SM_164b: Clinical Features of IBD Flashcards
IBD includes ____ and ____
IBD includes ulcerative colitis and Crohn’s disease
(there is also indeterminate colitis, which is in between)
- Peak incidence in 2nd-3rd decades, female predominance for Crohn’s and male for UC, Caucasian, Jewish
IBD pathogenesis involves an interaction between ____, ____, ____, and ____
IBD pathogenesis involves an interaction between genetics, immune response, environmental triggers, and microbial antigens
- Positive family history more common in Crohn’s disease
NOD2/CARD15 on chromosome 16q12 is implicated in ____
NOD2/CARD15 on chromosome 16q12 is implicated in Crohn’s disease
- Nucleotide-binding oligomerization domain protein 2 / caspase recruitment domain protein 15)
- Accounts for 20% of Crohn’s diseaase seen in the Caucasian and Jewish populations
- Associated with ileal disease, fibrostenotic phenotype, and earlier age
NOD2/CARD15 normally encodes a ____ which ____
NOD2/CARD15 normally encodes a protein that binds to bacterial cell wall (peptidoglycan) which activates NF-kB, stimulating the transcription of multiple pro-inflammatory and protective molecules
Host-microbe interactions have shaped the genetic architecture of ____
Host-microbe interactions have shaped the genetic architecture of IBD
Smokers are less likely to have ____ and more likely to have ____
Smokers are less likely to have ulcerative colitis and more likely to have Crohn’s disease
- More likely to have ileal disease rather than colonic or ileocolonic disease
- More likely to have disease recurrence
- Hygeine, smoking, infections, and diet influence IBD
IBD diagnosis is made based on ____, ____, ____, and ____
IBD diagnosis is made based on history / exam, laboratory tests, radiology, and endoscopy / histology
Describe clinical symptoms of IBD
Cinical symptoms of IBD
- Diarrhea
- Blood in stools
- Fecal urgency / incontinence
- Abdominal pain
- Abdominal mass
- Anal pain / drainage
Extraintestinal manifestations of IBD are ____, ____, and ____
Extraintestinal manifestations of IBD are rash, joint pain, and eye problems
Describe aspects of the history suggesting IBD
Aspects of the history suggesting IBD
- Acute or chronic symptoms
- PMHx: asthma, MS, T1DM, cecliac, autoimmune thyroid disorders, ankylosing spondylitis
- Meds: NSAIDs, antibiotics, immunosuppresants
- FMHx: IBD, cancers, RA, MS
- Smokign
Describe aspects of the physical exam consistent with IBD
Aspects of the physical exam consistent with IBD
- Signs of anemia, malnutrition
- Red eye, aphthous ulcers
- Abdominal tenderness and mass
- Perianal fissure, fistula, skin tag
- Rash
- Joint swelling
Crohn’s disease may involve ____ formation
Crohn’s disease may involve fistula formation
IBD has many ____ manifestations
IBD has many extra-intestinal manifestations
- Eyes: episcleritis, uveitis
- Kidneys: stones (nephrolithiasis), hydronephrosis, fistulae, UTIs
- Skin: erythema nodosum, pyoderma gangrenosum
- Mouth: stomatitis, aphthous ulcers
- Liver: steatosis
- Biliary tract: gallstones, sclerosing cholangitis
- Joints: spondylitis, sacroiliitis, peripheral arthritis
- Circulation: phlebitis
Bone and joint manifestations of IBD include ____ and ____
Bone and joint manifestations of IBD include spondyloarthropathy (axial, peripheral) and metabolic bone disease
- Axial spondyloarthropathy: sacroiliitis, ankylosing spondylitis
- Peripheral: type 1 (oligarticular, < 5 large joints), type 2 (polyarticular, small joints)
- Metabolic bone disease: osteoporosis / osteopenia, osteomalacia, osteonecrosis
____ presents as low back pain and stiffness typically worse in the morning and with rest and may indicate ____
Sacroiliitis presents as low back pain and stiffness typically worse in the morning and with rest and may indicate IBD
- SI joint narrowing and sclerosis
- HLA-B27 association
- NOT associated with IBD activity
____ presents as progressive stiffness and lordosis of the spine and may indicate ____
Ankylosing spondylitis presents as progressive stiffness and lordosis of the spine and may indicate IBD
- NOT associated with IBD activity
- Not associated with HLA-B27 activity
Osteopenia or osteoporosis is usually ____ common in patients with ulcerative colitis than Crohn’s disease
Osteopenia or osteoporosis is usually less common in patients with ulcerative colitis than Crohn’s disease
- Induction of osteopenia by pro-inflammatory cytokine effects on osteoblasts and osteoclasts
- Risk factors: chronic inflammatory activity, chronic or recurrent corticosteroid use, malnutrition, BMI < 20 (low body weight), low intake or absorption of Ca and Vitamin D, hypogonadism
____, ____, and ____ are common dermatologic manifestations of IBD
Pyoderma gangrenosum, erythema nodosum, and cutaneous (metastatic) Crohn’s disease are common dermatologic manifestations of IBD
- Erythema nodosum: pretibial, painful, tender, erythematous subcutaneous nodules, young women
- Pyoderma gangrenosum: pustular lesion evoving to ulcer with undermining borders, lower extremity and peristomal
- Aphthous stomatitis
____, ____, and ____ are inflammatory ocular manifestations in IBD
Episcleritis / scleritis, anterior uveitis (iritis), and retinitis are inflammatory ocular manifestations in IBD
- Episcleritis: eye irritation (burning / itching) and conjunctival erythema
- Anterior uveitis: ocular pain, redness, photophobia, blurred vision (diagnose with slit lamp)
Describe the hepatobiliary manifestations of IBD
Hepatobiliary manifestations of IBD
- Biliary: primary sclerosing cholangitis (large duct), small duct primary sclerosing cholangitis (pericholangitis), cholelithiasis / choledocholithiasis, cholangiocarcinoma, primary biliary cirrhosis
- Hepatic: fatty liver / steatohepatitis, autoimmune hepatitis
____ is the most common hepatobiliary manifestation of IBD
Primary sclerosing cholangitis is the most common hepatobiliary manifestation of IBD
___ are the most common kidney stones in people with IBD and are most common in people with Crohn’s with ileal disease
Calcium oxalate are the most common kidney stones in people with IBD and are most common in people with Crohn’s with ileal disease
- Intestinal: strictures, fistulas, perforation, toxic megacolon, short gut syndrome, colon cancer
Describe differential diagnosis of IBD
Differential diagnosis of IBD
- Infectious diarrhea
- Medication induced colitis
- Celiac disease
- Behcet’s disease
- Eosinophilic gastroenteritis
- GVHD
- IBS
- Lactose intolerance
Describe diagnosis of IBD
IBD diagnosis
- Blood tests: CBC, CMP, ESR, CRP, vitamins / minerals
- Stool tests: culture, C. difficile, ova and parasites, fecal leukocuytes
- Imaging: X-ray, CT, MRI
- Endoscopy: EGD, colonscopy, capsule endoscopy, double balloon / single balloon enteroscopy
Describe pathological differences between ulcerative colitis and Crohn’s disease
Pathological differences between ulcerative colitis and Crohn’s disease
- Ulcerative colitis: mucosal depth, crypt abscesses and architecture distortion are seen
- Crohn’s disease: transmural, crypt abscesses and architecture distortion are seen, granuloma occurs
