IBD, Diverticular Disease, Colon and Anorectal Neoplasia CIS - Tieman Flashcards Preview

Year2 GI Exam II > IBD, Diverticular Disease, Colon and Anorectal Neoplasia CIS - Tieman > Flashcards

Flashcards in IBD, Diverticular Disease, Colon and Anorectal Neoplasia CIS - Tieman Deck (37):
1

pANCA

ulcerative colitis

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ASCA

crohns disease

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apthous ulcers

crohns

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IBD

disease of developed countries

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north america

ulcerative colitis more prevalent

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crohns disease

young women

bimodal

15-30yo and 7th decade

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ulcerative colitis

bimodal

equal men and women

20-40 yo and 7th decade

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inflammatory bowel disease

polygenic - multiple causes

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cigarette smoking

helps UC
makes crohns worse

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29yo RLQ pain and diarrhea last 6 months
-fam hx UC
-smokes 1ppd x 10 years
-ulcers inside lower lip
-tender RLQ
-guaiac positive stool

WBC 12,000
ESR elevated
CRP elevated
ASCA elevated
IgA and IgG elevated

colonoscopy - hyperemia ascending colon fullness of medial aspect

biopsy - normal colonic mucosa

CT enterography - thick bowel wall, suggestive of crohns

DDx - crohns, UC, appendicitis, pregnancy

work up - CBC, pregnancy test, Ab studies - pANCA and ASCA,

ESR and CRP - inflammatory process

ASCA, IgA, and IgG - crohns

colonoscopy - fullness medial aspect - inflammation

terminal ileum - crohns

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ulcerative colitis

mucosal
rectum and progresses continuously proximally

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crohns

transmural

ileocecal region

can occur anywhere

skip lesions

terminal ileum** - 70%

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family history of UC or crohns

increased risk for both - doesn't matter which one

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ASCA, IgA and IgG elevation

90% specific for crohns

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cobblestone

crohns

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localization of crohns

small bowel imaging

-best for crohns - MRI enterography or CT enterography - with contrast material

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CT enterography

small bowel imaging

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tx of crohns

5-ASA - topical - targeted to area you need

diet changes - liquids, no milk, no grains

corticosteroids - systemic oral
-budesomide

infliximab - monoclonal Ab

methotrexate

6-MP

19

surgery in crohns

no - will come back in other places**

except to treat complications

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budesomide

corticosteroid for crohns

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Case 24yo M, 3 month abdominal pain, urgency and defecation
-bloody, mucous stools
-fam hx crohns
-weight loss
-aching hips, knee, shoulders

-hyperactive bowel sounds, tender abdomen
-guaiac positive
-swelling of knees

ESR elevated
CRP elevated
ASCA normal
IgA normal
IgG normal
p-ANCA elevated

DDx - cancer, UC, crohns

work-up - CBC, Ab tests

proctosigmoidoscopy - edematous friable in rectal vault

colonoscopy - extends to distal transverse colon

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arthralgias

with ulcerative colitis

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fistula

crohns

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complication of acute ulcerative colitits

toxic megacolon**

barium enema or colonoscopy can incite this

bowel dilates and loses blood supply and get necrosis and perforation

be careful of scopes with severe ulcerative colitis

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ulcerative colitis risk

adenocarcinoma of colon

from time of onset - risk goes way up at 8 years**

after 8 years - screen yearly
-cancers can be submucosal

take random biopsies

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tx of ulcerative colitis

5-ASA - oral or enema - determining of extent of UC

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to keep UC in remission

maintenance therapy - 5-ASA type - oral or enema admin

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surgery and UC

can be curative

total proctocolectomy

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Case 39yo M anorexia, LLQ pain, low grade fever and diarrhea, never before

-pain 6/10
-LLQ tender with guarding
-rectal - fullness on left and stool trace guaiac positive

WBC 16,000 w/ bands

CT - acute inflammation of sigmoid

DDx - diverticulitis, colorectal cancer, UC, crohns

work up - CBC, CT

WBC with bands - acute infection

CT - sigmoid diverticulitis

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CT for diverticulitis**

make sure they don't have complication**

also helps with diagnosis

perforation - to peritoneum
perforation - to sidewall

31

tx of acute diverticulitis

antibiotics, bowel rest, IV fluids

don't do scope until it is controlled**

then do colonoscopy - 6 weeks later - to rule out cancer

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LLQ tenderness and fever

think sigmoid diverticulitis

33

Case 33yo M, fullness left buttock when sits, soiling of underwear
-lower abdomen pain
-lost 10 pounds
-anorexia
-low grade fever

-tender deep palp LLQ
-dimple left buttock - pus and fecal matter
-erythematous pre-tibial nodules on left leg

anal fistula

often associated with crohns
-30%

but normally - infection and abscess in anal crypts**

work up - CBC, pANCA, ASCA, Ig levels

34

normal anal fistula

infection and abscess in anal crypt
-ischioanal space - perirectal abscess

-works out to skin

-can drain pus and stool

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tx of anal fistula

anal fistulotomy - open - from inside to outside

seton - if complex fistula

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crohns anal fistulas

surgery not 1st step

not going to cure the fistula
-they come back
-"waterpot perineum"

first - treat medically - infliximab or 6-MP

37

anal fissure

sores
-constipation association
-pain with bowel movement

if chronic - tx is surgery
-lateral internal sphincterotomy