IBD 2/1 Flashcards
(13 cards)
IBD epi
more common in jews, 15-25 y/o and sometimes late age
UC high in non-smokers while CD is high in smokers
genetics in IBD
CD has stronger genetic background than UC
CD gene on chromosome 16
serologic studies in IBD
p-ANCA in UC
ASCA in CD
CD clinical picture
crampy pain with diarrhea, fever and weight loss
aphthous ulcers in mouth
Tendernes with thickness often in RLQ
perianal fistulas or tender induration
Anemia and elevated ESR
UC clinical picture
bloody diarrhea
bowel urgency, rectal discomfort, abdominal cramping may be prominent
Abdominal tenderness often on LLQ
extra intestinal manifestations
primary sclerosing cholangitis seen with UC
also see ankylosing spondylitis, migratory polyarthralgia, pyoderma gangrenosum (ulcerating skin lesions), erythema nodosum(painful and hyperemic nodules on anterior legs), uveitis, episcleritis
IBD therapy
Aminosalicylates
initial therapy
Sulfasalazine (sulfa and 5-ASA)=mesalamine, more effective for UC than CD
Can be used as enema
Corticosteroids
prednisone. effective for immediate control of active IBD in pts unresponsive to 5-ASA
Can cause osteopenia/porosis–> therefore DEXA scan and treat with bisphosphonate before giving steroids
Immunomodulators
azathioprine and 6-mercaptopurines: takes months to have an effect
monitor WBC and platelets and 5% can develop pancreatitis
measure TPMT, which metabolizes these drugs prior to therapy
Antibiotics
only given in toxic megacolon or in the presence of fistulas–> metronidazole
Biologics=Infliximab
chimeric antibody against TNF-alpha or its receptor
also adalimumab which is completely humanized
Surgery
severe UC–> colectomy with ileoanal J-pouch
surgery for CD is usually for obstruction or abscess, though recurring CD is high
Neoplasia
dysplasia is more common in UC than CD–> colonoscopy after 8-10 years after diagnosis of UC
