Inflammatory & Irritable Bowel Syndrome - Brown Flashcards
Inflammatory Bowel Disease
- Ulcerative Coliits
- Chron Disease
- chronic and recurrent
Crohn’s Disease
transmural inflammation - fibrosis, obstruction, sinus tracts, fistulas
skip lesions - disease is not continuous
involves entire GI tract
familial
increased risk due to: smoking, western diet, NSAIDS?
diagnosed by colonoscopy, increased inflammatory markers
increases risk for colon cancer - colonoscopy annually
tx:
- well balanced diet,
- mesalamine,
- oral antibiotics,
- corticosteroids (symptom improvement);
- cholestyramine for binding bile salts (diarrhea)
- methotrexate
- anti-TNF drugs
prognosis: intermittent exacerbation and periods of remission
Identify this condition and explain the management:
patient complains of abdominal pain and fluctuating diarrhea
patient has felt fatigued lately and has been loosing weight
patient has a skin tag abover his anus and has noticed increased joint stiffness and a rash (see below)
Crohn’s Disease
- abdominal pain - fibrotic strictures result from the transmural disease
- diarrhea is common, but fluctuates
- other symptoms: fatigue, weight loss, fever
Clinical Presentation
- chronic inflammatory disease
- intestinal obstruction
- penetrating disease and fistulae
- perianal disease
- extraintestinal manifestations: arthralgias, arthritis, iritiis, uveitis, pyoderma gangernosum, erthema nodusm (rash on front of slide)
Diagnosed by:
- colonoscopy
- LAB: CBC, blood chem, ESR, CRP, Iron, B12
Ulcerative Colitis
inflammatory condition of mucosa - primarily the rectum
recurrent
BLOODY DIARRHEA
symptoms: bloody diarrhea, frequent stooling, cramps, abdominal pain, tenesmus, fever, weight loss
increases risk of colon cancer
colonoscopy every 1-2 years
tx:
- 5-ASA Agents
- Steroids
- Immunomodulating Agents
- Severe: hospitalization, NPO, TPN; steroids, anti-TNF, cyclosporine, surgery
Identify this condition:
patient has UC confined to the rectum, intermittent bleeding, mild diarrhea <4/day
Mild Ulcerative Colitis
Identify this condition:
patient has UC in the rectum, distal colon, proximally to the splenic flexure, bloody diarrhea 5/day, anemia, abdominal pain and a low grade fever
Moderate Ulcerative Colitis
Identify this condition:
patient has diarrhea 7/day, severe cramping and rapid weight loss
colonoscopy reveals patient has UC extending all the way to the cecum
Severe Ulcerative Colitis
Fulminant Colitis
- type of severe UC
- rapid progression
- severe S&S
- risk of perforation
- broad-spectrum antibiotics
Toxic Megacolon
- dilation of colon
- risk of perforation
- surgery to remove colon
- risk of death
Irritable Bowel Syndrome
**functional GI disorder - **absence of organic pathology
abdominal pain
**altered bowel habits **
- IBS-C, IBS-D or mixed
- constipation
- diarrhea
- postprandial urgency
chronic, relapsing condition
Irritable Bowel Syndrome - Pathophysiology
small bowel dysmotility
- delayed meal transit IBS-C (constipation dominant)
- accelerated meat transit IBS-D (diarrhea dominant)
- can also have mixed
visceral hyperalgesia
- enhanced perception of motility and visceral pain
pscyhopathology
- association not clearly defined
Irritable Bowel Syndrome - History
Abdominal Pain
- diffuse or LLQ
- acute sharp pain episodes, underlying dull ache
Abdominal Distension - bloated/gas
Associated Symptoms
- dyspepsia/heartburn
- nausea and vomiting
- urinary frequency and urgency
**NO: >40, progressively worsening, weight loss, anorexia, fever, rectal bleeding, steatorreha
Irritable Bowel Syndrome - Exam
- patient looks healthy
- mild, diffuse tenderness or LLQ tenderness
- rest of exam - insignficant
Irritable Bowel Syndrome - Diagnostic Work Up
- CBC - screen for anemia, infection, inflammation
- Chemistries - electrolytes, BUN, Cr, Ca
- TSH
- Hemoccult
- ESR - non specific for inflammation
- CRP - non specific for inflammation
- Hydrogen Breath Test - lactose/fructose intolerance
- Stool Culture
- Lactose-free diet
- Flex Sig or Colonoscopy - if bleeding, anemia, wt loss, anorexia, chronic diarrhea, age > 40
- EGD -weight loss dyspepsia
ROME III Criteria for Diagnosis of IBS
recurrent abdominal pain or discomfort for at least 3 days per month; 3 months; associated with 2 or more
- pain/discomfort relieved w/ defecation
- onset associated with change in stool frequency
- onset associated with change in stool form or appearance
supporting symptoms
- altered stool frequency
- altered stool form
- altered stool passage (straining/urgency)
- stool with mucus
- abdominal bloating or distension
Identify this condition:
onset: 15-35 years
bloody diarrhea with mucus, fever, abdominal pain, weight loss, tensmus
colonoscopy: mucousal erythema, ulcers
Ulcerative Colitis
inflammatory disease of mucosa and sub mucosa
Identify this condition:
onset 15-35 and 70-80 years
fever, abdominal pain, diarrhea (no blood), weight loss
anorectal fissures and abscesses
colonoscopy: nodularity, rigidity, ulcers, strictures, fistulas
Crohn’s Disease
can involve ANY part of GI tract, inflammation extends through intestinal wall from mucosa to serosa (small bowel, colon common)
Identify this condition:
chronic diarrhea with cramps
blood and mucus can be present in stool
malaise and weight loss common
recent travel
Infectious Diarrhea
can be bacterial, viral, or parasitic
consider stool culture
Identify this condition:
pain LLQ
fever
change in bowel habits
leukocytosis
colonoscopy reveals diverticula
diverticulitis - diverticular (pockets/hernias) or colonic mucosa through muscularis become occlude and inflammed
Identify this Condition:
abdominal distension and bloating
diarrhea occassionally constipation
symptoms exacerbated by intake of diary products
positive hydrogen breath test
Lactose Intolerance
Identify this condition
diarrhea (frothy, tan, foul smelly), flatulence, wt loss, abdominal distension, failure to thrive in children
Celiac Disease: inflammatory disorder characterized by malabsorption precipitated by gluten; genetic disorder
Irritable Bowel Syndrome Treatment
behavior modification, stress reduction, treat symptoms
Anticholinergics: antispasmodics inhibit intestinal smooth muscle depolarization at muscarinc receptor
- Dicyclomine HCL
- Hycosamine Sulfate
Antidiarrheals: non-absorbable synthetic opioids, prolong transmit time and decrease secretion
- Lomotil
- Immodium (Loperamide)
Tricyclic Antidepressants: visceral analgeisc effect, increasing pain threshold of gut, prolong oral-cecal transit time
- Imipramine
- Amitriptyline
GC-C Agnoist: alleviates abdominal pain and increases bowel movement frequency
- Linzess
Prokinetics: promotility for constipation dominant
- Propulsid
- Tegaserod
Bulk Forming Laxatives: fiber supplementation to improve symptoms of constipation and diarrhea
- Methylcellulsoe
- Psyllium
