Inflammatory Bowel Disease: Crohn’s Disease and Ulcerative Colitis, C51 P338-344 Flashcards
(63 cards)
1
Q
What is IBD?
P338
A
Inflammatory Bowel Disease,
inflammatory disease of the GI tract
2
Q
What are the two
inflammatory bowel
diseases?
P338
A
Crohn’s disease and ulcerative colitis
3
Q
What is another name for
Crohn’s disease?
P338
A
Regional enteritis
4
Q
What is ulcerative colitis
often called?
P338
A
UC
5
Q
What is the cause of IBD?
P338
A
No one knows, but probably an
autoimmune process with environmental
factors contributing
6
Q
What is the differential
diagnosis?
P338
A
Crohn’s versus ulcerative colitis, infectious
colitis (e.g., C. difficile, amebiasis,
shigellosis), ischemic colitis, irritable bowel
syndrome, diverticulitis, Zollinger-Ellison
syndrome (ZES), colon cancer, carcinoid,
ischemic bowel
7
Q
What are the extraintestinal
manifestations seen in both
types of IBD?
P338
A
Ankylosing spondylitis, aphthous (oral) ulcers, iritis, pyoderma gangrenosum, erythema nodosum, clubbing of fingers, sclerosing cholangitis, arthritis, kidney disease (nephrotic syndrome, amyloid deposits)
8
Q
How can these
manifestations be
remembered?
P339
A
Think of the acronym “A PIE SACK”:
Aphthous ulcers
Pyoderma gangrenosum Iritis Erythema nodosum
Sclerosing cholangitis
Arthritis, Ankylosing spondylitis
Clubbing of fingers
Kidney (amyloid deposits, nephrotic
syndrome)
9
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Crohn’s disease: Incidence P339
A
3–6/100,000
10
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Crohn’s disease: At-risk population P339
A
High in the Jewish population, low in the
African black population, similar rates
between African American and U.S.
white population
11
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Crohn’s disease: Sex? P339
A
Female > male
12
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Crohn’s disease: Distribution? P339
A
Bimodal distribution (i.e., two peaks in
incidence): peak incidence at 25 to 40
years of age; second bimodal distribution
peak at 50 to 65 years of age
13
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Ulcerative colitis: Incidence? P339
A
10/100,000
14
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Ulcerative colitis: At-risk population P339
A
High in the Jewish population, low in the
African American population
Positive family history in 20% of cases
15
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Ulcerative colitis: Sex? P339
A
Male > female
16
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INCIDENCE Ulcerative colitis: Distribution? P339
A
Bimodal distribution at 20 to 35 and
50 to 65 years of age
17
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INITIAL SYMPTOMS Crohn’s disease? P340
A
Abdominal pain, diarrhea, fever,
weight loss, anal disease
18
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS INITIAL SYMPTOMS Ulcerative colitis? P340
A
Bloody diarrhea (hallmark), fever, weight loss
19
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS ANATOMIC DISTRIBUTION Crohn’s disease? P340
A
Classic phrasing “mouth to anus”
Small bowel only (20%)
Small bowel and colon (40%)
Colon only (30%)
20
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS ANATOMIC DISTRIBUTION Ulcerative colitis? P340
A
Colon only (Think: ulcerative COLitis = COLon alone)
21
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS ROUTE OF SPREAD Crohn’s disease? P340
A
Small bowel, colon, or both with “skip
areas” of normal bowel; hence, the
name “regional enteritis”
22
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS ROUTE OF SPREAD Ulcerative colitis? P340
A
Almost always involves the rectum and
spreads proximally always in a continuous
route without “skip areas”
23
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS ROUTE OF SPREAD What is “backwash” ileitis? P340
A
Mild inflammation of the terminal ileum
in ulcerative colitis; thought to be
“backwash” of inflammatory mediators
from the colon into the terminal ileum
24
Q
COMPARISON OF CROHN’S DISEASE AND ULCERATIVE COLITIS BOWEL WALL INVOLVEMENT Crohn’s disease? P340
A
Full thickness (transmural involvement)
25
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
BOWEL WALL INVOLVEMENT
Ulcerative colitis?
P340
```
Mucosa/submucosa only
26
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
ANAL INVOLVEMENT
Crohn’s disease?
P340
```
Common (fistulae, abscesses, fissures,
| ulcers)
27
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
ANAL INVOLVEMENT
Ulcerative colitis?
P340
```
Uncommon
28
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
RECTAL INVOLVEMENT
Crohn’s disease?
P341
```
Rare
29
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
RECTAL INVOLVEMENT
Ulcerative colitis?
P341
```
100%
30
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
MUCOSAL FINDINGS
Crohn’s disease (6)?
P341
```
1. Aphthoid ulcers
2. Granulomas
3. Linear ulcers
4. Transverse fissures
5. Swollen mucosa
6. Full-thickness wall involvement
31
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
MUCOSAL FINDINGS
Ulcerative colitis (5)?
P341
```
1. Granular, flat mucosa
2. Ulcers
3. Crypt abscess
4. Dilated mucosal vessels
5. Pseudopolyps
32
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
MUCOSAL FINDINGS
How can ulcerative colitis
and Crohn’s anal and wall
involvement be remembered?
P341
```
“CAT URP”:
Crohn’s = Anal–Transmural
UC = Rectum–Partial wall thickness
33
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
DIAGNOSTIC TESTS
Crohn’s disease?
P341
```
Colonoscopy with biopsy, barium enema,
UGI with small bowel follow-through,
stool cultures
34
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
DIAGNOSTIC TESTS
Ulcerative colitis?
P341
```
Colonoscopy, barium enema, UGI with
small bowel follow-through (to look for
Crohn’s disease), stool cultures
35
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
COMPLICATIONS
Crohn’s disease?
P341
```
Anal fistula/abscess, fistula, stricture,
perforation, abscesses, toxic megacolon,
colovesical fistula, enterovaginal fistula,
hemorrhage, obstruction, cancer
36
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
COMPLICATIONS
Ulcerative colitis?
P341
```
Cancer, toxic megacolon, colonic
perforation, hemorrhage, strictures,
obstruction, complications of surgery
37
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
CANCER RISK
Crohn’s disease?
P342
```
Overall increased risk, but about half that
| of ulcerative colitis
38
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
CANCER RISK
Ulcerative colitis?
P342
```
≈5% risk of developing colon cancer at
10 years; then, risk increases ≈1% per
year; thus, an incidence of ≈20% after
20 years of the disease (30% at 30 years)
39
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INCIDENCE OF TOXIC MEGACOLON
Crohn’s disease?
P342
```
≈5%
40
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INCIDENCE OF TOXIC MEGACOLON
Ulcerative colitis?
P342
```
≈10%
41
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Crohn’s disease?
P342
```
```
Obstruction, massive bleeding, fistula,
perforation, suspicion of cancer, abscess
(refractory to medical treatment), toxic
megacolon (refractory to medical
treatment), strictures, dysplasia
```
42
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Ulcerative colitis?
P342
```
```
Toxic megacolon (refractory to medical
treatment); cancer prophylaxis; massive
bleeding; failure of child to mature
because of disease and steroids;
perforation; suspicion of or documented
cancer; acute severe symptoms refractory
to medical treatment; inability to wean
off of chronic steroids; obstruction;
dysplasia; stricture
```
43
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What are the common
surgical options for
ulcerative colitis?
P342
```
```
1. Total proctocolectomy, distal rectal
mucosectomy, and ileoanal pull
through
2. Total proctocolectomy and Brooke
ileostomy
```
44
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is “toxic megacolon”?
P342
```
Toxic patient: sepsis, febrile, abdominal
pain
Megacolon: acutely and massively
distended colon
45
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What are the medication
options for treating IBD?
P343
```
```
Sulfasalazine, mesalamine
(5-aminosalicylic acid)
Steroids, metronidazole (Flagyl®),
azathioprine, 6-mercaptopurine
(6-mp), infliximab
```
46
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is infliximab?
P343
```
Antibody vs. TNF- (tumor necrosis
| factor-alpha)
47
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is the active metabolite
of sulfasalazine?
P343
```
5’-aminosalicylate (5’-ASA), which is
| released in the colon
48
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is the medical
treatment of choice for
perianal Crohn’s disease?
P343
```
PO metronidazole (Flagyl®)
49
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What are the treatment
options for long-term
remission of IBD?
P343
```
6-mercaptopurine (6-mp), azathioprine,
| mesalamine
50
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What medication is used for
IBD “flare-ups”?
P343
```
Steroids
51
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is a unique medication
route option for ulcerative
colitis?
P343
```
Enemas (steroids, 5-ASA)
52
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Which disease has
“cobblestoning” more
often on endoscopic exam?
P343
```
Crohn’s disease
| Think: Crohn’s = Cobblestoning
53
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Which disease has
pseudopolyps on
colonoscopic exam?
P343
```
Ulcerative colitis; pseudopolyps are
polyps of hypertrophied mucosa
surrounded by mucosal atrophy
54
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Which disease has a
“lead pipe” appearance on
barium enema?
P343
```
Chronic ulcerative colitis
55
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Rectal bleeding/bloody
diarrhea is a hallmark of
which disease?
P343
```
Ulcerative colitis (rare in Crohn’s disease)
56
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is the most common
indication for surgery in
patients with Crohn’s
disease?
P344
```
Small bowel obstruction (SBO)
57
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What are the intraoperative
findings of Crohn’s disease?
P344
```
```
Mesenteric “fat creeping” onto the
antimesenteric border of the small
bowel
Shortened (and thick) mesentery
Thick bowel wall
Fistula(e)
Abscess(es)
```
58
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Why do you see fistulas and
abscesses with Crohn’s and
not ulcerative colitis?
P344
```
Crohn’s disease is transmural
59
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is the operation for
short strictures of the small
bowel in Crohn’s disease?
P344
```
Stricturoplasty; basically a Heineke-
Mikulicz pyloroplasty on the strictured
segment (i.e., opened longitudinally and
sewn closed in a transverse direction)
60
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Should the appendix
be removed during a
laparotomy for abdominal
pain if Crohn’s disease is
discovered?
P344
```
Yes, if the cecum is not involved with
| active Crohn’s disease
61
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is pouchitis?
P344
```
Inflammation of the pouch of an ileoanal
pull through; treat with metronidazole
(Flagyl®)
62
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
Do you need a frozen
section for margins during a
bowel resection for Crohn’s
disease?
P344
```
No, you need only grossly negative
| margins
63
```
COMPARISON OF CROHN’S DISEASE
AND ULCERATIVE COLITIS
INDICATIONS FOR SURGERY
What is it called when the
entire colon is involved?
P344
```
Pancolitis
