Inflammatory Bowel Dz

Question 1

Includes Crhons and Ulcerative Colitis

CD vs UC

Ab pain
Diarrhea
Dist
Inflmm
Ulcer
Lab findings

Answer 1

CD- crampy, large volume/watery, disc/asym, transmural, superficial/discrete, ASCA

UC- if severe, small/bloody, cont/sym, submucosal, extensive, pANCA

Question 2

Patho

both result from

Answer 2

genetics, IS, infections, environmental factors

immune dysreg, inflamm response

Question 3

Immune dysreg

key factors

Answer 3

disrupted pro/anti inflammatory response in IBD

exposure, epithelial dysfunction, aberrant immune response, altered microbiome

Question 4

Genes

Enviro factors

Smoking

Answer 4

IBD more than UC, usually a FH

Smoking, stress, infect, microorg colonizng, AB, OC, diet, hygiene, NSAIDs

inc CD dec UC

Question 5

Males vs females

peak ages

Geographic variations

Answer 5

M- UC more common
F- CD more common

3rd degade, 5-8 decade

N Europe/America, western countries

Question 6

Extraintestinal complications

Skin

Eyes

MSK

Biliary

Kidney

Lung

Answer 6

S- erythema nodosum, pyoderma gangrenosum

E- episclertitis, uveitis

M- AS, arthritis, ostoeporosis

B- PSC

K- nephrolitiasis (CaOx)

L- COP, ILD

Question 7

Inc riks of

rf include

pancolitis

other ca

Answer 7

CRC

extent of colitis and duration of dz (10+ yrs)

rectal (UC) and SB (CD)

inc risk of Ca, earlier

Question 8

CD involvement

Answer 8

all gi (ileum colon>sbo>colon)

Question 9

CM of CD

Crampy ab pain in

RLQ

Periumbilical

Lower ab\

Transmural inflamm

terminal ileus involved

Answer 9

watery diarrhea, ab pain (RLQ), WL, fever

ileitis

SB stricture

colitis/colonic stricture

excessive fluid sec/impaired absorpton

lack of BS resop, steatorrhea

Question 10

Compromised nutritional status

mild vs Mod vs severe

Fever
Ab pain
Wl
comp
Hb

Answer 10

more common in CD, WL, growth failure (SB involvement)

Mild- all normal
Mod- low, mod, min, min, normal

Severe- persis, severe RT, obvi, obstrct, <10

Question 11

Transmural inflamm leads to

Enterovesicular fistula

Enteroenteric fistula

enterovaginal fistula

enterocutaneous fistula

Answer 11

sinus tract/fistulas that penetrate serosa (form abscess)

tract bw intestine/bladder- recurrent UTI

asx, palp mass

intestine to vagina- stool from vagina

drain stool contents to skin

Question 12

Abscess formation

Hallmark of CD

GI involvement

Oral ulcers

Answer 12

tender mass, F

manifestations throughout GI tract- perianal tags/fussyres/abscess/fustulas

mistaken for PUD (Epigastric)

common- healthy indiv

Question 13

Dx

Charactertistic

Further investigations

lab features

Answer 13

colonoscopy- rectal sparing/perianal- diffuse aphtous ulcers throughout GI

fistulas w areas of normal mucosa around affected areas

upper endoscopy w upper GI sx

Elevated ESR/CRP/hypoalbumin/anemia

Question 14

Histo of CD

Micro findings

Answer 14

diffuse aphtous ulcers, linear ulcers

cobblestone mucosa, skip areas, fibrotic narrowing of lumen/fistuals/abscesses

Transmural inflammation, lymphoid cells
Thickened MM, ganulomas, hyperplasia

Question 15

Mx Mild dz

Moderate

Severe

Maintenace w remission

Answer 15

CS (budesonide) w AB (Cipro/metro)

CS + azathioprine

aathioprine+ anti TNF/methotrexate (useful for AS, sacroilitis, arthritis)

add azathiprine
Anti integrin AB block leukocyte migration (mod to severe)

Question 16

Surgery for pt w

kids

___ curative

Complications

Answer 16

complications failing med theray

growth retardation in kids

not

fistula, abscess, perforation, adhesions, intestinal obstruction

Question 17

UC defined by

begins in

Young males more likely to have

backwash ilieitis typical course

Answer 17

diffuse mucosal inflam of colon

distal rectum, progresses

pancolitis, less distal dz

IM exacerbations

Question 18

CM

Tenesmus

Answer 18

Bloody diarrhea, urgency
Freq BM, small

needing to pass stools though none is present (strraining, pain, cramping), LLQ cramps

Question 19

Mild to Mod to Severe

# stools day
F
Wl
Hb
ESR
Albumin

Answer 19

M- <4, normal

Mod- 4-6, normal, min, lowish, mild inc, mild dec

Severe- 6+, present, present, <10, inc, dec (<3)

Question 20

Dx

Involes, spreads

nitial presentation

Mucosal biopsy helps to

lab eval

Answer 20

colonoscopy- diffuse, symm erythematous mucosa, granules/friability

rectum, continuously

indisting- get stool studies for bacteria, shiga, ova/parasites, C diff

confirm dx

pANCA

Question 21

Histo of UC

severe
Ling standing

micro findings

Answer 21

Erythema, edema, granues, friabile

psuedopolyps
atrophy, lost folds

A/C inflamm into submucosa
Crypt distortion w abscesses
Basal plasma cells w lymphoid aggregeates

Question 22

Mx to induce remission

mild dz not remissing

Severe dz

Answer 22

5ASA (topical mesalamine via suppos/enema for mild)
CS (pred, methylpred) for all

using CS

CS/AB (cipro/metro)

Question 23

Relapses once a yr

Severe dz/CS to induce remission, maintenance therapy via

continue to have relapses

final step

Answer 23

daily emsalamine

azathiprine (6 wk min)

anti TNF agents needed

anti integrin AB

Question 24

Surgery

can be

Mild to mod dz, diet should minimize

Antidiarrhea agents

also beneficial

Answer 24

colectomy if refractory to tx

curative

alcohol, caff, gas prod, fiber

loperamide- mild to mod

probiotics

Question 25

Comp

severe sx may lead to

eventually

can also develo

Answer 25

bleeding to hemorrhage

fulminant colitis into MM

toxic megacolon- substantial dilation, concerned w perf

strcitrue in R/S area due to hypertrophy