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
