Inflammatory Bowel Disease

Question 1

Types of ibd

Answer 1

UC and crohsn

Question 2

which part does UC affect? crohns?

Answer 2

UC: mainly colon/large bowel crohns: gum to bum

Question 3

T/F IBD is multifactorial

Answer 3

true. more than 150 genes, envrionmental and dietary factors, innate immune dysfunction, gut microbiome.

Question 4

key envrionmental factor that will exacerbate crohns

Answer 4

smoking

Question 5

microbial dysbiosis

Answer 5

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

Question 6

How does Ulcerative colitis present?

Answer 6

• mucosal inflammation, always starts in the rectum and extends proximally and contiguously. DOES NOT AFFECT THE SMALL INTESTINE

Question 7

t/r: UC happens in the small intestine

Answer 7

false. it starts in the rectum and extends proximally and contiguously. it does not happen in “patches” like crohns

Question 8

which layers of the boweldoes UC affect

Answer 8

mucosal inflammation– typically does not involve the submucosa, muscularis and serosa

Question 9

definition of UC

Answer 9

chronic, idiopathic, immune mediated mucosal inflammation of the colon and rectum this is a superficial inflammation– only affects the mucosa.

Question 10

proctitis

Answer 10

inflammation of the rectum, type of UC

Question 11

which parts are affected by left sided UC

Answer 11

rectum, sigmoid and descending colon

Question 12

extensive colitis

Answer 12

left sided colitis plus constitutional sym,ptoms fatigue and fever. more extensinve that left sided UC

Question 13

how does colitis become ulcerative

Answer 13

colitis is inflammation. the mucosa gets so inflammed that it affects blood systems and such, leading to ulcerate.

Question 14

ulcerative colitis symptoms

Answer 14

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

Question 15

DDx of ulcerate colitis

Answer 15

1. infectious colitis (bacterial due to shugella, campylobacter, salmonella, e coli, yersinia) CDif, amebic colitis, infectious proctitis (chlamydia, gonorrhea)
2. ischemic colitis: different from mesenteric ischemic. IC is not enough blood flow to the colon. this presents with acute pain and bloody diarrhea.
3. crohn’s colitis
4. radiation colitis/ protitis
5. microscopic colitis.

Question 16

nild, moderate, and severe UC

Answer 16

• 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.

Question 18

natural history of UC

Answer 18

relapsing and remitting– there are times where symptoms will be very bad, and then it feels better for a little while.

Question 19

Acute Severe UC is a medical emergency. What is it’s definition?

Answer 19

OVER 6 BLOODY BM PER DAY, AND SYSTEMIC TOXICITY: HR up, WBC up, BP down, HIGH TEMP

Question 20

treatment for ASUC

Answer 20

this is a medical emergency. high risk for needing their colon taken out. intravenous corticosteroids, need a colorectal surgery consult.

Question 21

which layers of the bowel does crohns affect

Answer 21

its a tansmural inflammation. it can affect all layers and areas of the bowel. it’s transmural (all layers of the bowel)

Question 22

specific type of lesion seen in crohns

Answer 22

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

Question 23

most patients with crohns have ____ involvemnet

Answer 23

ileal involvement.

Question 24

stricturing crohns disease

penetrating crohns

perianally penetreting crohns

Answer 24

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.

Question 25

A patient presents with a fistula between colon and bladder. Should you suspect ulcerative colitis

Question 26

T/F you can treat crohns fistulas and absess through meds

Answer 26

false. you need surgery

Question 27

hallmark symptoms of crohns

Answer 27

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

Question 28

crohns complications

Answer 28

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.

Question 29

you see granulomas on large bowel biopsy. Crohns or ulcerative colitis?

Answer 29

crohns. Granulomas = crohns

Question 31

managing perianal disease (crohns)

Answer 31

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.

Question 32

penetrating crohns diseases: intra-abdominal abscess

Answer 32

• 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

Question 33

fibrostenotic (stricuring) crohn’s disease

Answer 33

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

Question 34

NOTE: difference between UC and Crohns

Question 35

oral and Ocular EIMS (extraintestinal manifestations of IBC)

Answer 35

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)

Question 36

pyoderma gangrenosum

Answer 36

a dermatological EIM that is pathergtic (gets worse as you touch it). looks like an ifection but its not.

Question 37

liver problems that’s EIM to IBD

Answer 37

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.

Question 38

After diagnosis of UC, when should you screen for Colon Cancer?

Answer 38

8 years after Dx of pancolitis, and 15 years after Dx of left-sided colitis

Question 39

Tests to run for somoene with IBD

Answer 39

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)

Question 40

Looking at autoantibodies, if pANCA is+ , then is it more likely UC or CD? What about if ASCA is +?

Answer 40

PANCA + = UC>CD

ASCA+ = CS>UC