DDx: Inflammatory Bowel Disease Flashcards Preview

03 GI AND HEPATOLOGY > DDx: Inflammatory Bowel Disease > Flashcards

Flashcards in DDx: Inflammatory Bowel Disease Deck (23):
1

Differential Diagnosis of Inflammatory Bowel Disease:

Bacterial enteritis 

Protozoan enteritis

Clostridium difficile infection

Irritable bowel syndrome 

Celiac disease

Microscopic colitis

Lactose intolerance

Diverticulitis

Ischemic colitis

Infectious proctitis

2

Hx: Extraintestinal Manifestations of Inflammatory Bowel Disease

Ankylosing spondylitis

Aphthous stomatitis

Peripheral arthritis

Primary sclerosing cholangitis

Sacroiliitis

Scleritis

Uveitis

Osteoporosis

Erythema nodosum

Pyoderma gangrenosum

3

Ankylosing spondylitis (see Spondyloarthritis)

Rare complication; seen more in CD than UC.

4

Aphthous stomatitis

Small ulcers between gums and lower lip or along tongue; related to IBD disease activity.

5

Peripheral arthritis

Frequently classified as one of two types: type 1 affects large joints of arms and legs (elbows, wrists, knees, ankles); symptoms often acute and migratory; correlate with active bowel disease. Type 2 is symmetric, affects small joints, and is often chronic; unrelated to bowel disease activity.

6

Primary sclerosing cholangitis (see Hepatitis)

Severe inflammation and scarring of bile ducts; more common in UC and men,

Hx: Jaundice, nausea, pruritus, weight loss.

May be complicated by cholangiocarcinoma or colon cancer.

7

Sacroiliitis

Pain and stiffness in lower spine and sacroiliac joints; may present before IBD symptoms.

8

Scleritis

Deep pain, redness of sclera. An ophthalmologic emergency.

9

Uveitis

Pain, blurry vision, photosensitivity, redness of eye. An ophthalmologic emergency.

10

Osteoporosis

More common in women with CD; related to IBD and therapy. Periodic screening important.

11

Erythema nodosum

Tender, red nodules over shins and ankles; more common in UC and women; related to IBD disease activity.

12

Pyoderma gangrenosum

Papules and pustules coalesce to form deep, chronic ulcers, often on shins and ankles; more common in UC; related to IBD disease activity.

13

Tx: Medical Therapy for Inflammatory Bowel Disease

5-Aminosalicylates

Sulfasalazine, olsalazine, balsalazide, mesalamine: oral, rectal

Antibiotics

Antibiotics (metronidazole, ciprofloxacin)

Glucocorticoids

Oral, intravenous, rectal

Budesonide

Immunomodulators

 

Methotrexate

Cyclosporine

6-MP, azathioprine

Biological Agents

Anti–TNF-α (adalimumab, certolizumab pegol, infliximab)

Natalizumab

 

14

Bacterial enteritis 

Acute-onset diarrhea with fever, chills, hematochezia, and/or pus in stool; positive stool culture (Escherichia coli or Campylobacter, Shigella, Salmonella, or Yersinia spp.)

15

Protozoan enteritis

Acute diarrhea caused by Entamoeba or Giardia spp.; Entamoeba spp. may cause hepatic abscess and RUQ pain; history of travel or drinking untreated water; stool antigens detected by ELISA

16

Clostridium difficile infection

Watery stool, lower abdominal cramping, fever, leukocytosis; recent antibiotic use, hospitalization, or stay in long term-care facility; C. difficile toxin in stool

17

Irritable bowel syndrome 

Hx: Patients meeting the Rome III (IBS) diagnostic criteria have recurrent abdominal pain or discomfort at least 3 days each month in the past 3 months (with onset more than 6 months earlier) associated with two or more of the following: improvement with defecation; onset associated with change in frequency of stool; onset associated with change in form (appearance) of stool.

Dx: Normal colonoscopy

Alarm symptoms (not present) include onset after age 50 years, brief history of symptoms, weight loss, nocturnal symptoms, family history of colon cancer, rectal bleeding, and recent antibiotic use.

18

Celiac disease

Celiac disease occurs in genetically predisposed persons with haplotype HLA-DQ2 or HLA-DQ8

Hx: Abdominal pain, bloating, diarrhea triggered by ingestion of gluten that is present in wheat, rye, and barley. Malabsorption, malnutru=ition, and iron deficiency anemia may be present.

Dx: Tissue transglutaminase antibody

Tx: Avoidance of gluten-containing foods is curative

19

Microscopic colitis

Hx: Abdominal pain, bloating, chronic watery diarrhea; chronic NSAID use implicated in >50% of cases

Dx: Normal colonoscopy but abnormal biopsy with two subtypes (lymphocytic, collagenous);

20

Lactose intolerance

Abdominal pain, bloating, diarrhea after lactose ingestion

21

Diverticulitis

LLQ pain, fever, diarrhea; abdominal CT shows inflamed diverticula

22

Ischemic colitis

Abdominal pain, diarrhea, hematochezia; elderly patients with vascular disease; imaging of mesenteric vessels confirms diagnosis

23

Infectious proctitis

Tenesmus, diarrhea, hematochezia; history of receptive anal intercourse; positive bacterial or viral cultures (Neisseria, Chlamydia, or Treponema spp.; HSV)