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Flashcards in IBD Deck (23):
1

Inflammatory Bowel Disease

Ulcerative Colitis
Chrons Disease

2

Bloody Diarrhea/Disentery

May be a symptom of UC and CD, but there are many causes other than IBD. If you have a patient presenting with bloody diarrhea the first thing in your head shouldn't be IBD, you should want to rule out other infectious causes like E coli 0157, salmonella, shigella, campylobacter, yersinia, c diff, ova and parasites

3

Ulcerative Colitis.

-Involves ulcers in intestinal tract, specifically in the colon (hence colitis). Inflammation of MUCOSA, NOT full thickness inflammation.
-Always starts in rectum and goes upward. ALWAYS has rectal involvement, pt often p/w left lower quadrant pain bc thats where your rectum is
-NEVER involves small intestine, JUST COLON

4

Ulcerative Colitis Morphology

-Pseudopolyps formed by healed ulcers
-Loss of haustra that leads to "Lead pipe" appearance on X-ray/ct

5

Extra intestinal Features of UC

-Pyodermic gangrenous, ulceration of skin
-Primary sclerosing cholangitis- biliary disorder where strictures form in bile tree only happening to pt with UC
-Ankylosing spondylitis- Inflammation of spine leading to back pain
-Uveitis-inflammation of middle of the eye, common in autoimmune disorders

6

Feared Complication of UC

_Toxic Megacolon
-colon stops contracting, rapid intestinal dilation, walls thin and are prone to rupture, and then PERF

7

Toxic Megacolon

-P/w abdominal pain, distention, FEVER, diarrhea, SHOCK
- You can see it on xray

8

UC- Adenocarcinoma

-Need to have disease for 10 years
-The more colon involved the greater risk
-Right sided colitis or pancolits are risk factors
-Screening colonoscopies are recommended
-multiple biopsies are taken

9

Churns Disease. High Yield features

-Granulomas inflammation!
-Transmural (entire wall is effected)
-Mouth to anus, any portion of GI tract can be effected

10

CHrons Disease Most common Location

-Terminal Ileum most common location
-Malabsorption, b12 deficiency, and malabsorption of bile salts
-Bc you can't reabsorb bile salts, pt with churns are at increased risk of gallstones and can lead to secretary diarrhea, malabsorption of fats so steatthorea develops, may have NON bloody diarrhea due to malabsorption
-RLQ pain bc terminal ileum radiates to RLQ

11

Other features of Chrons

-CHrons spares the rectum
-Has "Skip Sections"

12

Hallmark of Biopsy

-GRANULOMAS

13

Gross Morphology Hallmark of CHrons Disease

Cobblestone mucosa formed by transmural inflammation

14

Characteristic Feature Of Chrons

-Fistulas (perianal, abdominal, bladder (enter visceral fistula))
-Loop of small bowel affected by churns, we have transmural inflation can spread outside wall of intestine to whatever structure is nearby, if the bladder happens to be near by then the infection spreads to the bladder and they bridge.

15

Other Gross Morphology of Chrons

Creeping Fat
-transural inflammation heals and the condense fibrous tissue pulls fat around bowel wall, so the intestine of chrons disease pt will have fat wrapped entirely around the bowel
Strictures
-healing lumen leads to fibrous tissue which causes NARROWING of intestinal lumen
-Radiology finding: "String Sign" pt drinks barium we fill their intestines and take X-ray, the barium will fill normal parts of intestines, when the barium reached intestine like the ileum the barium will narrow down to a string

16

Chrons and Adenocarcinoma

-Adenocarcinoma is more common in UC pt unless a Chrons patient has colon involvement

17

Extra intestinal features of CD

Migratory Polyarthris (most common)
-Arthritis of large joints esp knees and hips
-So if pt p/w abdominal sx and bloody diarrhea and migratory polyarthritis you should think of CD
Erythema Nodosum
-inflammation of fat tissue under skin (red splotches on shin)
Kidney Stones
-Pt with CD have increased rate of development of calcium oxalate stones or KIDNEY STONES bc of high calcium oxalate level bc of involvement of terminal lieum which leads to fat malabsorption.
-All that fat not able to be absorbed leaves calcium oxalate free unbound from fat, to be absorbed by the gut, so there is more oxalate found in the serum and urine of people with CD
Ankylosing Spondylitis and Uveitis also just like UC

18

SMOKING

CD plus Smoking, doesn't mix
Worsens outcomes in CD, ppl who smoke can trigger a flare up and bloody diarrhea
For UC smoking doesnt affect outcomes much

19

Tx UC or Chrons, but really just colon involvement

SULFASALAZINE
-Activates as soon as it reaches the colon, it binds to colonic bacteria and splits it which then suupress inflammation in colon
-Induces and maintains remission in UC

20

Sulfasalazine Side Effects

-Infertility for men that is reversible
-Gi upset (n/v)
-Sulfonamide hypersensitivity (pt who are allergic to sulfa drugs)

21

5-ASA

MESALAMINE
-Cant administer by itself bc much of it is absorbed in jejunum, whereas sulfasalazine activates in colon

22

Modified 5 ASA

ASACOL
PENTASA
Have some coating on it that delays aborption through that until it hits where the inflammation actually is

23

Glucocorticoids in CD

-Prednisone, once pt is in remission taper off immediately, doesn't do anything for maintenance, just induces remission