Flashcards in Inflammatory Bowel Diseases and IBS Deck (34):
Name the two inflammatory bowel diseases
Crohn's and ulcerative colitis
What is the major difference between Crohn's and ulcerative colitis?
ulcerative colitis involves mucosal ulceration in the colon whereas Crohn's involves transmural inflammation (ileitis, ileocolitis, and colitis)
Ethinic group with increased incidence of inflammatory bowel disease
Age group most commonly affected by inflammatory bowel disease
2nd and 3rd decades
Defect in the function of the intestinal lumen. Breakdown of the defense barrier of the gut. Exposure of mucosa to microorganisms or their products. Results in chronic inflammatory process mediated by T cells
pathophysiology of inflammatory bowel disease
Systemic complications include: apthous stomatitis, episcleritis and uveitis, arthritis, vascular complications, E. nodosum, P. gangrenosum
inflammatory bowel disease
complications of inflammatory bowel disease related to small bowel pathophysiology
gallstones, malabsorption, renal stones
Involves the mucosal surface of colon with the formation of crypt abscesses. Always includes the rectum, spreads proximally
Clinical course is marked by flare-ups and remissions. More common in nonsmokers. Higher risk for development of cancer
Hallmark of ulcerative colitis
Symptoms include: rectal bleeding, LLQ cramps, severe diarrhea, fever, anemia, hypoalbuminemia, and hypovolemia
severe ulcerative colitis
disease of bile ducts that causes inflammation and obstruction, 80% have UC, liver transplant
Systemic associations include: peripheral and central arthritis, uveitis, sclerosing cholangitis
What is needed for the diagnosis of ulcerative colitis?
sigmoidoscopic demonstration of inflammation and the exclusion of bacterial and parasitic infection.
What are dietary recommendations for treatment of ulcerative colitis?
reduce dietary fiber during exacerbation, folic acid supplements w/sulfasalazine.
What are pharmacological options for ulcerative colitis?
oral Fe w/rectal bleeding or anemia. Loperamide for troublesome diarrhea. Prednisone for inflammation.
What do the following have in common in relation to ulcerative colitis: exsanguinating hemorrhage, toxicity/perforation, suspected cancer, dysplasia, systemic complications, growth retardation, and intractibility
indications for surgery
Transmural involvement with formation of fistulas, narrowing of lumen, obstruction. Can involve any segment of the G.I. tract, but usually rectal sparing.
Name of predominant segment of GI tract when it's involved with Crohn's disease
strongly associated with the development of Crohn’s Disease, resistance to medical therapy and early disease relapse
cigarettes (not e-cigs though)
Insidious onset. Intermittent bouts of low-grade fever, diarrhea and RLQ pain. Postprandial pain common. RLQ mass. Perianal disease (abscess, fistula)
Often nocturnal B.M.’s, night sweats, weight loss.
Skin lesions, primarily erythema nodosum, may precede intestinal symptoms.
Common presentation of physical exam includes: abdominal distention, abnormal bowel sounds, tenderness in area of involvement.
Associated with abscesses, fistulas, skin tags in the perianal region as well as anal strictures.
Serum test that can be used for Crohn's disease that is highly specific, but has low sensitivity
ASCA (anti-saccharomyces cerevisiae antibody)
Radiography that is better for finding complications of Crohn's disease including strictures and fistulas
Barium contrast studies
“cobble stoning”, “skip lesions”, pseudodiverticula, dilated bowel, fistulas communicating to adjacent bowel/mesentery/bladder/vagina
Serum test that can be used for detection of ulcerative colitis but is not useful as the sole diagnostic test due to low sensitivity.
Perinuclear antineutrophil cytoplasmic antibodies (pANCA)
Common radiologic finding of Crohn's disease due to narrowing and stricturing of terminal ileum
A functional gastrointestinal disorder that is a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities
irritable bowel syndrome
How long must a patient have abdominal pain or discomfort, pain relieved by defecation, and pain with a change in frequency or form of stools to be classified as having irritable bowel syndrome?
Associated symptoms in order of prevalence includes: fatigue, back ache, early satiety, nausea, HA, irritable bladder, functional dyspepsia
irritable bowel syndrome
How do we make a positive diagnosis of irritable bowel syndrome without costing the patient tons of money
Rome and Manning Guidelines