Ulcerative Colitis & Crohn's Flashcards
Ulcerative Colitis Definition/Pathophysiology
Chronic idiopathic immune-mediated inflammatory condition of large intestine. Frequently associated with inflammation of rectum & often extends proximally to involve colon. Relapsing & remitting, with symptoms of active disease alternating with periods of remission.
UC Risk factors/prevention
Onset peaks between 15-30 years of age. Recent smoking cessation, NSAIDs, C.diff
UC Clinical Manifestations
Inflamed rectum (bleeding, urgency, tenesmus-sense of pressure)
abdominal cramping
weight loss
UC Diagnosis
Infectious etiology should be ruled out (C.diff)
Colonoscopy to include ileum & biopsies of affected/unaffected areas
UC Endoscopic Index of Severity looks at what 3 descriptors?
Vascular pattern
Bleeding
Erosions and ulcers
UC Management
Induction of remission: (Mild)
rectal 5-aminosalicylate 1g/d (+ po 5-aminosalicylate 2g/d if left-sided UC)
PO 5-aminosalicylate 2g/d if extensive UC
PO steroids if no remission (budesonide MMX 9mg/d)
UC Management
Maintenance (Mild)
rectal 5-aminosalicylate 1g/d
PO 5-aminosalicylate 2g/d if extensive UC or left-sided UC
UC Management
Induction of remission (Mod-Severe)
PO budesonide MMX
5-ASA (not in severe cases)
anti-TNF therapy
Vedolizumab (monoclonal Ab)
tofacitinib 10mg po BID x 8 weeks
anti-TNF therapy ioncludes what drugs?
adalimumab
golimumab
infliximab + thiopurine
UC Management
Maintenance (Mod-Severe)
thiopurines if used steroids for induction (azathioprine, mercaptopurine)
anti-TNF therapy
Vedolizumab
tofacitinib
UC Management (acute, hospitalized)
DVT prophylaxis
C. Diff testing
Vanco if C.diff
methylprednisolone 60mg/d or hydrocortisone 100 mg TID/qid to induce remission
UC prevention of colon cancer
colonoscopies q 1-3 years beginning 8 years after initial dx
Poor prognostic factors for UC
Age < 40 at dx
Extensive colitis
Severe endoscopic disease
Hospitalization for colitis
Elevated CRP
Low Serum Albumin
Crohn’s Definition/Pathophysiology
Idiopathic inflammatory d/o of UK etiology with genetic, immunologic, & environmental influences. Chronic, intermittent, progressive, destructive. Most present with non-penetrating, non-stricturizing dz. 50% develop intestinal comps (stricture, abscess, fistula, phlegmon) w/n 20 yrs of dx. Extensive anatomic involvement & deep ulcerations are other risk factors for progression to comps.
Crohn’s Risk Factors/prevention
Smoking & NSAIDs may exacerbate disease activity
Crohn’s Clinical Manifestations
abdominal pain (RLQ)
diarrhea
fatigue
weight loss
fever
growth failure
anemia
recurrent fistulas
Crohn’s Extraintestinal manifestations include
ocular?
derm?
hepatobiliary dz?
thromboembolic?
uveitis, scleritis
pyoderma gangrenosum & erythema nodosum
PSC
venous & arterial
Crohn’s Extraintestinal manifestations (other) include?
arthopathy
metabolic bone dzs
osteonecrosis
cholelithiasis
nerpholithiasis
asthma
chronic bronchitis
pericarditis
psoriasis
celiac disease
RA
MS
Crohn’s Dx:
Clinical Dx On Endoscopy
discontinuous involvement with skip areas,
sparing of rectum,
deep/linear/serpiginous ulcers of colon
strictures
fistulas
granulomatous inflammation
What can help differentiate b/t inflammatory bowel dz & irritable bowel?
Fecal Calpropectin
Crohn’s Dx:
if suspicion of small bowel involvement use what imaging?
What imaging modalities should be used if patient is < 35?
Endoscopy provides opportunity to obtain what?
video capsule endoscopy
CT enterography of small bowel; MR enterography
Bx
Risk factors for progressive course of Crohn’s include?
younger age at dx
initial extensive bowel involvement (ileal/ilealcolonic, perianal/severe rectal dz, penetrating or stenosis dz)
Crohn’s Management (mild-mod)
sulfasalazine for treating symptoms
controlled ileal release budesonide 9mg/d for induction of remission
anti-diarrheals diet mod
Crohn’s Management (Mod-Severe)
use what for treating symptoms?
Short term PO steroids
Crohn’s Management (Mod-Severe)
consider what instead of steroids? or for maintenance of remisson?
thiopurines
Crohn’s Management (Mod-Severe)
Use what for S&S of steroid dependent Crohn’s & maintaining remission?
methotrexate
Crohn’s Management (Mod-Severe)
Use what if steroid, thiopurine, and methotrexate resistant?
Anti-TNF
Crohn’s Management (Mod-Severe)
What combination treatment is more effective than single agents if niave to both?
infliximab + thiopurine
Crohn’s Management (Mod-Severe)
What combination treatment can be considered for induction of remission?
vedolizumab +/- thiopurine, natalizumab
Crohn’s Management (Severe/Fullminant)
IV steroids
Anti-TNFs can be considered to treat active dz
Crohn’s Management (Fistulas)
infliximab, thiopurines, tracrolimus, abx (imidazoles), surgical drain can be considered
Crohn’s Management (Fistulas)
Use for maintenance?
Methotrexate or thiopurines
Crohn’s Management (Fisutlas)
Use for maintenance if used for induction?
Anti-TNF
Vedolizumab
Crohn’s Management (Abscesses)
Abx & Drainage
