Flashcards in Inflammatory Bowel Disease Deck (24)
What is ulcerative colitis?
inflammation and ulceration of the colon and rectum - limited to the mucosal layer - pattern of inflammation is continuous
What is Crohn's disease?
transmural inflammation of segments of the GI tract - affects the entire GI tract from mouth to perianal area (80% of patients have small bowel involvement - distal ileum)
What are distinctive features of Crohn's (differentiate from UC)?
transmural (all layers of the bowel) inflammation with skip lesions (cobblestone appearance), fibrosis, strictures, fistulas, affects primarily the ileum and proximal colon (sparing of rectum), absence of gross bleeding, presence of perianal disease
What is the mechanism of effect in IBD?
autoimmune disease - antigen initiates inflammation - tissue damage is from inappropriate sustained immune response
Which blood studies should be ordered to diagnose IBD?
CBC - iron deficiency and blood loss, WBC - signs of toxic mega colon/perforation, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) - chronic inflammation, serum electrolytes, protein levels - hypoalbumin due to poor nutrition and protein loss, serum iron/B12
What diagnostic studies should be ordered to diagnose IBD?
stool cultures (pus, blood, mucus), colonoscopy (patients presenting primarily with diarrhea), imaging (patients presenting with abdominal pain)
What nutritional therapy is recommended for IBD?
high calorie, high protein, low-residue, vitamin/iron supplements, decrease dairy (for those lactose intolerant), low-fat (fats may trigger diarrhea)
What are pseudopolyps?
tongue-like projections into the bowel lumen
What are potential complications of Crohn's disease?
abscesses or fistula tracts between bowel and skin, bladder, rectum, or vagina; thromboembolism; arthritis; ankylosing spondylitis; osteoporosis; liver disease; skin lesions
What are potential complications of UC?
severe bleeding/hemorrhage (anemia), perforation, fulminant colitis (> 10 stools/day, continous bleeding, abdominal pain, distension, fever, anorexia), toxic megacolon (colonic dilation greater than 5 cm)
What are the endoscopic findings with Crohn's disease?
aphthous ulcers (earliest lesions seen), large ulcers interspersed with normal mucosa, cobblestone appearance (nodular thickening and linear/serpigious ulcers), strictures due to fibrosis
What are the common symptoms of UC?
bloody diarrhea, abdominal cramping, tenesmus (painful spasm of the anal sphincter with urgent desire to defecate but without significant production of feces), rectal bleeding, fever, weight loss, anemia/fatigue - due to iron deficiency, tachycardia, dehydration, discharge of blood and mucus, small/frequent bowel movements
What are the common symptoms of Crohn's disease?
depends on site of involvement - diarrhea (non-bloody), colicky abdominal pain, malabsorption, nutritional deficiencies, fatigue, weight loss, fever
How is UC classified (Montreal classification)?
(1) mild (<4 semi-formed stools/day - with or without blood, normal ESR, crampy pain, tenesmus, constipation)
(2) moderate (4-5 stools/day, bleeding, fever, malaise, anorexia, abdominal pain)
(3) severe (bloody diarrhea >5 stools/day, severe cramps, systemic toxicity, fever, techycardia, anemia, elevated ESR > 30 mm/hr, rapid weight loss)
What are the types of UC?
proctitis, proctosigmoiditis, distal colitis, extensive colitis, pancolitis
Which pharmaceutical agents are used for UC?
aminosalicylates (sulfasalazine/Azulfidine - decreases GI inflammation) and corticosteroids (decrease inflammation)
Which pharmaceutical agents are used for Crohn's disease?
aminosalicylates (sulfasalazine/Azulfidine - decreases GI inflammation); antimicrobials (metronidazole [10 or 20 mg/kg/day] or the combination of metronidazole and ciprofloxacin [500 mg twice daily]); corticosteroids (decrease inflammation); immunosuppressants; biologic therapy (tumor necrosis factor inhibitors - infliximab); antidiarrheals
What are the common extraintestinal symptoms associated with IBD?
arthritis, ankylosing spondylitis (inflammatory disease that can cause some of the vertebrae in your spine to fuse together), uveitis, episcleritis, iritis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis (inflammation and scarring of the bile ducts - fatigue, pruritis, fevers, chills, night sweats, RUQ pain), fatty liver, autoimmune liver disease, venous/arterial thromboembolism, renal stones, osteoporosis, vitamin B12 deficiency
What are common laboratory findings in UC?
anemia, elevated ESR (>30 mm/hr), low albumin, electrolyte abnormalities, elevated serum alkaline phosphatase concentration, elevated fecal calprotectin/lactoferrin
What are common imaging (abdominal radiography) findings with UC?
constipation, mucosal thickening, "thumbprinting"
What conditions should be ruled out with UC?
recent travel, recent antibiotic use, Hx of/risk factors for STIs, atherosclerotic disease, Hx of abdominal/pelvic radiation, Hx of NSAID/medication exposure, cytomegalovirus (immunocompromise)
What are common endoscopic findings in UC?
loss of vascular markings, granularity of mucosa, petechiae, exudates, edema, erosions, touch friability, spontaneous bleeding, pseudopolyps
What are some long-term complications of chronic UC?
strictures, dysplasia, colorectal cancer