Inflammatory Bowel Disease = IBD

Question 1

What are the subtypes of IBD?

Answer 1

Ulcerative Colitis and Crohns Disease

Question 2

What are the characteristics of UC?

Answer 2

UC is characterized by diffuse mucosal inflamation in a continuous pattern limited to the colon. It usually begins in the rectosigmoid area and proceeds proximally, but it may develop in extensive areas of he colon at the same time.

Question 3

What are the characteristics of CD?

Answer 3

CD is characterized by transmural inflammation in a discontinuous pattern that can occur in any part of the GI tract from mouth to anus. The distal ileum and colon are the most common sites of CD involvement.

Question 4

What is the etiology of IBD?

Answer 4

Inflammatory changes in the GI tract, caused by an immune response against gut bacteria

Question 5

What is the age of onset for IBD?

Answer 5

Age of onset is bimodal, but is much more common in 15-30 year olds ( second peak is in the 60’s)

Question 6

What is the disease course of IBD?

Answer 6

Disease course is characterized by lifelong exacerbtions

Question 7

What is the treatment for CD?

Answer 7

• Steroids for acute flares
• Sulfasalazine, Mesalamine : best results with colonic disease
• Immunomodulators: 6-MP/Imuran, Methotrexate (slow onset)
• Anti-TNF (fistulous disease, immunomodulator failures, steroid resistant)
• Antibiotics (especially those aimed at enteric flora: Cipro, Flagyl, etc)
• Surgery will not cure!!

Question 8

What is the treatment for UC?

Answer 8

• Mesalamine- maintenance; different products deliver drug to different locations
• Steroids (Prednisone)- used for acute flares, steroid dependence is common
• Cyclosporine - for steroid refractory patients
• 6-MP/Imuran (slow onset) - severe, refractory disease, or steroid dependence
• Anti-TNF for steroid intolerant/immunomodulator medication therapy
• Surgery IS AN OPTION FOR CURE (ileal pouch with anal anastomosis)

Question 9

How is IBD diagnosed?

Answer 9

Diagnosis involves clinical, endoscopic and histologic criteria

Question 10

What are the endoscopic characteristics of UC?

Answer 10

• Mucosal involvement: diffuse/continuous/superficial ulceration
• Strictures: rare (always neoplastic)
• Rectal involvement: a;ways present at diagnosis

Question 11

What are the endoscopic characteristics of CD?

Answer 11

• Mucosal involvement: focal/asymmetric/a[hthoid or linear ulcerations or cobblestoning
• Strictures: common
• Rectal involvement: rectal sparing is common

Question 12

What are the extraintestinal features of uncontrolled IBD?

Answer 12

ocular disorders, aphtous stomatitis, ankylosing spondolytis, nephrolithasis, sacroileitis, thrombombolic complications, skin disorders, peripheral arthritis, primary sclerosing cholangitis/hepatobiliary disorders

Question 13

What are the most common symptoms of UC?

Answer 13

Tenesmus and bloody, pus-filled diarrhea are the most common symptoms

Question 14

Toxic megacolon and malignancy are more likely in ____ than in _____.

Answer 14

UC; CD

Question 15

Smoking is protective in which disease?

Answer 15

UC

Question 16

Smoking increases the disease in _____.

Answer 16

CD

Question 17

What are common diagnostic studies for UC?

Answer 17

Anemia, increased sedimentation rate and decreased serum albumin are common

Question 18

What is the best diagnostic method for establishing UC?

Answer 18

sogmoidoscopy or colonoscopy

Question 19

Fistulas are common in which form of IBD?

Answer 19

CD

Question 20

What physical exam findings would you expect to see in a patient with UC?

Answer 20

• Pale, tachycardia, fever
• Distention, decreased bowel sounds, tenderness LLQ
• Heme (+) stools

Question 21

Pain for UC tends to be in the ___ where for CD it is in the ____.

Answer 21

LLQ; RLQ

Question 22

What physical exam findings would you expect to see in a patient with CD?

Answer 22

• Thin, undernourished
• Tender RLQ
• Rectal: fistula, fissures