Wk 5

Question 1

path characteristics of Crohn’s

Answer 1

transmural inflamm (involves all layers of intestinal wall), skip lesions, cobblestoning, fissures, sinuses, fistulas

Question 2

path characteristics of UC

Answer 2

continuous, inflammatory dz of colon or rectal mucosal layer
starts in rectum, moves proximally
thinning of wall
pseudopolyps, loss of goblet cells, distortion of crypts, loss of haustra

Question 3

What is indeterminate colitis

Answer 3

within venn diagram, it’s where UC and Crohn’s overalp. therefore no difinitive dx

Question 4

What are the two forms of microscopic colitis and why are they called microscopic?

Answer 4

lymphocytic (MC) and collagenous (rare)

-can only see via microscope (dx by biopsy) of the large intestine

Question 5

what’s the difference between ulcerative proctitis, pancolitis and left sided colitis?

Answer 5

proctitis- just the rectum (most common)
pancolitis- entire large intestine (2nd most common)
left sided colitis- descending colon and rectum

Question 6

which type of ulcerative colitis is associated with increased risk for colon CA?

Answer 6

pancolitis

Question 7

UC can be seen on what exam?

Answer 7

anoscopic exam

Question 8

sequelae of UC?

Answer 8

• toxic megacolon (massive dilation) because of tenuation and thinning of wall. can lead to perforation
• hemorrhage

Question 9

systemic effects of IBD?

Answer 9

Eyes: Episcleritis, Uveitis
Kidneys: nephrolithiasis, hydronephrosis, fistulae, urinary tract infection
Skin: erythema nodosum, pyoderma gangrenosum
Mouth: stomatitis, apthous ulcers
Liver: steatosis
Billiary tract: gallstones, sclerosing cholangitis
Joints: spondylitis, sacrolitis, peripheral arthritis
Circulation: phlebitis

Question 10

Location of Crohn disease?

Answer 10

R colon (35%)
colon alone (20%)
distal ileum (35%)
SI alone (5%)
gastroduodenal (5%)

Question 11

Sequelae for Crohn’s?

Answer 11

• transmural thinking leading to obstruction of terminal ileum
• fistulas, abscesses, fissures, stenosis (of ileocecal valve), inflammation

Question 12

anatomical limits of colonoscopy?

Answer 12

can go through ICV to terminal ileum (cannot rule out Crohn’s unless it goes through terminal ileum)

Question 13

which type of endoscopy is used to biopsy for Celiac disease?

Answer 13

upper endoscopy

Question 14

which type of endoscopy is used to dx IBD?

Answer 14

colonoscopy

Question 15

Common ssx of UC?

Answer 15

cramping pain in lower abdomen
relieved by BM
bloody stool

Question 16

Common ssx of Crohn’s?

Answer 16

constant pain in RLQ
NOT relieved by BM
abdominal mass in RLQ

Question 17

Is IBS or IBD considered AI?

Answer 17

IBD

Question 18

lab tests for IBD?

Answer 18

-fecal calprotectin- screening test that tells you level of inflammation and whether they are in acute flare or not
250 indicates impending relapse or active dz
-CBC (mild anemia in IBD)
-low serum iron, low B12 in Crohns
-ESR & CRP (elevated)

Question 19

dietary treatments for IBD?

Answer 19

Specific carbohydrate diet
Elimination diet
Exclusive enteral nutrition
GAPS

Question 20

supplements and botanicals for IBD?

Answer 20

• Folic acid, DHEA or Ashwagandha (dec. side effect of IBD meds)
• LDN
• Turmeric and Boswelia
• Aloe vera (UC only)
• Salmon, fish oil
• rPC (retarded release phosphatidylcholine)
• VSL #3 probiotic
• Fecal transplant