Inflammatory & Irritable Bowel Syndrome - Brown Flashcards Preview

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Inflammatory Bowel Disease

  • Ulcerative Coliits
  • Chron Disease
  • chronic and recurrent


Crohn's Disease 

transmural inflammation - fibrosis, obstruction, sinus tracts, fistulas

skip lesions - disease is not continuous

involves entire GI tract


increased risk due to: smoking, western diet, NSAIDS?

diagnosed by colonoscopy, increased inflammatory markers

increases risk for colon cancer - colonoscopy annually


  • well balanced diet,
  • mesalamine,
  • oral antibiotics,
  • corticosteroids (symptom improvement);
  • cholestyramine for binding bile salts (diarrhea)
  • methotrexate
  • anti-TNF drugs

prognosis: intermittent exacerbation and periods of remission


Identify this condition and explain the management:

patient complains of abdominal pain and fluctuating diarrhea

patient has felt fatigued lately and has been loosing weight

patient has a skin tag abover his anus and has noticed increased joint stiffness and a rash (see below)

Crohn's Disease

  • abdominal pain - fibrotic strictures result from the transmural disease
  • diarrhea is common, but fluctuates
  • other symptoms: fatigue, weight loss, fever

Clinical Presentation

  • chronic inflammatory disease
  • intestinal obstruction
  • penetrating disease and fistulae
  • perianal disease
  • extraintestinal manifestations: arthralgias, arthritis, iritiis, uveitis, pyoderma gangernosum, erthema nodusm (rash on front of slide)

Diagnosed by:

  • colonoscopy
  • LAB: CBC, blood chem, ESR, CRP, Iron, B12


Ulcerative Colitis

inflammatory condition of mucosa - primarily the rectum



symptoms: bloody diarrhea, frequent stooling, cramps, abdominal pain, tenesmus, fever, weight loss

increases risk of colon cancer

colonoscopy every 1-2 years


  • 5-ASA Agents
  • Steroids
  • Immunomodulating Agents
  • Severe: hospitalization, NPO, TPN; steroids, anti-TNF, cyclosporine, surgery


Identify this condition:

patient has UC confined to the rectum, intermittent bleeding, mild diarrhea <4/day

Mild Ulcerative Colitis


Identify this condition:

patient has UC in the rectum, distal colon, proximally to the splenic flexure, bloody diarrhea 5/day, anemia, abdominal pain and a low grade fever

Moderate Ulcerative Colitis


Identify this condition:

patient has diarrhea 7/day, severe cramping and rapid weight loss

colonoscopy reveals patient has UC extending all the way to the cecum

Severe Ulcerative Colitis


Fulminant Colitis

  • type of severe UC
  • rapid progression
  • severe S&S
  • risk of perforation
  • broad-spectrum antibiotics


Toxic Megacolon

  • dilation of colon
  • risk of perforation
  • surgery to remove colon
  • risk of death


Irritable Bowel Syndrome


functional GI disorder - absence of organic pathology

abdominal pain

altered bowel habits 

  • IBS-C, IBS-D or mixed
  • constipation
  • diarrhea
  • postprandial urgency

chronic, relapsing condition


Irritable Bowel Syndrome - Pathophysiology

small bowel dysmotility

  • delayed meal transit IBS-C (constipation dominant)
  • accelerated meat transit IBS-D (diarrhea dominant)
  • can also have mixed

visceral hyperalgesia

  • enhanced perception of motility and visceral pain


  • association not clearly defined


Irritable Bowel Syndrome - History

Abdominal Pain

  • diffuse or LLQ
  • acute sharp pain episodes, underlying dull ache

Abdominal Distension - bloated/gas

Associated Symptoms

  • dyspepsia/heartburn
  • nausea and vomiting
  • urinary frequency and urgency

**NO: >40, progressively worsening, weight loss, anorexia, fever, rectal bleeding, steatorreha


Irritable Bowel Syndrome - Exam

  • patient looks healthy
  • mild, diffuse tenderness or LLQ tenderness
  • rest of exam - insignficant


Irritable Bowel Syndrome - Diagnostic Work Up

  • CBC - screen for anemia, infection, inflammation
  • Chemistries - electrolytes, BUN, Cr, Ca
  • TSH
  • Hemoccult
  • ESR - non specific for inflammation
  • CRP - non specific for inflammation
  • Hydrogen Breath Test - lactose/fructose intolerance
  • Stool Culture
  • Lactose-free diet
  • Flex Sig or Colonoscopy - if bleeding, anemia, wt loss, anorexia, chronic diarrhea, age > 40
  • EGD -weight loss dyspepsia


ROME III Criteria for Diagnosis of IBS

recurrent abdominal pain or discomfort for at least 3 days per month; 3 months; associated with 2 or more

  • pain/discomfort relieved w/ defecation
  • onset associated with change in stool frequency
  • onset associated with change in stool form or appearance

supporting symptoms

  • altered stool frequency
  • altered stool form
  • altered stool passage (straining/urgency)
  • stool with mucus
  • abdominal bloating or distension


Identify this condition:

onset: 15-35 years

bloody diarrhea with mucus, fever, abdominal pain, weight loss, tensmus

colonoscopy: mucousal erythema, ulcers

Ulcerative Colitis

inflammatory disease of mucosa and sub mucosa


Identify this condition:

onset 15-35 and 70-80 years

fever, abdominal pain, diarrhea (no blood), weight loss

anorectal fissures and abscesses

colonoscopy: nodularity, rigidity, ulcers, strictures, fistulas

Crohn's Disease

can involve ANY part of GI tract, inflammation extends through intestinal wall from mucosa to serosa (small bowel, colon common)


Identify this condition:

chronic diarrhea with cramps

blood and mucus can be present in stool

malaise and weight loss common

recent travel

Infectious Diarrhea

can be bacterial, viral, or parasitic

consider stool culture


Identify this condition:

pain LLQ


change in bowel habits


colonoscopy reveals diverticula

diverticulitis - diverticular (pockets/hernias) or colonic mucosa through muscularis become occlude and inflammed


Identify this Condition:

abdominal distension and bloating

diarrhea occassionally constipation

symptoms exacerbated by intake of diary products

positive hydrogen breath test

Lactose Intolerance


Identify this condition

diarrhea (frothy, tan, foul smelly), flatulence, wt loss, abdominal distension, failure to thrive in children

Celiac Disease: inflammatory disorder characterized by malabsorption precipitated by gluten; genetic disorder


Irritable Bowel Syndrome Treatment 

behavior modification, stress reduction, treat symptoms

Anticholinergics: antispasmodics inhibit intestinal smooth muscle depolarization at muscarinc receptor

  • Dicyclomine HCL
  • Hycosamine Sulfate

Antidiarrheals: non-absorbable synthetic opioids, prolong transmit time and decrease secretion

  • Lomotil
  • Immodium (Loperamide)

Tricyclic Antidepressants: visceral analgeisc effect, increasing pain threshold of gut, prolong oral-cecal transit time

  • Imipramine
  • Amitriptyline

GC-C Agnoist: alleviates abdominal pain and increases bowel movement frequency

  • Linzess

Prokinetics: promotility for constipation dominant

  • Propulsid
  • Tegaserod

Bulk Forming Laxatives: fiber supplementation to improve symptoms of constipation and diarrhea

  • Methylcellulsoe
  • Psyllium