Lecture 7 IBD Part 1

Question 1

What is IBD

Answer 1

Term used to describe two chronic inflammatory diseases of the GI tract

Ulcerative colitis
Crohn disease

Question 2

Epidemiology of IBD

Answer 2

0.8 % overall affecting 1 in 140 in Canada

Affect male and female equally

Can be diagnosed at any age

Kids, biggest growing rate

Question 3

Etiology of IBD (increased risk)

Genetic
Diet
Geographic
Infectious
Psychology

Answer 3

Genetic: disease specific loci

Diet: saturated/trans fats, red meat, refined sugar, smoking

Geographical location: improved sanitation, western diet

Infectiou: triggered by GI

Psychological: stress (-> flare)

Question 4

Etiology of IBD ( Decreased risk)

Answer 4

Lifestyle
Diet: whole foods, omega 3
Physical health: sleep, excercise, healthy weight
Mental health: sleep, stress reduction
Adequate Vitamind D

Medication : not using NSAID/antibiotics

Smoking (protective in UD)

Question 5

Ulcerative colitis

Areas of inflammation?
Depth of inflammation?
Distribution of lesions?

Answer 5

Areas of inflammation: Restricted to colon, 95% rectum is involved, ileum is not except as backwash

Depth of inflammation: mucosal/submucosal layers of GI tract

Distribution of lesion: Continuous

Question 6

What are other features of ulcerative colitis

Answer 6

Abscesses of the crypts of the mucosa

Pseudopolyps formed when ulcer surrounding uninvolved mucosa oalesce

Question 7

Ulcerative colitis signs and symtpoms

Answer 7

Abdominal pain
Frequent bowl movements, diarrhea, blood in stool, mucous in stool

Tenesmus ( feeling like u gotta go)

Severe disease: systemic symptoms, fever, weakness, dehydration

Question 8

Complications of ulcerative colitis ( local and systemic)

Answer 8

Local:
Hemorrhoids, anal fissures, perirectal abcesses, toxic mega colon(big ballon) , intestinal obstructions, colorectal cancer ( >20% risk)

Systemic: malnutrition, anemia, malabsorption syndromes

Question 9

Crohns disease

Areas of inflammation
Depth of inflammation
Distribution of lesions
Other features

Answer 9

Areas of inflammation: anywhere in GI tract (mouth to anus), terminal ileum is most common site

Depth of inflammation: Transmural

Distribution of lesions : discontinuous

Other feature: granulomas and fibrosis are common

Question 10

Explain this terminology

Crohns colitis

Crohns ileitis

Crohns ileocolitis

Answer 10

Crohns colitis: disease involving only colon

Crohns ileitis: disease involving only ileum

Crohns ileocolitisL disease involving both ileum and colon

Question 11

Crohn disease sign and symptoms

Answer 11

Abdominal pain
- mostly right lower quadrant

Frequent bowel movements, diarrhea
- mucous in stool
- blood in stool

Systemic symptoms
- fever, weight loss, weakness

Question 12

Crohn disease compilations (local)

Answer 12

Small bowel strictures -> bowel obstruction
- area of high inflammation, where loops of bowel are matted together by fibrous adhesions

Abscesses
Sinus tract infections

Question 13

Complications of Crohn’s disease ( Systemic))

Answer 13

Nutritional deficiencies

Anemia ( most common iron deficiency)

VTE

Osteoporosis

Growth retardation in kids

Question 14

IBD: UC and CD- etraintestinal manifestations

Answer 14

Enterophathic arthritis/ artralgia

Hepatobililairy - abnormal liver enzymes, fatty liver, autoimmune hepatitis

Dermatological - aphthous stomatitis

Ocular - spectrum from dry eye to inflammatory

Question 15

IBD : Patient assessment diagnosis and follow up

Answer 15

Stool frequency, prescence of mucous
Abdominal pain
Prescence of abdominal mass
Perinatal disease
Malnutrition
Extrainstestinal manifestation
Family hx, social hx ( tobacco use)

Question 16

IBD: patient assessment ( lab tests and life)

Answer 16

Lab tests:

Measures of inflammation: increase CPR, increase fecal calprotectin, increase WBC

Albumin
Check: electrolytes, renal/liver fx

Others: low HB, Lower Fe, Lower B12, Lower folate

Life: ability to work, ability to participate, frequency of hospitalization

Question 17

Ulcerative colitis: disease calcification ( mild, moderate, severe

Answer 17

MILD : Stools per day <4, no blood in stool, no systemic symptoms, ESR/CRP normal.

MODERATE: stool per day 4-6, no blood in stool, no systemic symptoms, normal ESR/CRP.

Severe: >6 stools per day, blood in stool, systemic symptoms present, elevated ESR/CRP.