Inflammatory Bowel Diseases and IBS

Question 1

Name the two inflammatory bowel diseases

Answer 1

Crohn’s and ulcerative colitis

Question 2

What is the major difference between Crohn’s and ulcerative colitis?

Answer 2

ulcerative colitis involves mucosal ulceration in the colon whereas Crohn’s involves transmural inflammation (ileitis, ileocolitis, and colitis)

Question 3

Ethinic group with increased incidence of inflammatory bowel disease

Answer 3

Jewish

Question 4

Age group most commonly affected by inflammatory bowel disease

Answer 4

2nd and 3rd decades

Question 5

Defect in the function of the intestinal lumen. Breakdown of the defense barrier of the gut. Exposure of mucosa to microorganisms or their products. Results in chronic inflammatory process mediated by T cells

Answer 5

pathophysiology of inflammatory bowel disease

Question 6

Systemic complications include: apthous stomatitis, episcleritis and uveitis, arthritis, vascular complications, E. nodosum, P. gangrenosum

Answer 6

inflammatory bowel disease

Question 7

complications of inflammatory bowel disease related to small bowel pathophysiology

Answer 7

gallstones, malabsorption, renal stones

Question 8

Involves the mucosal surface of colon with the formation of crypt abscesses. Always includes the rectum, spreads proximally

Answer 8

ulcerative colitis

Question 9

Clinical course is marked by flare-ups and remissions. More common in nonsmokers. Higher risk for development of cancer

Answer 9

ulcerative colitis

Question 10

Hallmark of ulcerative colitis

Answer 10

bloody diarrhea

Question 11

Symptoms include: rectal bleeding, LLQ cramps, severe diarrhea, fever, anemia, hypoalbuminemia, and hypovolemia

Answer 11

severe ulcerative colitis

Question 12

disease of bile ducts that causes inflammation and obstruction, 80% have UC, liver transplant

Answer 12

sclerosing cholangitis

Question 13

Systemic associations include: peripheral and central arthritis, uveitis, sclerosing cholangitis

Answer 13

ulcerative colitis

Question 14

What is needed for the diagnosis of ulcerative colitis?

Answer 14

sigmoidoscopic demonstration of inflammation and the exclusion of bacterial and parasitic infection.

Question 15

What are dietary recommendations for treatment of ulcerative colitis?

Answer 15

reduce dietary fiber during exacerbation, folic acid supplements w/sulfasalazine.

Question 16

What are pharmacological options for ulcerative colitis?

Answer 16

oral Fe w/rectal bleeding or anemia. Loperamide for troublesome diarrhea. Prednisone for inflammation.

Question 17

What do the following have in common in relation to ulcerative colitis: exsanguinating hemorrhage, toxicity/perforation, suspected cancer, dysplasia, systemic complications, growth retardation, and intractibility

Answer 17

indications for surgery

Question 18

Transmural involvement with formation of fistulas, narrowing of lumen, obstruction. Can involve any segment of the G.I. tract, but usually rectal sparing.

Answer 18

Crohn’s Disease

Question 19

Name of predominant segment of GI tract when it’s involved with Crohn’s disease

Answer 19

ileocolitis (45%)

Question 20

strongly associated with the development of Crohn’s Disease, resistance to medical therapy and early disease relapse

Answer 20

cigarettes (not e-cigs though)

Question 21

Insidious onset. Intermittent bouts of low-grade fever, diarrhea and RLQ pain. Postprandial pain common. RLQ mass. Perianal disease (abscess, fistula)

Answer 21

Crohn’s disease

Question 22

Often nocturnal B.M.’s, night sweats, weight loss.

Skin lesions, primarily erythema nodosum, may precede intestinal symptoms.

Answer 22

Crohn’s disease

Question 23

Common presentation of physical exam includes: abdominal distention, abnormal bowel sounds, tenderness in area of involvement.

Answer 23

Crohn’s disease

Question 24

Associated with abscesses, fistulas, skin tags in the perianal region as well as anal strictures.

Answer 24

Crohn’s disease

Question 25

Serum test that can be used for Crohn’s disease that is highly specific, but has low sensitivity

Answer 25

ASCA (anti-saccharomyces cerevisiae antibody)

Question 26

Radiography that is better for finding complications of Crohn’s disease including strictures and fistulas

Answer 26

Barium contrast studies

Question 27

“cobble stoning”, “skip lesions”, pseudodiverticula, dilated bowel, fistulas communicating to adjacent bowel/mesentery/bladder/vagina

Answer 27

Crohn’s Disease

Question 28

Serum test that can be used for detection of ulcerative colitis but is not useful as the sole diagnostic test due to low sensitivity.

Answer 28

Perinuclear antineutrophil cytoplasmic antibodies (pANCA)

Question 29

Common radiologic finding of Crohn’s disease due to narrowing and stricturing of terminal ileum

Answer 29

String sign

Question 30

A functional gastrointestinal disorder that is a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities

Answer 30

irritable bowel syndrome

Question 31

How long must a patient have abdominal pain or discomfort, pain relieved by defecation, and pain with a change in frequency or form of stools to be classified as having irritable bowel syndrome?

Answer 31

3 months

Question 32

Associated symptoms in order of prevalence includes: fatigue, back ache, early satiety, nausea, HA, irritable bladder, functional dyspepsia

Answer 32

irritable bowel syndrome

Question 33

How do we make a positive diagnosis of irritable bowel syndrome without costing the patient tons of money

Answer 33

Rome and Manning Guidelines

Question 34

positive diagnosis is usually made from h/o that includes onset during late teens/early twenties, intermittent, crampy pain that doesn’t occur at night

Answer 34

irritable bowel syndrome