LEC 11: Inflammatory Bowel Disease Flashcards
What is the primary role of the small intestine?
- To absorb nutrients from the food we eat
- Is 15 to 20 ft long
What is the primary role of the large intestine?
- To absorb water and rom our stool
- Is 3 to 5 ft long
What are the 2 types of inflammatory bowel disease?
- Crohn’s Disease (CD)
- Ulcerative Colitis (UC)
Crohn’s Disease (CD)
- Affect small and large intestine
- Affects full thickness of the bowel wall
- Inflammation is patchy with spots of ulceration and normal tissue (skip lesions)
- Rectal bleeding
- Fistulas, strictures, and abscesses common
- Toxic megacolon unusual
- Sever nutritional deficits’ malabsorption issues
- Weight loss is severe
- Surgery will not cure
Ulcerative Colitis (UC)
- -Limited to large intestine, rectum, and anus, possible terminal ileum
- Affects lining of the large bowel
- Inflammation starts distally and spreads continuously up colon
- Rectal bleeding
- Fistulas, strictures, and abscesses rare
- Toxic megacolon rare
- Weight loss common; less nutritional deficits
- Surgery will cure
What causes IBD?
- Genetics
- Environment
- Immune respomnse
Who gets IBD?
- Age factors
- All ages
- Peaks 15 to 35; 50 to 70
- Gender
- Both genders
- Genetics
- 20% blood relative
- Population
- More common in Caucasians and those with Jewish heritage
What are the symptoms of IBD?
- Abdominal pain
- Rectal bleeding an urgency
- Stools: loos, bloody, mucousy
- Cramping prior to bowel movement
- Increased gas production
- Fatigue, weakness
- Weight loss
- Anemia
- Malnutrition/ dehydration
Intestinal Obstruction
- Occurs when there is a partial or complete blockage of the intestine that prevents intestinal contents from passing though the GI tract 2. Symptoms include: - Nausea - Vomiting - Abdominal pain - Distension - Inability to pass flatus or stool - Hyperactive bowel sounds above obstruction 3. Goals for care: - Relieve the obstruction - Normal fluid and electrolyte imbalance - Maintenance of adequate nutrition 4. Treatment: - NPO - Removal of gas and fluid from intestine with a nasogastric tube - Possible surgery
How do you diagnose IBD?
- History/ symptoms - Physical exam - Blood work (C-Reactive protein, Erythrocyte sedimentation rate, WBC count, Hemoglobin) - Stool samples ( C&S and parasites; fecal calprotectin) - Colonoscopy with biopsies - Medical imaging (Barium swallow, CT scan)
What does the hemoglobin blood test assess for?
Want to assess for anemia from blood loss
What are the 3 disease management options?
- Drugs 2. Diet 3. Surgery
What is the goal of drug therapy?
- Reduce and control inflammation 2. Induce and maintain remission 3. Improve the quality of life *Medications are the first line of therapy and they fenerally target inflammation *Medications are for life
Types of drugs used for IBD?
a. Aminosalicylates - Decreases inflammation b. Glucocorticoids - Decreases inflammation and suppresses activity of immune system c. Immunomodulators/ Immunospuppresents - Decrease inflammation and suppress the immune system d. Biologis and Biosimilars - Block inflammation or decrease inflammation targeting specific molecules
Diet
a. Well balanced diet - Eat all food groups -May avoid trigger foods b. Dietary Supplements - Encouraged/ may be needed - Multivitamin - Calcium - Vitamin D - Vitamin B12 c. Probiotics - Microbiome - Promote good gut bacteria d. Omega 3 fatty acids - Anti-inflammatory effects e. FODMAPs - Sugar molecules - Causes GI symptoms - May avoid or reduce
