Surgical Recall - Ch. 51 IBD

Question 1

What are the extraintestinal manifestations seen in both types of IBD?

Answer 1

• Aphthous (oral) ulcers
• Pyoderma gangrenosum
• Iritis
• Erythema nodosum
• Sclerosing cholangitis
• Ankylosing spondylitis, Arthritis
• Clubbing of fingers
• Kidney disease (nephrotic syndrome, amyloid deposits)

Question 2

Crohn’s vs. UC

Initial Symptoms

Answer 2

Crohns: Abdominal pain, diarrhea

UC: Bloody diarrhea (hallmark)

Question 3

Crohn’s vs. UC

Anatomic Distribution

Answer 3

Crohn’s: “mouth to anus”

UC: Colon only

Question 4

Crohn’s vs. UC

Route of Spread

Bowel Wall Involvement

Answer 4

Crohn’s: Small bowel, colon, or both with “skip areas” of normal bowel / [Full thickness - transmural]

UC: Almost always involves rectum and spreads proximally in a continuous route w/o “skip areas” / [Mucosa/submucosa only]

Question 5

A 32 y/o man with a 3 year hx of UC presents for discussion for surgical intervention. The patient is otherwise healthy and does not have evidence of rectal dysplasia. What is the most appropriate elective operation for this patient?

Answer 5

Total proctocolectomy with ileal pouch-anal anastomosis and diverting ileostomy

Total proctocolectomy with end ileostomy (typically reserved for older or incontinent patients)

Question 6

What are the medication options for treating IBD?

Answer 6

• Sulfasalazine, mesalamine
• Steroids, metronidazole (Flagyl), azathioprine, 6-MP, infliximab

Question 7

• What is the medical treatment of choice for perianal Crohn’s disease?
• What medication is used for IBD “flare-ups”?

Answer 7

• PO metronidazole (Flagyl)
• Steroids

Question 8

• Which disease has “cobblestoning” more often on endoscoping exam?
• Which disease has pseudopolyps on colonoscopic exam?
• Which disease has a “lead pipe” appearance on barium enema?
• Rectal bleeding/bloody diarrhea is a hallmark of which disease?

Answer 8

• Which disease has “cobblestoning” more often on endoscoping exam? Crohn’s
• Which disease has pseudopolyps on colonoscopic exam? UC
• Which disease has a “lead pipe” appearance on barium enema? UC
• Rectal bleeding/bloody diarrhea is a hallmark of which disease? UC

Question 9

• What is the most common indication for surgery in patients with Crohn’s disease?
• Why do you see fistulas and abscesses with Crohn’s and not UC?

Answer 9

• What is the most common indication for surgery in patients with Crohn’s disease? SBO
• Why do you see fistulas and abscesses with Crohn’s and not UC? Transmural