Lec 28 Flashcards
What are some things you see in IBD but not IBS?
- anemia
- increased platelets, increased ESR, decreased albumin
- weight loss, fever
- perianal disease
- bloody stool, tenesmus
- fecal WBC, occult blood
How do you differentiate acute infection from IBD?
acute infection:
< 2 wks duration; abrupt onset; normal platelets; normal Hbg; neutrophils see in biopsy
IBD: > 4 wks, insidious, high platelets, low Hgb, mixed infiltrate and abnormal architecture
Where do you primarily see crohns in the GI tract?
- can see any portion of GI tract
- usually terminal ileum and/or colon
- have skip lesions and usually rectal sparing
- transmural inflammation
What is typical patient who presents with IBD?
teens to 30s; pretty even men/women
What are 2 factors that protect against ulcerative colitis
- smoking
- appendectomy
What are 4 factors that put you at risk for crohns?
- smoking
- high sanitation level in childhood
- high intake of refined carbs
- perinatal infection
How does smoking affect risk for crohns vs UC?
protective against UC; significantly increases risk for crohsn
Is genetic influence stronger in crohns or UC? Example of an implicated gene?
stronger in crohns –> NOD2/CARD15 mutation of chr 16
What is the role of bacteria in development of IBD?
if you remove bacteria –> no immune activation and no IBD
if you add in resident bacteria –> get macrophage and TH1 immune activation leading to colitis
Where does UC localize?
- mucosal inflammation limited primarily to colon
- continuous lesion
- always involves the rectum
What is the hallmark symptoms of ulcerative colitis?
bloody diarrhea
What extra-intestinal manifestations of ulcerative colitits?
- ankylosing spondylitis
- peripheral arthritis
- erythema nodosum
- pyoderma gangrenosum = ulcers in legs
- uveitis
- primary sclerosing cholangitis
What are some possible complications of ulcerative colitis?
- toxic megacolon
- sclerosing cholangitis
- colorectal carcinoma
- cholangiocarcinoma
What are some possible complications of crohns?
- strictures –> obstruction
- fistulas
- ## perianal disease
What is primary presentation of crohns?
chronic inflammation –> diarrhea, ab pain, fever, tender RLQ fullness
What do you see on endoscopy in crohns?
transmural inflammation leading to fistulas; cobblestone mucosa; creeping fat; linear ulcers; strictures
Is crohns or UC associated with granuloma formation?
crohns
What are smptoms of strictures in crohns?
- post prandial cramps
- distension
- borboyrgmi = hear bowel sounds across the room
- vomiting
- weight loss / food avoidance
What two diseases can a confined perforation in crohns mimic?
appendicitis if in terminal ileum
diverticulitis if in sigmoid colon
What are symptoms of enteroenteric fistula?
may be asymptomatic
What symptoms of enterovesical fistula?
recurrent UTI
pneumaturia = peeing bubbles
What symptoms of retroperitoneal fistula?
psoas abcess signs = back, hip, thigh pain
What symptoms of rectovaginal fistula?
feces and/or air drainage
Is UC or crohns associated with perianal disease?
crohns
What are features that distinguish crohns from UC?
- granulomas
- focal lesions
- fistulization
- perianal disease
- rectal sparing
- small bowel involevement
- skip lesions
- strictures
What are extraintestinal manifestations of crohns?
migratory polyarthritis erythema nodosum ankylosing spondylitis pyoderma gangrenosum apthous ulcers uveitis kidney stones
Which joints involved in IBD associated peripheral arthritis?
- large > small
usually asymmetrical; no senovial destruction or subcutaneous nodules
What childhood presentation of IBD?
fever
anemia
arthritis
failure of growth/development
What are treatments for IBD?
5-aminosalicylates
immune suppressants
anti_TNFs = infilixmab
Is surgery a better choice for UC or crohns?
UC – crohns have high rate of recurrence
