Ulcerative colitis

Question 1

Life threatening complications of colitis

Answer 1

Perforation, toxic megacolon, fistulas, recurrency is common

Question 2

DDx of colitis

Answer 2

ischemic, infectious, radiation and IBD

infxn – C diff, E coli, Salmonella, Shigella, Campylobacter

Question 3

History suggesting ischemic

Answer 3

atherosclerotic disease or other hypoperfusion cause, post-prandial “intestinal angina,” no fevers

Question 4

History suggesting infectious

Answer 4

acute onset, recent foreign travel, recent antibiotic use

Question 5

Age groups affected by IBD

Answer 5

bimodal, age 15-35 and 60-70

Question 6

Sxs of IBD

Answer 6

low-grade fever, anemia of chronic dz or iron deficiency due to chronic GI blood loss

Question 7

Sxs of ulcerative colitis

Answer 7

grossly bloody stool, diarrhea, pain typically minimal

Question 8

Sxs of Crohn disease

Answer 8

chronic abd pain, diarrhea, weight loss +/- blood

Question 9

Complication of Crohn’s

Answer 9

Fibrosis causing bowel obstruction from repeated inflammation

Question 10

Endoscopic and bx findings of UC

Answer 10

only involves colon beginning in the rectum with proximal continuous pattern of spread, lesions with mucosal and submucosal inflamm only

Question 11

Endoscopic and bx findings of Crohn’s

Answer 11

affects any part of the GI tract particularly terminal ileum, rectal-sparing with skip lesions, lesions with transmural inflamm

Question 12

Tx of U.C

Answer 12

1) 5-ASA (sulfasalazine or mesalaine, PO or rectal)
+/- corticosteroids (pred vs budesonide) if mod-severe
+/- immune modulators for severe

Question 13

Immune modulators for severe UC

Answer 13

6-mercaptopruine, azathioprine, methotrexate, TNF-an infliximab

Question 14

Anti-TNF treatment puts patient’s at risk for _____.

Answer 14

Infection, specifically latent TB

Question 15

Indications for total colectomy

Answer 15

carcinoma or dysplasia, toxic megacolon, perforation, uncontrollable bleeding

Question 16

Definition/findings of toxic megacolon

Answer 16

Colonic dilation >6cm –> fever, leukocytosis, tachycardia, appears toxic (hypoTN, AMS)

Question 17

Tx of toxic megacolon

Answer 17

Straight to OR, temporized by IVF, NG tube, NPO, broad-spectrum IV abx, IV steroids

Question 18

Colon CA screening in UC patients

Answer 18

Annual or biennial colonoscopies are advised starting 8 years after diagnosis of pancolitis

Question 19

Extracolonic manifestations are found …

Answer 19

skin, rheum, ocular, hepatobiliary, urologic

Question 20

Skin manifestations Crohns/UC

Answer 20

erythema nodosum, pyoderma gangrenosum (15%, rare)

Question 21

Rheum manifestations, Crohn

Answer 21

Poly asymm arthritis, ankylosing spondylitis (less common in UC)

Question 22

Rheum manifestations, UC

Answer 22

Less common compared to Crohn, but arthritis and ankylosing spondylitis possible

Question 23

Ocular manifestations

Answer 23

Uveitis (photophobia, blurred vision, headache), more common in Crohn

Question 24

Hepatobiliary manifestations

Answer 24

Cholelithiasis common, PSC rare