Inflammatory Bowel Disease pg 2174 Flashcards
what does the umbrella term “inflammatory bowel disease” encompass?
Ulcerative Colitis and Crohns Disease
Which of the Inflammatory Bowel Diseases is limited to colonic mucosa and may have pseudo polys?
Ulcerative Colitis
Which of the inflammatory diseases can affect any segment of the GI tract from mouth to anus, has skip lesions, and transmural inflammation?
Crohns Disease
Which disease process is especially likely to have extra intestinal manifestations of the inflammatory bowel diseases?
Crohns
What is the most common portion of the GI tract that Crohns affects?
terminal ilium. Resulting in malabsorption of foods, B12, Bile Salts, and Calcium
What are some common sx of B12 macrocytic anemia?
numbness and tingling in distal aspects of upper and lower extremities and disequilibrium
clinicians should take note of the following when examining a patient with Crohns:
fever
sense of well being
weight loss
abdominal pain
# of liquid bowel movements per day
surgical.hospitalization history
Common Sx of Crohns:
ileitis or ile-colitis
diarrhea, non bloody
fever
malaise
cramping
palpable, tender mass (abscess)
SBO
What can develop between adjacent structures from the transmural nature of the Crohns?
fistulas
if there is a fistula in the bladder a patient may complain of what sx?
“peeing out air”
1/3 or crohns patients develop perianal disease, name some manifestations:
skin tags
fissures
perianal abscess
peri anal fistulas
why are patients with Crohns likely to have cholelithiasis?
malabsorption of bile salts from the terminal ileum, creating imbalance of bile salts, precipitating cholesterol in the biliary system.
Pertinent Pathophysiology of Crohns:
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.
Labs for Crohns
CBC and serum albumin. (assess immune response and nutritional status)
RAD for Crohns:
Endoscopy
Colonoscopy
(not recommended during acute exacerbation)
CT scan
(during an acute exacerbation)
available therapies for symptomatic treatment of Crohns
5 aminosalicylic acid derivatives (5 ASA)
Corticosteroids
Immuno modulating and biologic agents (e.g. Monoclonal antibodies, methotrexate)
management of Crohsn:
discontinue tobacco products
consult to GI and General Surger
MEDEVAC
Aside from complications such as abscess, SBO, fistulas, perianal diseases, what is a major complication of Crohns?
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.
Ulcerative colitis manifests in inflammation of the mucosa of the colon causing what sx:
ulcerations
edema
bleeding (common, unlike Crohns)
fluid and electrolyte loss
where are the diseases confined to in the patient with UC, usually in even 1/3 distribution?
1/3 confined to recto sigmoid region
1/3 extends to splenic flexure (left sided colitis)
1/3 extends more proximally (extensive colitis)
appendectomy’s before what age are associated with reduced risk of developing UC?
20 years old.
Which IBD actually has an increase in SX in the non smoker vs the smoker?
UC
what is tenesmus?
consistent feeling of needing to defecate, a pertinent history of patients with UC .
Sx of UC?
bloody diarrhea (hallmark)
Lower Abdomen cramps, tenesmus
anemia (due to blood loss and inflammation)
low serum albumin (due to inflammation)
negative stool cultures
how is a mild case of UC defined?
gradual onset of diarrhea (less than 5 movements a day)
fecal urgency and tenesmus
LLQ cramps relieved by defecation.
No abdominal tenderness
how is moderate UC defined?
severe diarrhea with bleeding
abdominal pain and tenderness (present, not severe)
fever, anemia, hypoalbuminemia
how is severe UC defined?
6-10 bloody bowel movements per day
anemia, hypovolemia, low albumin
abd pain and tenderness
What should the examiner focus on in the initial flare up of UC?
volume status determined by orthostatic BP, HR, urine output.
Mental and Nutritional status
labs for UC:
CBC, ESR, CRP, stool bacteria, C dif, O/P, serum albumin, and electrolytes
Rad or imaging for UC
CT if suspected fistula, abscess, or perf.
8 years post flare up
colonoscopy to screen for carcinoma
treatments for UC:
terminate the acute, symptomatic attack
prevent recurrence
Meds: mesalamine, corticosteroids, 5 ASA, DO NOT USE LOPERAMIDE
Surgery in severe cases.
Disposition of Crohns and UC
both need higher echelon evaluation
treat SX
both need biopsy
MEDEVAC, refer to GI or gen surgery
