ULCERATIVE COLITIS - age of onset - ethnicity - gender - smoking - oral contraceptives - appendectomy - Monozygotic twins - dizygotic twins - Infections in the 1st yr of life

- age of onset: 2nd-4th decades and 7th-9 decades - ethnicity: jewish> non> black>latin>asian - gender: male - smoking: may prevent - oral contraceptives: no increased risk - appendectomy: protective - Monozygotic twins: 6-18% - dizygotic twins: 0-2% - Infections in the 1st yr of life: more risk by the age of 10 and 20

CROHN'S DIEASE - age of onset - ethnicity - gender - smoking - oral contraceptives - appendectomy - Monozygotic twins - dizygotic twins - Infections in the 1st yr of life

- age of onset: 2nd-4th decades and 7th-9 decades - ethnicity: jewish> non> black>latin>asian - gender: male - smoking: may cause - oral contraceptives: hazardous - appendectomy: not protective - Monozygotic twins: 38-58% - dizygotic twins: 4% concordance - Infections in the 1st yr of life: more risk by the age of 10 and 20

ULCERATIVE COLITIS Diagnostics - CRP - PLT - ESR - FECAL LACTOFERRIN - CALPROTECTIN - pANCA - Surgeries

Elevated - CRP - PLT - ESR - FECAL LACTOFERRIN - CALPROTECTIN - pANCA Surgeries - Sigmoidoscope - colonscopy

IBD Flashcards by Aserah Blank

ULCERATIVE COLITIS

age of onset
ethnicity
gender
smoking
oral contraceptives
appendectomy
Monozygotic twins
dizygotic twins
Infections in the 1st yr of life

age of onset: 2nd-4th decades and 7th-9 decades
ethnicity: jewish> non> black>latin>asian
gender: male
smoking: may prevent
oral contraceptives: no increased risk
appendectomy: protective
Monozygotic twins: 6-18%
dizygotic twins: 0-2%
Infections in the 1st yr of life: more risk by the age of 10 and 20

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CROHN’S DIEASE

age of onset
ethnicity
gender
smoking
oral contraceptives
appendectomy
Monozygotic twins
dizygotic twins
Infections in the 1st yr of life

age of onset: 2nd-4th decades and 7th-9 decades
ethnicity: jewish> non> black>latin>asian
gender: male
smoking: may cause
oral contraceptives: hazardous
appendectomy: not protective
Monozygotic twins: 38-58%
dizygotic twins: 4% concordance
Infections in the 1st yr of life: more risk by the age of 10 and 20

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Involves the rectum and extend proximally to
involve all or part of the colon
Limited to the mucosa and superficial
submucosa

ULCERATIVE COLITIS

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2 major histology [catures: ULCERATIVE COLITIS

Distorted crypt
architecture, basal plasma cells
multiple basal lymphoid aggregates

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Erythematous mucosa with fine granular surface that resembles “sandpaper”
Backwash ileitis
Pscudopalyps
Toxic megacolon

ULCERATIVE COLITIS

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ULCERATIVE COLITIS : Signs and symptoms

Diarrhea
Rectal bleeding
‘Tenesmus *
Passage of mucus
Crampy abdominal pain

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

EXTENT
E1: Ulcerative proctitis
INVOLMENT:

limited to the rectum

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

EXTENT
E2: Left-sided UC (distal UC)
INVOLMENT:

limited to the colorectum distal to the splenic flexure

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

EXTENT
E3: Extensive UC (pancolitis)
INVOLMENT:

extends proximal to the splenic

flexure

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
Absence of symptoms
SEVERITY

S0: Clinical remission

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
=4 stools/d (with or without blood), absence of systemic illness, normal inflammatory markers (ESR)

S1: Mild disease activity

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
>/=4 stools/d but minimal signs of systemic toxicity

S2: Moderate disease

activity

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Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)

DEFINITION
>/=6 bloody stools/d, pulse >/= 90 beats/min,
temperature >/=37.5°C, hemoglobin <10.5 g/100 mL, and ESR 230 mm/h

S3: Severe disease activity

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ULCERATIVE COLITIS
Diagnostics

CRP
PLT
ESR
FECAL LACTOFERRIN
CALPROTECTIN
pANCA
Surgeries

Elevated

CRP
PLT
ESR
FECAL LACTOFERRIN
CALPROTECTIN
pANCA

Surgeries

Sigmoidoscope
colonscopy

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Affects any part of the GI tract from the mouth to the anus
Rectum is often spared
Segmental w/ skip areas
Transmural
Aphthoid ulceration and focal crypt abscesses w/ loose
aggregations of macrophages forming non caseating
granuloma —> earliest lesion
Cobblestone appearance
Creeping fat
Pseudopolyps

CROHN’S DISEASE

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CROHN’S DISEASE

2 patterns of disease:

Fibrostenotic obstructing pattern

- Penetrating fistulous pattern

mc site of inflammation is Terminal Ileum
RLQ pain (colicky) and diarrhea
Low grade fever, weight loss

Ileocolitis

CROHN’S DISEASE
* DIAGNOSTICS

ESR
CRP
ASCAs

Elevated

Endoscopic feature of Crohn’s Disease

rectal sparing,
aphthous ulcerations,
fistulas,
skip lesions

Infectious Etiologies of Crohn’s Disease

BACTERIAL

Salmonella
Shigella
Toxigenic
Escherichia coli
Campylobacter
Yersinia
Clostridium difficile
Gonorrhea
Chlamydia trachomatis

Infectious Etiologies of Crohn’s Disease

VIRAL

Cytomegalovirus

- Herpes simplex

Infectious Etiologies of Crohn’s Disease

Mycobacterial

Tuberculosis

- Mycobacterium avium

Infectious Etiologies of Crohn’s Disease

PARASITIC

Amebiasis
Isospora
Trichuris trichiura
Hookworm
Strongyloides

Infectious Etiologies of Crohn’s Disease

FUNGAL

Histoplasmosis
Candida
Aspergillus

NonInfectious Etiologies of Crohn's Disease Drugs and Chemicals

- NSAIDs - Phosphosoda - Cathartic colon - Gold - Oral contraceptives - Cocaine - Immune checkpoint - inhibitor colitis - Mycophenolate mofetil

EX TRAINTESTINAL MANIFESTATION Exythema Nodusom - Pyoderma Ganerenosum

- Exythema Nodusom - UC (10%), CD (15%) | - Pyoderma Ganerenosum - UC (1-12'%o), less common in CD

RHEUMA - ,Peripheral arthritis - - Ankylosing spondylitis - Sacroilitis

- Peripheral arthritis - 15-20% of IBD, more common in CD - Ankylosing spondylitis - 10% of IBD, more common in CD than UC - - Sacroilitis both

OCULAR MANIFESTATION IN IBS

- conjunctivitis, | - uveitis/iritis, - episcleritis

MANIFESTATION | » HEPATOBILIARY

- Hepatic steatosis, - cholelithiasis, - primary sclerosing cholangitis

MANIFESTATION | UROLOGIC

- Calculi, | - ureteral obstruction, - - ileal bladder fistula

MANIFESTATION | METABOLIC BONE D/O

- low bone mass, | - osteonecrosis

‘Treatment for IBS

- 5 ASA agents Sulfasalazine, Balsalazide, Delzicol, Asacol, Lialda, Apniso, Pentasa, Rowasa, Canasa - Glucocorticoids Prednisone, Hydrocortisone - Antibiotics Metronidazole, Ciprofloxacin - Azathioprine and 6 Mercaptopurine