine adverse reactions
5 ASA - mesalamine
- fever, rash, nausea, vomiting and headache.
can cause reversible sperm abnormalities
impairs folate absorption.