3.04 IBD: UC + Crohn's

Question 1

IBD is a broad term that describes what?

Answer 1

chronic or recurring inflammation of GI tract

Question 2

What are the two most common IBD?

Answer 2

Crohn’s and ulcerative colitis

Question 3

What is IBD thought to be caused by?

Answer 3

aberrant immune response to gut bacteria in genetically susceptible host

Question 4

Located at any portion of the GI tract except the rectum?

Answer 4

Crohn’s

Question 5

Has skip lesions and usually affects the ileum the most?

Answer 5

Crohn’s

Question 6

Continuous damage that always has rectal involvement?

Answer 6

ulcerative colitis

Question 7

Transmural inflammation? (entire gut wall thickness impacted)

Answer 7

Crohn’s

Question 8

“lead pipe” appearance on imaging due to loss of haustra?

Answer 8

ulcerative colitis

Question 9

noncaseating granulomas Th1 response?

Answer 9

Crohn’s

Question 10

no granulomas and Th2 response?

Answer 10

ulcerative colitis

Question 11

malabsorption, malnutrition, and colorectal cancer increased risk associated with what IBD?

Answer 11

both

Question 12

blood diarrhea is more characteristic of?

Answer 12

ulcerative colitis

Question 13

kidney stones (calcium oxalate) associated with?

Answer 13

Crohn’s

Question 14

sclerosing cholangitis associated with?

Answer 14

ulcerative colitis

Question 15

ASCA associated with?

Answer 15

Crohn’s

Question 16

P-ANCA is associated most commonly with?

Answer 16

Ulcerative colitis

Question 17

pseudopolyps are more common in what IBD?

Answer 17

ulcerative colitis

Question 18

“string sign” on barium enema associated with what IBD?

Answer 18

Crohn’s

Question 19

In what IBD can severity worsen when patients stop smoking?

Answer 19

ulcerative colitis

Question 20

1/3 of patients with UC have the disease confined to the?

Answer 20

rectosigmoid

Question 21

1/3 of patients with UC have the disease that extends to what (left-sided colitis)?

Answer 21

splenic flexure

Question 22

1/3 of patients with UC have the disease that spreads more proximally referred to as?

Answer 22

extensive colitis

Question 23

Severe UC is graded based on?

Answer 23

stool frequency increases, large amount of blood in stool, extraintestinal symptoms (ESR, Hg, Temp, heart rate)

Question 24

What are you looking for/worried about in severe UC, especially in terms of extraintestinal symptoms?

Answer 24

toxic megacolon
(perforation risk)

Question 25

What extracolonic manifestations are specific to UC?

Answer 25

sclerosing cholangitis + thromboembolic events

Question 26

How common are extracolonic manifestations in UC?

Answer 26

50%

Question 27

erythema nodosum, pyoderma gangrenosum, oral ulcers, spondylitis, uveitis, and arthritis are common extracolonic manifestations seen in?

Answer 27

Both Crohn's and UC

Question 28

What are some UC differentials?

Answer 28

infectious colitis ischemic colitis Crohns diverticular disease colon cancer radiation colitis/proctitis

Question 29

What can be used to assess the possible consequences of UC?

Answer 29

hematocrit, ESR, and serum albumin

Question 30

What should you rule out for a UC and Crohn's diagnosis?

Answer 30

Bacterial stools exam (C. diff) cultures, ova/parasites

Question 31

What establishes a UC diagnosis?

Answer 31

sigmoidoscopy

Question 32

What can precipitate a toxic megacolon in UC patients and is of little diagnostic use?

Answer 32

barium enema

Question 33

What diet should you recommend for UC patients?

Answer 33

regular diet, reduce caffeine or gas prod veggies, avoid opioids or anticholinergics

Question 34

UC complications?

Answer 34

toxic megacolon, colon cancer

Question 35

With patients with extensive colitis, when are biopsies recommended?

Answer 35

every 1-2 years beginning 8-10 years after diagnosis

Question 36

For most patients how is UC managed?

Answer 36

medical therapy

Question 37

What can lead to a complete cure of the colonic disease in UC (but not the extraintestinal manifestations)?

Answer 37

surgery

Question 38

Supplementation with what can decrease the risk of colon cancer in UC patients?

Answer 38

folate 1mg oral

Question 39

What is frequently involved in crohn's disease?

Answer 39

terminal ileum

Question 40

intestinal obstruction is a common complication in what IBD due to inflammation, spasm, or fibrotic stenosis that can lead to postprandial bloating, cramping, and loud growling?

Answer 40

crohn's

Question 41

What is very unique to Crohn's that hints at its transmural nature?

Answer 41

fistulization leading to intraabdominal/retroperitoneal abscesses manifested by fevers, chills, tender abdominal mass, and leukocytosis

Question 42

Fistulas between the small intestine and colon are typically?

Answer 42

asymptomatic but can result in diarrhea, weight loss, bacterial overgrowth, malnutrition (lots of infections)

Question 43

Are extraintestinal manifestations unique to Crohn's?

Answer 43

gallstones, nephrolithiasis (b/c fat malabsoprtion: fat binds to oxalate)

Question 44

Differentials for Crohn's?

Answer 44

UC appendicitis mesenteric adenitis segmental colitis (2ndary) diverticulitis with abscess NSAID induced IBS

Question 45

What can be used to differentiate Crohn's from appendicitis?

Answer 45

CT scan abdomen

Question 46

How do you evaluate the consequences of Crohn's?

Answer 46

B12, blood loss, iron deficinecy, anemis, leukocytosis

Question 47

Imaging for Crohn's?

Answer 47

upper GI series barium

Question 48

Diagnostic procedures for Crohn's disease?

Answer 48

colonoscopy biopsy of the intestine ( only 25% granulomas)

Question 49

What are the indications for surgery with Crohn's disease?

Answer 49

medical therapy no go intarabdomnainal abcess massive blee obstruction fibrous incision and drain abscess resection of the stenotic area/strictoplastuy

Question 50

Crohn's diet recommendations?

Answer 50

no lactose fiber supplementation low roughage diets (obstruction) low-fat diet vitamin B12 supplement (IM)

Question 51

What is Crohn's prognosis?

Answer 51

most able to cope and few die

Question 52

Prevention recommendations for patients with Crohn's?

Answer 52

annual colonoscopy with 8+ year history of crohns colitis