IBD Flashcards
What is IBD
how do you differentiate between UC and Crohn’s
Inflammatory Bowel Disease (IBD)
- an inflammatory disease (2 groups mainly, but can be two other small groups; total of 4)
- in this in flammatory disease; the body attacks its own intestinal system
Ulcerative Colitis (UC)
- involves ONLY the colon
- begins at the rectum; thus the rectum must be involved
- a continuous pattern of inflammation, without any breaks in the lesions
- involves only the mucosal and submucosal layers
Crohn’s Disease
- can occur at any portion of the digestive tract, from mouth to anus
- most commonly, it occurs at the terminal illeum, or illoceccal junction
- involves the full thickness; trasnmurual inflammation
- can have skip lesions; in which there are areas of inflammation and damange intermixed with normal
Briefly, what is microscopic colitis
Microscopic Colitis
- inflammation which is found on biopsy to have inflammatory patterns within the colon, does not appear damagned from gross observation
- can be lymophcytic or collagenous
- lymphocytic = increased number of lymphoctes found on biopsy
- collagenous = lymphocytes AND collagen band found on biopsy
Etiology of IBD
Risk Factors (modifiable and non-modifiable)
Etiology
- not well understood, but known to be a type of auto-immune disease
- heriditary componente: first degree relatives at an increased risk
- genetic: NOD2 gene, IBD5, IL23R, IP31
- Turner’s syndrome associated
it is understood that there is a genetic underlying predisposing in some pt., and then when an event occurs (viral, bacterial or otherwise) this triggers the autoimmune process to occur
Risk Factors
- ashkenazi jewish population
- possible protective effect of VIt D and sun expsoure
- ages: bi-modal distribution 15-35 & then 50-80
- female = crohns
- male = ulcerative colitis
- Exercise = decreased increases risk
- Western Diet = increased risk
- sleep duration
- infections: campylobacter and salmonella can increase risk
- NSAIDS is a IBD mimicer
- OCPS
- Stress
- smoking increases risk of Crohn’s but decreased risk of UC direclty ipacts the ability of the immune response to take place in the mucosal
Crohn’s Disease
- specifics
- subtypes (based on location)
Specifics
- a transmural inflammatory condition which can occur at any area of the digestive tract associated with skip lesions
- occurs: gradually/insidiously
Subtypes
- ilitis
- ileocolitis - most common presentation
- crohns coloitis
- gastroduodenal crohns or UGI crohns least common
- (some can have perianal invovlement)
Crohn’s Disease
Symptoms
Quality of Abd. Pain
Eating Habitis
Symptoms
1. Systemic
- fever
- general sense of off
- weight loss
- low energy
- GI symptoms
- abdominal pain
- eating habits altered
- bowel movement altered
- perianal symptoms
Abdominal Pain
- most commong RLQ because thats the localation of teh ileoceccal junction & MC area of involvment
- also seen at periumbilical, diffuse, lower abd. pain
- pain usually right before BM; may resolve with BM
- ** focal tenderness in ilocecal region; +/- a mass due to matted or looped intestines**
Eating Habits
- decreased appetite: causing weight loss
- if giving post-meal pain = think lower GI involvment
- if trouble swallowing = think upper GI invovement
- “food running through them”
Weight Loss
- can be due to lack of nutrition and absorbtion
- terminal ileum: impacts B12 absorbtion –> anemia ; impact ADEK absorbtion & bile acid
- proximal SI: impacts calcium and iron
- diffuse SB; zinc
- severe colonic: IDA due to blood loss
Crohn’s Disease
Symptoms of…
Diarrhea
Perianal Symptoms
Fistulas
Perianal Abscess
Diarrhea
- frequency
- consistency
- nocturnal stools possible
- urgency
- episodes of incontinence
Periana Disease Symptoms
- 1/3 of pts.
- skin tags
- anal fissures
- fistulas
- these are a result of the TRANSMURUAL involvement of the disease
Fistulas
- sinus tracking connecting organs which shouldnt be
- enteroenteric: bowel to bowel
- entrovesicular or rectovaginal: UTI risk & feces to vaginal
- entercutaneous: drainage
Abscess
- severe pain in the rectum/buttock
- tender, warm and red
- purulent discharge & fever
- abscess can forma anywhere where there might be full thickness, trasnmural inflammation
- find leukocytosis on labs and may need to give opioids
Extra-GI Manifestations of Chrons Disease
- what other organs (8)
- what are the key signs that the Crohn’s disease is worsening
- Eyes
- anterior uveitis
- episcleritis - Mouth
- apthous ulcers - Arthritis
- ankylosing spondylitis
- peripherial arthritis - Skin
- erythema nodosum
- pyoderma gangrenosum
- vulvular involvement
signs the Crohn’s is getting worse
- episcleritits
- peripheral arthritis
- erythema nodosum
- Hepatobilliary Involvement
- can be related to the medications
- primary sclerosing cholangitis
- gallstones due to back up because of poor absorpbtion - Kidney Stones
- calcium oxalate
- uric acid - Bone Loss (steroid use)
- Pulmonary
- inflammation
- ILD
- Pneumonia
- bronchitis, bronchectasis
Crohn’s Diseae
- Workup
- Diagnosis (test of choice)
- what do you see on endo? hsitology?
Labs and Stool Studies
- CBC, CMP, vit D, B12, zinc, ESR, CRP = see anemia of CD, inflammation
- FCP, infectious panel, O&P = stool sample
- celiac markers
- ASCA +
Imaging
- CT & MRI: good for seeing complications (fistual and abscess)
- can do capusle endoscopy: if not strictures or obstruction
- barium study: see + String sign of contrast = inital test of choice
according to dubes email….
- chrons disease: inital choice of study is colonscopy
- CTE/MRI for concerns of small bowl disease
On Endoscopy….
- see uclers
- skip lesions
- cobblestoning (nodular changes)
On Pathology
- noncaseating granulomas: but not necessary for a dx.
Complications of Crohn’s Disease
- strictures (narrowing) due to inflammation or fiberosis
- fistulas & abscesses
- bowel obstrction
- thromboic events; increased risk of DVT
- refractory disease
- increased risk for cancer- specifically colon
Ulcerative Colitis (UC)
- what is it
- subtypes
UC is an autoimmune inflammatory condition involving only the mucosa and begins within the rectum and is a pattern of continuous inflammation
Subtypes
- ulcerative Proctitis
- ulcearitive protosigmoidits
- left sided colitis
- extensive/pancolitis
UC
Symptoms
Symptoms
- hallmark is bloody diarrhea
- gradual; but more sudden than crohns is
- crampy, colicky LLQ pain
- increased stool frequency
- urgency & tenesmus
- incontinence
- fever, fatigue & weight loss
- Iron Deficiency anemia with DOE
UC
- Diagnosis
- Work-up
- what imaging
- what do you see on endo? on patho?
Diagnosis
labs
- CBC = anemia
- ESR, CRP = increase
- PANCA
- CMP: phosphatase
- low albumin
- elevated alkaline
- stools: + fecal calprotectien
Imaging
- colonoscopy
- Xray: wall thickening and thumb printing due to edema
- CT/MRI: to see disease and complications
- US: thickened mucosa
- Barium Enema: DO NOT DO IN SEVERELY ILL ; INCREASE RISK OF TOXICMEGACOLON ; see stove pipe/lead pipe sign - lots haustra
Dubes email…. do signmoidoscopy for UC
Endoscopy
- lost vascular
- eryhthema
- granualr, friability (bleeding)
- erosins, ulcers, bleeding!
- cecal paths: isolated patches of inflammation
- backwas illeitis
PAthology
- crypt absecesses, branching and atrophy at the rectum and throughout the colon
Complications of UC
pt. may need colectomy
- strictures
- increased risk of colorectal cancer (mostly in pancolitis & left sided dz.)
- concom. primary sclerosis colitis = increase risk = colonscopy more freqeuntly
Treatment of IBD
- first line is what med; part of what class
- what must you rx. with it
first line treatment is 5-ASA = mesalamine therapy; specifically SULFASALAZINE
- good for UC because it works on the mucosal layer, can be used in mild crohn’s too
- ALWASY GIVE FOLIC ACID WITH THIS MED
- risk fo agranulocytosis, GI, CNS side effects
for UC
- other topical 5-ASAs
Dubes email
- sulfasalazine if mild disease and responsive to steroids – nonresponsive to steroids then move onto biologics
if severe disease: can use sulfasalazine but most jump to biologics
Treatment of IBD
- when is steroid use used
- when is abx. used
during acute flares, not long term management
- prednisone & taper
- can use budesonide
watch side effects of steroid use
abx. may be used in chron’s not common
- metonidazole
- cirpfloxicin
