NOT ON TEST Crohn's Disease Vignette

Question 1

1. Employ listening and empathy in actively listening to patients’ symptoms and not dismissing them as “stress-related”.

Answer 1

will do boss.

Question 2

2. Appreciate why patients with IBD experience feelings of shame and embarrassment related to their symptoms and their disease.

Answer 2

a

Question 3

3. Describe how the activation of IBD during puberty can impact patients’ emotional and social development.

Answer 3

a

Question 4

4. Formulate a medical history of IBD patients that extends beyond merely asking them about frequency and quality of their bowel movements.

Answer 4

a

Question 5

5. Organize a discussion about proceeding with an ostomy surgery for a patient with IBD that incorporates the patient’s own perspective and values in the patient-physician conversation.

Answer 5

a

Question 6

6. Correctly diagnose clinical presentations of inflammatory disease.

Answer 6

IBD can be either Crohn Disease or Ulcerative Colitis
CROHN DISEASE:
Symptoms:
-abdominal pain
-diarrhea
-nausea
-vomiting
-weight loss
-rarely obstructive or perforating systems
Smoking is a risk factor.
Location:
-entire GI tract

Pattern:
-discontinuous with skip lesions primarily in small intestine and colon; most commonly in terminal ileum and cecum; perianal disease is common. Rectal involvement uncommon.

Endoscopic features:
view of terminal ileum with ulcerations, granularity,edema, & erythema

OTHER:
transmural inflammation, occurrence of fistulas and stricture are common

ULCERATIVE COLITIS:
Symptoms:
-abdominal pain
-rectal bleeding
-bloody diarrhea
Smoking is protective.

Location:
-limited to the colon

Pattern:
-continuous; originates in rectum, and progresses proximally. Rectal involvement is very common. Perianal disease is uncommon.

Endoscopic features:
view of sigmoid colon demonstrating diffuse oss of vascular pattern, erythema, edema, granularity and friabilty.

OTHER:
mucosal inflammation, occurrence of fistulas and stricture are uncommon

Question 7

Crohn’s Disease: The Bio-Medical View

Answer 7

IBD: Crohn or UC
25% of IBD patients show extra-intestinal manifestations:
- look at phone pic for specs
Epidemiology:
1.4 million americans with peak onset in persons 15 to 30 years of age

Tobacco:

• smokers at increased risk for crohns
• smokers are protective for UC

Question 8

Crohn’s vs UC

Answer 8

look at pic on phone table

Question 9

IBD ETIOLOGY

Answer 9

-inappropriate inflammatory response to intestinal microbes in a genetically susceptible host

Genetic Factors:
-nucleotide oligomerization domain 2 (NOD2)
-interleukin-23–type 17 -helper T-cell (Th17) pathway
autophagy genes

Rising Prevalence:

• Changes in diet
• Antibiotic use,
• Altered intestinal colonization (e.g., the eradication of intestinal helminths)
• tobacco