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Flashcards in IBD Deck (54):
1

What is IBD?

Inflammatory Bowel Disease

2

What are the two inflammatory bowel diseases?

1. Crohn's disease
2. Ulcerative colitis

3

What is another name for Crohn's disease?

Regional enteritis

4

What is the cause of IBD?

Unknown; probably an autoimmune process with environmental factors

5

What is the differential diagnosis of IBD?

Crohn's vs. UC, infectious colitis (e.g. C. diff, amebiasis, shigellosis), ischemic colitis, IBS, diverticulitis, ZES, colon cancer, carcinoid, ischemic bowel

6

What are the extraintestinal manifestations seen in both types of IBD?

A PIE SACK:
Ankylosing spondylitis, Aphthous ulcers, Pyoderma gangrenosum, Iritis, Erythema nodosum, Sclerosing cholangitis, Arthritis, Clubbing, Kidney disease (e.g. nephrotic syndrome, amyloid deposits)

7

What is the incidence of Crohn's disease?

3-6/100,000

8

What is the at-risk population for Crohn's disease?

Jewish, male, 25-40 yo or 50-65 yo

9

What is the incidence of UC?

10/100,000

10

What is the at-risk population for UC?

Jewish, male, 20-35 yo or 50-65 yo

11

What are the initial symptoms of Crohn's disease?

Abdominal pain, diarrhea, fever, weight loss, anal disease

12

What are the initial symptoms of UC?

Bloody diarrhea, fever, weight loss

13

What is the anatomical distribution of Crohn's disease?

"Mouth to anus"
Small bowel only: 20%
Large bowel only: 30%

14

What is the anatomical distribution of UC?

Colon only

15

What is the route of spread of Crohn's disease?

Small bowel, colon, or both with skip lesions of normal bowel

16

What is the route of spread of UC?

Involves rectum and spreads proximally in a continuous route

17

What is "backwash" ileitis?

Mild inflammation of the terminal ileum in UC

18

What is the bowel wall involvement of Crohn's disease?

Full thickness, transmural

19

What is the bowel wall involvement of UC?

Mucosa, submucosa only

20

What is the anal involvement of Crohn's disease?

Common (fistulae, abscesses, fissures, ulcers)

21

What is the anal involvement of UC?

Uncommon

22

What is the rectal involvement of Crohn's disease?

Rare

23

What is the rectal involvement of UC?

100% of cases

24

What are the mucosal findings in Crohn's disease?

1. Aphthous ulcers
2. Granulomas
3. Linear ulcers
4. Transverse fissures
5. Swollen mucosa
6. Full-thickness wall involvement

25

What are the mucosal findings in UC?

1. Granular, flat mucosa
2. Ulcers
3. Crypt abscesses
4. Dilated mucosal vessels
5. Pseudopolyps

26

What diagnostic tests are used for Crohn's disease?

Colonoscopy w/ biopsy, barium enema, UGI w/ small bowel follow-through, stool cultures

27

What diagnostic tests are used for UC?

Colonoscopy, barium enema, UGI w/ small bowel follow-through (r/o Crohn's), stool cultures

28

What are complications of Crohn's disease?

Anal fistula or abscess, fistula, stricture, perforation, abscesses, toxic megacolon, colovesical fistula, enterovaginal fistula, hemorrhage, obstruction, cancer

29

What are complications of UC?

Cancer, toxic megacolon, colonic perforation, hemorrhage, strictures, obstruction, complications of surgery

30

What is the cancer risk of Crohn's disease?

Overall increased risk, but half that of UC

31

What is the cancer risk of UC?

5% risk of colon cancer at 10 years; risk increases 1% per year

32

What are indications for surgery in Crohn's disease?

Obstruction, massive bleeding, fistula, perforation, suspicion for cancer, abscess (refractory to antibiotics), toxic megacolon (refractory to meds), strictures, dysplasia

33

What are indications for surgery in UC?

Toxic megacolon (refractory to meds), cancer PPx, massive bleeding, FTT, perforation, suspicion for cancer, acute severe symptoms, inability to wean off steroids, obstruction, dysplasia, stricture

34

What are common surgical options for UC?

1. Total proctocolectomy, distal rectal mucosectomy, ileoanal pull through
2. Total proctocolectomy, Brooke ileostomy

35

What is toxic megacolon?

An acutely and massively distended colon in a patient that is septic, febrile with abdominal pain

36

What are the medication options for IBD?

Sulfasalazine, mesalamine, steroids, metronidazole, azathioprine, 6-mp, infliximab

37

What is infliximab?

An antibody against TNF-alpha

38

What is the active metabolite of sulfasalazine?

5-ASA, which is released in the colon

39

What is the medical treatment of choice for Crohn's disease?

PO metronidazole

40

What are the treatment options for long-term remission of IBD?

6-mp, azathioprine, mesalamine

41

What medication is used for IBD flares?

Steroids

42

What is a unique medication route option for UC?

Enemas (steroids, 5-ASA)

43

Which disease has cobblestoning more often on endoscopic exam: Crohn's or UC?

Crohn's disease

44

Which disease has pseudopolyps on colonoscopic exam?

UC

45

What are pseudopolyps?

Polyps of hypertrophied mucosa surrounded by mucosal atrophy

46

Which disease has a lead pipe appearance on barium enema?

Chronic UC

47

What is the most common indication for surgery in patients with Crohn's disease?

SBO

48

What are the intraoperative findings of Crohn's disease?

Mesenteric "fat-creeping" onto anti-mesenteric border of small bowel, shortened mesentery, thick bowel wall, fistulae, abscesses

49

Why do you see fistulae and abscesses with Crohn's disease and not UC?

Crohn's is transmural

50

What is the operation for short strictures of the small bowel in Crohn's disease?

Stricturoplasty: open longitudinally and sew closed in transverse direction

51

Should the appendix be removed during a laparotomy for abdominal pain if Crohn's disease is discovered?

Yes, if the cecum is not involved with active Crohn's disease

52

What is pouchitis?

Inflammation of the pouch of an ileoanal pull through, treated with metronidazole

53

Do you need a frozen section for margins during a bowel resection for Crohn's disease?

No, only need grossly negative margins

54

What is it called when the entire colon is involved?

Pancolitis