Inflammatory Bowel Disease pg 2174

Question 1

what does the umbrella term “inflammatory bowel disease” encompass?

Answer 1

Ulcerative Colitis and Crohns Disease

Question 2

Which of the Inflammatory Bowel Diseases is limited to colonic mucosa and may have pseudo polys?

Answer 2

Ulcerative Colitis

Question 3

Which of the inflammatory diseases can affect any segment of the GI tract from mouth to anus, has skip lesions, and transmural inflammation?

Answer 3

Crohns Disease

Question 4

Which disease process is especially likely to have extra intestinal manifestations of the inflammatory bowel diseases?

Answer 4

Crohns

Question 5

What is the most common portion of the GI tract that Crohns affects?

Answer 5

terminal ilium. Resulting in malabsorption of foods, B12, Bile Salts, and Calcium

Question 6

What are some common sx of B12 macrocytic anemia?

Answer 6

numbness and tingling in distal aspects of upper and lower extremities and disequilibrium

Question 7

clinicians should take note of the following when examining a patient with Crohns:

Answer 7

fever
sense of well being
weight loss
abdominal pain
# of liquid bowel movements per day
surgical.hospitalization history

Question 8

Common Sx of Crohns:

Answer 8

ileitis or ile-colitis
diarrhea, non bloody
fever
malaise
cramping
palpable, tender mass (abscess)
SBO

Question 9

What can develop between adjacent structures from the transmural nature of the Crohns?

Answer 9

fistulas

Question 10

if there is a fistula in the bladder a patient may complain of what sx?

Answer 10

“peeing out air”

Question 11

1/3 or crohns patients develop perianal disease, name some manifestations:

Answer 11

skin tags
fissures
perianal abscess
peri anal fistulas

Question 12

why are patients with Crohns likely to have cholelithiasis?

Answer 12

malabsorption of bile salts from the terminal ileum, creating imbalance of bile salts, precipitating cholesterol in the biliary system.

Question 13

Pertinent Pathophysiology of Crohns:

Answer 13

insidious onset with fevers, diarrhea, RLQ pain
Perianal diseases after exacerbations
RAD evidence of ulcers, strictures, fistulas
Ileitis or ileocolitis

Cigarette smoking is strongly associated with development of disease.

Question 14

Labs for Crohns

Answer 14

CBC and serum albumin. (assess immune response and nutritional status)

Question 15

RAD for Crohns:

Answer 15

Endoscopy
Colonoscopy

(not recommended during acute exacerbation)

CT scan
(during an acute exacerbation)

Question 16

available therapies for symptomatic treatment of Crohns

Answer 16

5 aminosalicylic acid derivatives (5 ASA)
Corticosteroids
Immuno modulating and biologic agents (e.g. Monoclonal antibodies, methotrexate)

Question 17

management of Crohsn:

Answer 17

discontinue tobacco products
consult to GI and General Surger
MEDEVAC

Question 18

Aside from complications such as abscess, SBO, fistulas, perianal diseases, what is a major complication of Crohns?

Answer 18

Screening colonoscopy is recommended for patients with 8 or more years of flare ups due to patients being 20x more likely to develop colon cancer.

UC has a higher chance of carcinoma.

Question 19

Ulcerative colitis manifests in inflammation of the mucosa of the colon causing what sx:

Answer 19

ulcerations
edema
bleeding (common, unlike Crohns)
fluid and electrolyte loss

Question 20

where are the diseases confined to in the patient with UC, usually in even 1/3 distribution?

Answer 20

1/3 confined to recto sigmoid region
1/3 extends to splenic flexure (left sided colitis)
1/3 extends more proximally (extensive colitis)

Question 21

appendectomy’s before what age are associated with reduced risk of developing UC?

Answer 21

20 years old.

Question 22

Which IBD actually has an increase in SX in the non smoker vs the smoker?

Answer 22

UC

Question 23

what is tenesmus?

Answer 23

consistent feeling of needing to defecate, a pertinent history of patients with UC .

Question 24

Sx of UC?

Answer 24

bloody diarrhea (hallmark)
Lower Abdomen cramps, tenesmus
anemia (due to blood loss and inflammation)
low serum albumin (due to inflammation)
negative stool cultures

Question 25

how is a mild case of UC defined?

Answer 25

gradual onset of diarrhea (less than 5 movements a day)
fecal urgency and tenesmus
LLQ cramps relieved by defecation.
No abdominal tenderness

Question 26

how is moderate UC defined?

Answer 26

severe diarrhea with bleeding
abdominal pain and tenderness (present, not severe)
fever, anemia, hypoalbuminemia

Question 27

how is severe UC defined?

Answer 27

6-10 bloody bowel movements per day
anemia, hypovolemia, low albumin
abd pain and tenderness

Question 28

What should the examiner focus on in the initial flare up of UC?

Answer 28

volume status determined by orthostatic BP, HR, urine output.
Mental and Nutritional status

Question 29

labs for UC:

Answer 29

CBC, ESR, CRP, stool bacteria, C dif, O/P, serum albumin, and electrolytes

Question 30

Rad or imaging for UC

Answer 30

CT if suspected fistula, abscess, or perf.
8 years post flare up

colonoscopy to screen for carcinoma

Question 31

treatments for UC:

Answer 31

terminate the acute, symptomatic attack
prevent recurrence

Meds: mesalamine, corticosteroids, 5 ASA, DO NOT USE LOPERAMIDE

Surgery in severe cases.

Question 32

Disposition of Crohns and UC

Answer 32

both need higher echelon evaluation
treat SX
both need biopsy

MEDEVAC, refer to GI or gen surgery