Flashcards in 27. IBD Deck (31):
What are the two type of IBD?
Ulcerative colitis 50%
Crohn disease 50%
What countries have the highest incidence of IBD?
What is UC?
Continuous inflammation in the colon only
Limited to the superficial mucosa, LP, submucosa
Increased risk for cancer and has extraintestinal manifestations
What is the clinical presentation of UC?
Diarrhea with blood and mucus
Abdominal pain and tenderness
Loss of appetite and weight
Fever and fatigue
Urgency for bowel movement
What is the presentation of UC in children?
Growth and development failure
What are the endoscopic findings in UC?
Loss of fine vascular pattern
Granularity of the mucosa
Erosions and ulcers
What is fulminant colitis?
Severe UC with:
- Fever, elevated WBC, and unstabile vitals
- High risk of preforation
What is Crohn's disease?
Patchy, full thickness inflammation with mouth to anus involvement
What area is MC involved in Crohn's disease?
What is the presentation of Crohn's in a pediatric patient?
Abdonminal pain **
Weight loss and anorexia
What are the three major endoscopic findings that are specific to Crohn's disease?
Discontinuous lesions (skip lesions)
What are 5 findings that favor Crohn's over UC?
1. Rectal sparing (UC will always affect rectum)
2. Normal vasculature next to affected tissue
3. Fistulas or strictures
4. Isolated involvement of the terminal ileum
5. Granulomas on biopsy
When is backwash ileus seen?
Pancolitis (severe UC)
What are the MC extraintestinal manifestations of IBD?
Acute arthropathy 15-20% **
Erythema nodosum 15% **
Choledocholithiasis 15-30% **
Ocular complications 5-15% **
Sacroilitis 9-11% **
Ankylosing spondylitis 3-5%
Pyroderma gangrenosum 1-2%
What is the main difference of presentation of epischleritis and uveitis, two manifestations of IBD?
Episcleritis: white part of the eye is inflamed, but not painful
Uveitis: more painful
What are the goals of management of IBD?
Confirm accurate dx
Enhance quality of life
What is the best characterized mutation that is associated with Crohns?
What are the 4 potential forms of pathogenesis of IBD?
1. Genetic: NOD2
2. Mucosal immune responses: Th17 cells
3. Epithelial defects: in tight junctions
What cytokine released from Th1 in IBS is the main target for therapy?
Of the penetrating, stricturing, and inflammatory forms of IBD, what do most poeple present with?
can progress to stricturing and penetrating
What are the key biologics that are used to treat IBD?
Certolizumab pegol (anti-TNF)
Natalizumab (anti alpha 4 integrin)
What % of patients require maintenence thereapy
What are the two kinds of microscopic colitis?
What is the presentation of microscopic colitis?
Chronic, nonbloody, watery diarrhea without weight loss
Normal radiological and endoscopic findings
What happens histologically in collagenous colitis, a type of microscopic colitis?
Dense subepithelial collagen layer, increased numbers of intraepithelial lymphocytes, and mixed inflammatory infiltrate within the lamina propria
What is found histologically in lymphocytic colitis, a type of microscopic colitis?
Subepithelial collagen layer is of normal thickness and the increase in intraepithelial lymphocytes may be greater than in collagenous colitis
What diseases is lymphocytic colitis associated with?
What tx do the microscopic colitises respond to?
The small intestine is relatively sterile compated to the colon, and is protected by:
What are some things that can lead to small intestinal bacterial overgrowth?