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IBD & IBS Flashcards

(57 cards)

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1
Q

Main Diseases of IBD

A

Crohn’s Disease

Ulcerative Colitis

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2
Q

Difference between Ulcerative Colitis & Crohn’s Disease

A

UC: mucosal colitis, recurring episodes

Crohn’s: transmural inflammation, skip lesions

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3
Q

Epidemiology of IBD

A

Males = females

Infrequent in countries with poor sanitation

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4
Q

Etiology Theories of IBD

A 
Infectious
Immunologic
Genetic
Dietary
Environmental
Vascular
Neuromotor
Allergic
Psychogenic
Autoimmune
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5
Q

Pathophysiology of IBD

A

Defect in function of intestinal lumen
Breakdown defense barrier
Results in chronic inflammatory process

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6
Q

Systemic Complications of IBD

A 
Aphthous stomatitis
Episcleritis & uveitis
Arthritis
Vascular complications
E. Nodosum
P. Gangrenosum
Gallstones
Malabsorption
Renal stone, fistulae, hydronephrosis, amyloidosis
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7
Q

Define Ulcerative Colitis

A

Involves mucosal surface of colon with the formation of crypt abscess

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8
Q

Where is the initial point of ulcerative colitis?

A

Rectum

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9
Q

Clinical Course of Ulcerative Colitis

A

Flare-ups

Remission

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10
Q

What can cause a flare-up in ulcerative colitis?

A

Stress
Lack of sleep
Illness

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11
Q

What is protective in the case of ulcerative colitis?

A

Smoking

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12
Q

Signs/Symptoms of Mild to Moderate Ulcerative Colitis

A

Bloody diarrhea
Lower abdominal cramps- relieved with defecation
Fecal urgency

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13
Q

Signs/Symptoms of Severe Ulcerative Colitis

A 
Rectal bleeding
LLQ cramps
Severe diarrhea
Low-grade fever
Anemia
Hypoalbuminemia
Hypovolemia
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14
Q

Systemic Associations of Ulcerative Colitis

A 
Peripheral arthritis
Central arthritis
Erythema nudism
Uveitis
Sclerosing cholangitis
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15
Q

Labs for Ulcerative Colitis

A

CBC: anemia, leukocytosis
ESR & CRP: elevated
CMP: electrolyte disturbances, decreased albumin, prolonged clotting time
pANCA: Perinuclear antineutrophil cytoplasmic antibodies

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16
Q

Mild Ulcerative Colitis

A

Stools:

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17
Q

Moderate Ulcerative Colitis

A 
Stools: 4-6/day
Pulse: 90-100
Hematocrit: 30-40
Weight loss: 1-10%
Temp: 99-100
ESR: 20-30
Albumin: 3-3.5
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18
Q

Severe Ulcerative Colitis

A 
Stools: >6/day (bloody)
Pulse: >100
Hematocrit: 10%
Temp: >100
ESR: >30
Albumin:
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19
Q

Diagnostics of Ulcerative Colitis

A

Bloody diarrhea
Plain abdominal X-rays
Sigmoidoscopy or colonoscopy
CT

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20
Q

Differential Diagnosis of Ulcerative Colitis

A 
Infectious colitis
CMV colitis
Rectal CA
 Crohn's
GI bleed
Mesenteric ischemia
Diverticulitis
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21
Q

Intestinal Complications of Ulcerative Colitis

A 
Bleeding
Toxic megacolon
Perforation
Benign stricture
Malgnant stricture
Colorectal CA
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22
Q

Treatment of Ulcerative Colitis

A 
Reduce fiber during exacerbation 
Folic acid supplements with sulfasalazine
Oral iron with bleeding
Frequent follow-up
Short course loperamide
Yearly colonoscopy
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23
Q

Treatment of Mild to Moderate Ulcerative Colitis

Study These Flashcards
A

Sulfasalazine
Olsalazine
Mesalamine
+/- prednisone

24
Q

Treatment of Moderate to Severe Ulcerative Colitis

Study These Flashcards
A

Sulfasalazine
Olsalazine
+/- prednisone

25
Sulfasalazine
Mild anti-inflammatory compared to steroids Azospermia Severe depression in males
26
Types of Sulfasalazine
Oral Topical Hydrocortisone (enema, suppositories, foam)
27
Indications for Surgery in Ulcerative Colitis
``` Exsanguinating hemorrhage Toxicity/perforation Suspected CA Significant dysplasia Growth retardation Systemic complications Intractability ```
28
Define Crohn's Disease
Transmural involvement with formation of fistulas, narrowing of lumen, obstruction
29
Main Areas where Crohn's is Located
``` Ileocolitis Ileitis Colitis Gastroduodenitis Jejunoileitis ```
30
What is smoking strongly associated with?
Development of Crohn's Resistance to medical therapy Early disease relapse
31
Clinical Manifestations of Crohn's Disease
``` Depends on site/severity Insidious onset Intermittent bouts of low-grade fever, diarrhea, & RLQ pain Postprandial pain RLQ mass Perianal disease Nocturnal BM's, sweats, weight loss Skin lesions Chronically ill: weight loss, pallor ```
32
Children & Adolescent Clinical Manifestations of Crohn's Disease
``` Insidious onset Weight loss Failure to grow or develop secondary sex characteristics Arthritis Fever of unknown origin ```
33
Distinguishing Features of Crohn's Disease
``` Small bowel involvement Rectal sparing 25-30% without gross bleeding Perianal disease Focal lesions Skip lesions Asymmetric involvement Fistulization Granulomas Endoscopic features ```
34
PE Findings in Crohn's Disease
Abdominal distention Abnormal bowel sounds Tenderness in involved area Perianal abscess, fistula, skin tag, anal stricture
35
Crohn's Disease Labs
CBC: anemia, leukocytosis ESR & CRP: elevated B12, folate, & iron levels CMP: electrolyte disturbances, decreased albumin, prolonged clotting time ASCA: anti-saccharomyces cerevisiae antibody
36
Radiography for Crohn's Disease
Barium contrast studies
37
What will you see on barium contrast studies?
``` Cobble stoning Skip lesions Pseudodiverticula Dilated bowel Fistulas communicating to adjacent bowel/ mesentery/bladder/ vagina ```
38
Treatment of Crohn's Disease
``` 5-Aminosalicylic acid agents Antibiotics: acute infections Steroids: acute infections Anti-TNF therapy (Infliximab) Immunomodulating drugs ```
39
Examples of 5-Aminosalicylic Acid Agents
Sulfasazine Mesalamine Pentasa
40
Examples of Immunomodulating Drugs
Azathioprine Mercaptopurine Methotrexate
41
Define IBS
Functional gastrointestinal disorder that is a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities
42
Characteristics of IBS
Continuous or recurrent symptoms for at least 3 months of: abdominal pain or discomfort, pain relieved by defecations, pain with a change in frequency or form And a varying pattern of defecation with 3 or more of the following: altered stool frequency, form, stool passage, abdominal dissension & bloating, passage of mucus
43
Epidemiology of IBS
Females > males | Younger > older
44
Associated symptoms of IBS
``` Fatigue Back ache Early satiety Nausea Headache Irritable bladder Functional dyspepsia ```
45
Rome II Criteria for IBS
Abdominal discomfort/pain with 2 of the follow 3 features for at least 12 weeks not necessarily consecutive: relief with defecation, onset associated with change in stool frequency or formation
46
Manning Criteria for IBS
Pain relieved by defecation More frequent stools associated with pain onset Looser stools associated with onset of pain Abdominal distention Passage of mucus Feeling of incomplete evacuation
47
Important History for IBS
``` Dietary habits Travel history Medication use Recent gastro-enteritis Recent food-born illness Lactose intolerance Gender, age Family Hx Night time defecation ```
48
PE Findings of IBS
``` Full findings Won't have abdominal guarding Rebound tenderness Abdominal distension EBM: no tests can be justified ```
49
Labs for an IBS Work-up
``` CBC ESR Serum electrolytes Liver enzymes Stool occult blood x3 Stool cultures x3 Stool O & P UA ```
50
Imagining for an IBS Work-up
Flex sigmoidoscopy Upper GI series with small bowel follow through Plain abdominal radiograph Air contrast barium enema
51
Warning Signs & Red Flags for IBS
``` Any abnormality of PE Anemia Clinical/biochemical evidence of malnutrition Family Hx of GI CA, IBD, or sprue Fever Hematochezia Nocturnal symptoms Symptoms >50 ```
52
Alarm Symptoms for IBS
``` Constant abdominal pain Constant diarrhea Constant abdominal distension Nocturnal disturbance Passage of blood with stool Weight loss ```
53
Management of IBS
Make a positive diagnosis Consider patients agenda Make management classification Plan a management strategy
54
Make a Positive Diagnosis of IBS
Usually from Hx alone Symptoms begin late teens to 20s Pain intermittent & crampy Pain doesn't occur at night/interfere with sleep Full PE Normal Hgb & ESR Sigmoidoscopy and/or barium enema may help to reassure
55
Consider Patients Agenda for IBS
Complete H&P
56
Make a Management Classification of the IBS Disease
``` Bloating & pain predominant Constipation predominant Diarrhea predominant Anxiety associated Depression associated ```
57
Plan a Management Strategy
Establish a therapeutic provider-patient relationship: focus symptom relief, shift responsibility to patient, commitment to patient well-being Patient education: validate patient's illness, set realistic goals, teach symptom monitoring, reassure benign nature of IBS, address psychosocial issues

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