Inflammatory Bowel Disease Flashcards
Types of ibd
UC and crohsn
which part does UC affect? crohns?
UC: mainly colon/large bowel crohns: gum to bum
T/F IBD is multifactorial
true. more than 150 genes, envrionmental and dietary factors, innate immune dysfunction, gut microbiome.
key envrionmental factor that will exacerbate crohns
smoking
microbial dysbiosis
reciprocal relaitonship to IBD that involves in less biodiversity of commensal bacteria. there are higher concentrations of mucosa assocaited bacteria, and more mucoltic bacteria associated with mucosal membranes
How does Ulcerative colitis present?
- mucosal inflammation, always starts in the rectum and extends proximally and contiguously. DOES NOT AFFECT THE SMALL INTESTINE
t/r: UC happens in the small intestine
false. it starts in the rectum and extends proximally and contiguously. it does not happen in “patches” like crohns
which layers of the boweldoes UC affect
mucosal inflammation– typically does not involve the submucosa, muscularis and serosa
definition of UC
chronic, idiopathic, immune mediated mucosal inflammation of the colon and rectum this is a superficial inflammation– only affects the mucosa.
proctitis
inflammation of the rectum, type of UC
which parts are affected by left sided UC
rectum, sigmoid and descending colon
extensive colitis
left sided colitis plus constitutional sym,ptoms fatigue and fever. more extensinve that left sided UC
how does colitis become ulcerative
colitis is inflammation. the mucosa gets so inflammed that it affects blood systems and such, leading to ulcerate.
ulcerative colitis symptoms
rectal symptoms: urgency and tenesmus - abdominal cramping - diarrhea (low volume, frequent, nocturnal, bloody) - CHRONIC– DISTINGUISH THIS FROM ACUTE INFECTION (EX/ 3 DAYS OF DIARRHEA IS NOT ULCERATIVE COLITIS) - systemic symptoms: weight loss, fatigue, fever (severe disease), extraintestinal manifestations
DDx of ulcerate colitis
- infectious colitis (bacterial due to shugella, campylobacter, salmonella, e coli, yersinia) CDif, amebic colitis, infectious proctitis (chlamydia, gonorrhea)
- ischemic colitis: different from mesenteric ischemic. IC is not enough blood flow to the colon. this presents with acute pain and bloody diarrhea.
- crohn’s colitis
- radiation colitis/ protitis
- microscopic colitis.
nild, moderate, and severe UC
- the more bowel mobements, the more severe. severe has higher heart rate, temperature, and lower Hb because they are bleeding. CRP is >30, indicating severe inflammation.
natural history of UC
relapsing and remitting– there are times where symptoms will be very bad, and then it feels better for a little while.
Acute Severe UC is a medical emergency. What is it’s definition?
OVER 6 BLOODY BM PER DAY, AND SYSTEMIC TOXICITY: HR up, WBC up, BP down, HIGH TEMP
treatment for ASUC
this is a medical emergency. high risk for needing their colon taken out. intravenous corticosteroids, need a colorectal surgery consult.
which layers of the bowel does crohns affect
its a tansmural inflammation. it can affect all layers and areas of the bowel. it’s transmural (all layers of the bowel)
specific type of lesion seen in crohns
SKIP LESIONS: discontinous inflammation areound the GI tract. there are aras of normal bowel inbetween sites of inflammation from GUM to BUM.
unlike UC which has continous mucosal lesions
most patients with crohns have ____ involvemnet
ileal involvement.
stricturing crohns disease
penetrating crohns
perianally penetreting crohns
B2: parts of the bowel squeezes
B3: penetrating: parts of the bowels start to stick to other parts of bowel or bladder through FISTULA FORMATION
B4: bowel becomes more and mores strictures and fistulas.
A patient presents with a fistula between colon and bladder. Should you suspect ulcerative colitis
T/F you can treat crohns fistulas and absess through meds
false. you need surgery
hallmark symptoms of crohns
abdominal pain
diarrhea– due to malabsorption of fats, bile acid malabsorption (cause ileum is usually negatively affect), plus water malabsorption (if crohns is affected colon/large bowel)
rectal bleeding– but if you don’t have colonic or rectal involvemnet, then it most likeyl wont be present. rectal bleeding is hallmark UC symptom.
perianal abscess/fistula
weight loss
extraintestinal manifestations
overall, symptoms are poorly correlated with objective disease activity in Crohns. These symptoms are common for many conditions. you need to scope
crohns complications
stricturing crohns. the ulcer got so bad and healing is trying to occur. this is penetating quite deep. you can tell its not UC because its DEEP and affecting many layers, whereas UC is superficial mucosal damage.
you see granulomas on large bowel biopsy. Crohns or ulcerative colitis?
crohns. Granulomas = crohns
managing perianal disease (crohns)
perianal diseases usually causes abscesses and fistulas between rectum and surrounding areas (ex rectovaginal or rectostricture)
- need antibiotics to clear perianal sepsis
- drain abscesses : need surgical examination under anesthesia.
penetrating crohns diseases: intra-abdominal abscess
- Fever, abdominal pain, peritoneal signs • Typically subacute • Psoas abscesses common
- Fistula tract from the terminal ileum to the retroperitoneum
- Flank pain, fever, positive psoas sign
- Limping gai
fibrostenotic (stricuring) crohn’s disease
longstanding crohns inflammation, leads to fibrosis.
-postprandial pain, bloating, distention.
• Insidious onset • Colicky nature • Results in decreased oral intake and
weight loss • Complete obstruction (obstipation,
distention, nausea/vomiting)
surgical emergency
NOTE: difference between UC and Crohns
oral and Ocular EIMS (extraintestinal manifestations of IBC)
Aphthae, stomatitis, angular cheiliti– ulcers in the mouth
- Episcleritis
- Inflammation of the episcleral
- Red and irritated
- No visual loss • Scleritis
- Severe pain/tenderness to palpation
- Visual loss, retinal detachment • Uveitis
- Painful red eyes
- Visual blurring/photophobia
- Visual loss (if retina/posterior uvea involved)
pyoderma gangrenosum
a dermatological EIM that is pathergtic (gets worse as you touch it). looks like an ifection but its not.
liver problems that’s EIM to IBD
PSC. IBD patients are predisposed to PSC. They need to be screened every year. People with PSC need to be screened for colon cancer every year.
After diagnosis of UC, when should you screen for Colon Cancer?
8 years after Dx of pancolitis, and 15 years after Dx of left-sided colitis
Tests to run for somoene with IBD
CBC- look for anemia, microcytosis, thrombocytosis (inflammatory response) and leukicytosis (infection
CRP (inflammation
Metabolic studies (hypokalemia
Iron studies (iron deficiency anemia/anemia of chronic disease
albumin (nutritional status, negative acute phase reactant
autoantibodies (If pANCA+, UC>CF)
Looking at autoantibodies, if pANCA is+ , then is it more likely UC or CD? What about if ASCA is +?
PANCA + = UC>CD
ASCA+ = CS>UC
