Intro to IBD and Miscellaneous GI Disorders Flashcards
Characteristics of Ulcerative Colitis
o Continuous inflammation o Colon only o Superficial inflammation o Variable involvement o Risk of cancer o Extraintestinal manifestation
Clinical presentation of UC
o Diarrhea (bloody and mucus), abd pain and tenderness
o Loss of appetitie and weight, fever, fatigue, urgency for bowel movement
o Children: growth and developmental failure
Endoscopic findings of UC
Erythema, loss of usual fine vascular pattern, granularity of mucosa, friability, edema, pseudopolyps, erosions, ulcers, spontaneous bleeding, cecal path, backwash ileitis
Fulminant colitis (9%)
o Severe UC with fever, elevated WBC with unstable vitals. Full colonoscopy not necessary.
o Flex sig only to rule out other causes like C. diff and take biopsies
o High risk of perforation
General characteristics of Crohn’s disease
o Patchy inflammation, mouth to anus, full-thickenss inflammation, variable involvement, cobblestone appearance, fistulae, strictures and surgery, extraintestinal manifestations.
Clinical presentation of Crohn’s
o Peds: abd pain, diarrhea, weight loss, anorexia, vomiting, rectal bleeding, stunted growth, fevers
o Adult: similar presentation, growth and development issues less apparent, often had silent disease as child/teen
Endoscopic findings in Crohn’s
o Aphthous ulcers
o Cobblestoning
o Discontinuous lesions
Stuff that favors Crohn’s
- Rectal sparing: UC always affects rectum
- Normal vasculature next to affected tissue
- Isolated involvement of terminal ileum: backwash ileitis only in pancolitis
- Fistula or strictures (very rare in UC, malignant)—transmural
- Granulomas on biopsy
IBD Tx
- Anti-TNF therapy has been shown to induce and maintain remission
- Steroid sparing medication
- Heal perianal fistulizing disease
- Need regular dosing and concomitant immunomodulators to: avoid immunogenicity, boost drug levels, improves mucosal healing rates.
- Decreased rates of infection because: fewer are on steroids (less opportunistic infections), improved mucosal healing, fewer fistula/stricture/abscesses
Irritable Bowel Syndrome
- Chronic and relapsing abd pain, bloating, changes in bowel habits—diarrhea + constipation
- Pathogenesis is poorly understood: psychologic stressors, diet, abnormal GI motility, visceral hypersensitivity
- 20-40 yo females, post-infectious IBS
- Lab: Normal CBC, electrolytes, LFTs
- Row III criteria: recurrent abd pain or discomfort for 3 days/month or last 3 months associated with 2+ of the following: 1. Improvement with defecation. 2. Onset associated with change in freq or stool. 3. Onset associated with change in form of stool
Diverticular disease and Diverticulitis
- Pseudodiverticular outpouchings of colonic mucosa and submucosa. Unique structure of the colonic muscularis propria. Nerves and arterial vasa recta penetrate the inner circular muscle coat to create discontinuities in the muscle wall.
- Rare under 30yo. Develops under conditions of elevated intraluminal pressure in sigmoid colon. Can be exacerbated by diets low in fiber, which reduce stool bulk.
- Most common in sigmoid colon, but all regions of colon can be affected.
- Obstruction of diverticula → inflammation → divertculitis → perforation → formation of pericolonic abscesses, development of sinus tracts and sometimes peritonitis.
- Sx: most are asx, 20% develop complaints—intermittent cramping, continuous lower abd discomfort, consiptation, diarrhea.
- High-fiber diet can prevent diverticulitis—can resolve on its own or after antibiotic tx, few require surgery.
Acute appendicitis
- Adolescents and young adults but may occur in any age group. Lifetime risk = 7%.
- M>F, 50-80% have luminal obstruction—stonelike mass of stool or fecalith. Ischemic injury and stasis of luminal contents—favors bacterial proflieration, trigger inflammatory responses.
- Early AA → periumbilical pain, moves to the right lower quadrant
- N/V, low grade fever, mildly elevated white cell count.
- McBurney’s sign = deep tenderness at 2/3rd of distance from umbilicus to the right anterior superior iliac spine.
Ischemic Colitis
- Ranges from mucosal infarction to transmural infarction
- Mucsoal infarction: from hypoperfusion (hypotension or arterial spasm)
- Transmural infarction from arterial occlusion (acute arterial thrombosis or embolis)
- Intestinal segments at end of their respective arterial supplies are particularly susceptible to ischemia.
- Disease is often segmental and patchy, mucsoa is hemorrhage and ulcerated.
- Resolves when inciting event resolves (hypotension is corrected).
- Occurs in older people with coexisting cardiac or vascular disease.
- Acute transmural infarction usually manifests with sudden, severe abd pain and tenderness, sometimes with nausea, vomiting, bloody diarrhea, or grossly melanotic stool.
What is the watershed zone?
• Watershed zones = splenic flexure, sigmoid colon and rectum
Small Intestinal Bacterial Overgrowth
- SI is relatively sterile compared to colon. It’s protected by gastric acid and ICV at either end and relatively fast transit of contents.
- Disruption of these mech → increased bacterial contact with unabsorbed carbs: surgery, antacid, slow motility.
- Difficult to diagnose: duodenal aspirate, hydrogen breath test.
