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
