Inflammatory Bowel Dz Flashcards
Includes Crhons and Ulcerative Colitis
CD vs UC
Ab pain Diarrhea Dist Inflmm Ulcer Lab findings
CD- crampy, large volume/watery, disc/asym, transmural, superficial/discrete, ASCA
UC- if severe, small/bloody, cont/sym, submucosal, extensive, pANCA
Patho
both result from
genetics, IS, infections, environmental factors
immune dysreg, inflamm response
Immune dysreg
key factors
disrupted pro/anti inflammatory response in IBD
exposure, epithelial dysfunction, aberrant immune response, altered microbiome
Genes
Enviro factors
Smoking
IBD more than UC, usually a FH
Smoking, stress, infect, microorg colonizng, AB, OC, diet, hygiene, NSAIDs
inc CD dec UC
Males vs females
peak ages
Geographic variations
M- UC more common
F- CD more common
3rd degade, 5-8 decade
N Europe/America, western countries
Extraintestinal complications
Skin
Eyes
MSK
Biliary
Kidney
Lung
S- erythema nodosum, pyoderma gangrenosum
E- episclertitis, uveitis
M- AS, arthritis, ostoeporosis
B- PSC
K- nephrolitiasis (CaOx)
L- COP, ILD
Inc riks of
rf include
pancolitis
other ca
CRC
extent of colitis and duration of dz (10+ yrs)
rectal (UC) and SB (CD)
inc risk of Ca, earlier
CD involvement
all gi (ileum colon>sbo>colon)
CM of CD
Crampy ab pain in
RLQ
Periumbilical
Lower ab\
Transmural inflamm
terminal ileus involved
watery diarrhea, ab pain (RLQ), WL, fever
ileitis
SB stricture
colitis/colonic stricture
excessive fluid sec/impaired absorpton
lack of BS resop, steatorrhea
Compromised nutritional status
mild vs Mod vs severe
Fever Ab pain Wl comp Hb
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
Transmural inflamm leads to
Enterovesicular fistula
Enteroenteric fistula
enterovaginal fistula
enterocutaneous fistula
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
Abscess formation
Hallmark of CD
GI involvement
Oral ulcers
tender mass, F
manifestations throughout GI tract- perianal tags/fussyres/abscess/fustulas
mistaken for PUD (Epigastric)
common- healthy indiv
Dx
Charactertistic
Further investigations
lab features
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
Histo of CD
Micro findings
diffuse aphtous ulcers, linear ulcers
cobblestone mucosa, skip areas, fibrotic narrowing of lumen/fistuals/abscesses
Transmural inflammation, lymphoid cells
Thickened MM, ganulomas, hyperplasia
Mx Mild dz
Moderate
Severe
Maintenace w remission
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)
Surgery for pt w
kids
___ curative
Complications
complications failing med theray
growth retardation in kids
not
fistula, abscess, perforation, adhesions, intestinal obstruction
UC defined by
begins in
Young males more likely to have
backwash ilieitis typical course
diffuse mucosal inflam of colon
distal rectum, progresses
pancolitis, less distal dz
IM exacerbations
CM
Tenesmus
Bloody diarrhea, urgency
Freq BM, small
needing to pass stools though none is present (strraining, pain, cramping), LLQ cramps
Mild to Mod to Severe
# stools day F Wl Hb ESR Albumin
M- <4, normal
Mod- 4-6, normal, min, lowish, mild inc, mild dec
Severe- 6+, present, present, <10, inc, dec (<3)
Dx
Involes, spreads
nitial presentation
Mucosal biopsy helps to
lab eval
colonoscopy- diffuse, symm erythematous mucosa, granules/friability
rectum, continuously
indisting- get stool studies for bacteria, shiga, ova/parasites, C diff
confirm dx
pANCA
Histo of UC
severe
Ling standing
micro findings
Erythema, edema, granues, friabile
psuedopolyps
atrophy, lost folds
A/C inflamm into submucosa
Crypt distortion w abscesses
Basal plasma cells w lymphoid aggregeates
Mx to induce remission
mild dz not remissing
Severe dz
5ASA (topical mesalamine via suppos/enema for mild)
CS (pred, methylpred) for all
using CS
CS/AB (cipro/metro)
Relapses once a yr
Severe dz/CS to induce remission, maintenance therapy via
continue to have relapses
final step
daily emsalamine
azathiprine (6 wk min)
anti TNF agents needed
anti integrin AB
Surgery
can be
Mild to mod dz, diet should minimize
Antidiarrhea agents
also beneficial
colectomy if refractory to tx
curative
alcohol, caff, gas prod, fiber
loperamide- mild to mod
probiotics
Comp
severe sx may lead to
eventually
can also develo
bleeding to hemorrhage
fulminant colitis into MM
toxic megacolon- substantial dilation, concerned w perf
strcitrue in R/S area due to hypertrophy
