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Flashcards in Inflammatory Bowel Disease Deck (13):


– chronic lifelong disease with inflammation of the GI tract; acute flare-ups with remission
o Ulcerative Colitis – colon only, mucas and submucosa
 Associated with ex-smokers
 Glandular atrophy with crypt distortion; hypertrophy of Muscularis mucosa
o Crohn’s Disease – anywhere in GI tract; transmural inflammation



-1 million people worldwide with white people and jewish most common
o Often diagnosed between ages of 15-30 or 50-70



– genetic predisposition, environmental triggers (bacteria/infection), mucosal immune system defect


Colonoscopy Morphology

o Ulcerative colitis – rectum involved, ileum not involved, diffuse, superficial ulcers, pseudopolyps common; granular mucosa, primary sclerosing cholangitis (fibrotic disease of the bile duct)
o Crohn’s disease – ileum involved; rectum not involved; segmental disease, perianal disease, strictures/fistulas; deep linear ulcers


Symptoms (GI, Specific to chrones, Systemic)

o GI – diarrhea, abdominal pain, mucus/pus/blood, tenesmus, urgency, incontinence, rectal pain
o Specific to Crohn’s – intra-abdominal abscess, perianal abscess, fistula
o Systemic – fever, weight loss, fatigue, pyoderma gangrenosum (ulcers on body from ulceritive colitis)


Therapeutic Pyramid

aim to induce remission  sustain remission  improve quality of life
o Topical, oral antibiotics and steroid (5ASA) – mild cases
o Moderate – IV steroids and infliximab
o Severe – surgery


Possible Diagnosis

o Ulcerative colitis
o Crohn’s colitis
o C. Difficile – bacterial infection causing diarrhea and inflammation of colon toxic megacolon; use of antibiotics can cause the infection because competing bacteria in gut get killed by antibiotics; can mask ulcerative colitis until it C. difficile is treated
o E.coli 0157:H7


Side Effects of Steroids

sleep distrurbances, mood changes, fatigue, increase appetite, fluid retention, acne, heartburn, osteoporosis, headaches, avascular necrosis, myopathy (skin striae), cataracts


Side Effects of Immunosuppressive Agents

(6MP, Azathioprine, Imuran, Purinethol) – pancreatitis, bone marrow toxicity, liver toxicity, lymphoma
 Useful to keep patient in remission but frequent lab work required to monitor


Side Effects of Biologics/Anti-tumor necrosis factor

 infliximab IV infusion – used for induction, maintentance of CD and UC and fistulizing Crohn’s
 adalimuman (humira), Certolizumab (cimezia)
 reactivation of TB and hepatitis B, opportunistic infections, risk of lymphoma


Symptoms Common to ulcerative colitis and crohn's

diarrhea, abdominal pain, mucus/pus/blood in stool, tenesmus, urgency, incontinence, rectal pain, weight loss, fever, fatigue


Ulcerative Colitis

affects ONLY colon
 Begins in rectum and extends proximally in CONTINUOUS fashion
 Quitting smoking can unmask ulcerative colitis (quitting does NOT CAUSE IT)
 Superficial inflammation
 Colonoscopy – reveals continuous inflammation, superficial ulcers, granular mucosa, pseuodopolyps
 Biopsy – grandular atrophy with crypt distortion
 Total colectomy is curative however extra-intestinal manifestations can still exist


Crohn's Disease

– can affect entire GI tract (rarely the rectum)
 Inflammation is transmural
 Complications include: stricture, fistula, abscess, perianal disease
 Colonoscopy – segmental inflammation, deep/linear ulcers, cobblestoning
 Biopsy – granulomas
- surgery can treat complications but NOT CURE