Flashcards in Bernadino: IBD Deck (33):
What is IBD?
Idiopathic and chronic intestinal inflammation
What is UC?
involves the rectum and extends proximally to involve part of the entire colon
Chronic and relapsing
What is CD?
Effects ANY portion of the luminal GI tract
*more aggressive b/c has ability to generate TRANSMURAL inflammation and BEYOND
Presents in two patterns:
1. obstructive/fibrostenotic (inflammatory> hard woody strictures)
Who is IBD most commonly seen in?
15-25 yrs but SECOND peak 60-70 (more aggressive)
A pt presents w/ bloody mucoid diarrhea and tenesmus.
UC (mucosal involvement> blood)
A pt presents w/ nonbloody diarrhea, abdominal pain, weight loss/anorexia, perianal abscess, and growth failure.
Crohns (mores systemic, penetration> fistulas)
What infections can mimic IBD/cause bloody diarrhea/have a RIGHT pref.?
Bacteria: c. diff
Parasites: e. histolytica, trichinella
Viruses: CMV (punched out ulcers and bloody diarrhea)
What are complications of UC?
Mucosal shedding> bloddy diarrhea
Starts in the rectum and moves UP> chronic/relapsing
30% will undergo colectomy over 30 years
Colon cancer: 18% over 30 years (1 in 5 people)*
Primary Sclerosing Cholangitis 4%** (almost never seen w/ crohns)
What is Crohn's Disease?
A pan-enteric transmural inflammatory disease
(Mouth to sigmoid, usually spares rectum)
Usually (70%) involves the terminal ileum
Skip lesions (patchy distribution)
Perianal involvement (fistulas/fissures/red boil around anus)
80% require surgery by 15 yrs
What complications are associated w/ CD?
A pt presents w/ painful diarrhea, anemia and less bleeding than seen in UC.
What is the microscopic morphology of IBD?
noncaseating granulomas and lymphoid aggregates (Th1 medaited)
What serologies can be useful in diagnosing CD?
*ASCA (anti-saccharomyces cerevisiase Abs)
What serologies can be useful in diagnosing UC?
What are Extraintestinal manifestations of IBD?
Oral/Opthalmmalogic: APTHOUS ulcers, uveitis, iritis
What are common complications of UC?
What are common complications of CD?
How does IBD increase the risk of CRC?
Happens more w/ duration and extent of disease
Increased risk with:
Disease proximal to splenic flexure
> 8 years duration; young age at diagnosis
Primary sclerosing cholangitis
Family history of CRC
Pseudopolyps at colonoscopy
Flat or depressed adenomas--fields of dysplasia> CRC
What is a protective treatment against CRC used to tx pts w/ IBD?
How does CRC present in IBD?
Doesn't follow adenoma-carcinoma sequence:
Dysplasia/ DALM (dysplasia associated lesion or mass)--> colon comes out
What type of surveillance for CRC occurs in a pt who has had IBD for more than 7 yrs?
colonoscopy and biopsies every 1-2 years
IBD induction therapy?
1. 5-ASA (mild disease):
3. Biologics – Infliximab
4. Cyclosporine (pt not getting better w/ anything, transition to surgery)
UC – cure
Crohn’s – to treat complications
What is maintenance therapy for IBD?
Biologics – Infliximab
*NO ONE WILL BE ON MAINTENANCE STEROIDS
What medications are used to specifically treat the sml bowel and R colon?
What medications are used to specifically tx the left colon?
What are complications from ileal disease/resection?
bile salt diarrhea
vit B12 def
What do biologics do (infliximab)?
Most are Abs to TNFa or to where it binds
What are toxicities of TNF-a inhibitors (infliximab)?
malignancy- lymphomas, leukemias
Make sure they dont have latent TB or HBV. Make sure they don't have an active infection.
What are indications for surgery in UC?
unresponsive acute disease
cancer or dysplasia
What is the MC surgical option for UC?
ileal pouch anal anastamosis
What are indications for surgery w/ crohns disease?
unhappy w/ medical therapy