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Duke PA Inflammatory Bowel Disease

what are the two types of IBD Crohn's, and ulcerative colitis
incidence of IBD is highest in westernized countries
Crohn's disease is more common in whites (traditionally Ashkenazi Jews have been at higher risk)
there is a low incidence of Crohn's disease in __ populations Hispanics and Asian
common symptoms of IBD diarrhea (often bloody), fatigue (anemia), weight loss, anorexia, N/V, crampy abdominal pain
can affect any portion of the GI tract (lips to anus), disease tends to skip areas, disease is transmural (involves the entire thickness of the wall) Crohn's disease
limited to the colon, disease starts in the rectum (proctitis), disease is usually continuous, more superficial disease Ulcerative colitis
proctitis often results in __ tenesmus
feeling of incomplete evacuation of the rectum tenesmus
IBD tends to have a __ course relapsing and remitting
IBD is an __ disorder not infectious immune
IBD exact etiology unknown, but the working hypothesis is that this is an abnormal immune response to bacteria within the gut
with ulcerative colitis b/c the rectum is almost universally involved, __ is more common bloody diarrhea
CD is associated with __ both around the anus and internally fistula
fistulas can lead to __ abscesses
CD is associated with __ of the intestine which can lead to blockages stricture
__ + Crohn's = BAD smoking
for UC.CD there is a strong association with __ primary biliary cirrhosis
primary biliary cirrhosis is often first recognized by __ alkaline phosphatase
primary manifestation of biliary cirrhosis is __. There is no effective therapy for this, refer to hepatologist stricturing of the bile ducts
arthralgia associated with IBD flares type 1-self limited, short lived, affecting 6 or fewer joints
arthralgia not associated with IBD flares type 2-multiple joints, can be migratory, can be more chronic
raised tender red-purplish nodules parallels IBD activity and responds to IBD therapy erythema nodosum
wide spectrum of necrotic inflammation. parallels IBD activity about half the time, may respond to therapy aimed at IBD, dermatology should be involved, do not biopsy pyoderma gangrenosum
big concern, eye pain, blurred vision, photophobia, headaches associated with IBD. prompt diagnosis and treatment to prevent complications. Get Ophtho involved Uveitis
IBD is most often diagnosed in the __ young
tenesmus is suggestive of __ proctitis
gold standard diagnostic for IBD there is none. diagnosis relies on a combination of endoscopy, histology, radiography, laboratory, and clinical data
do not order __ if IBD is suspected serologies
#1 risk factor for IBD family history
Ulcerative colitis treatment 5-ASA, corticosteroids, 6-MP/azathioprine, Infliximab
Crohn's disease 5-ASA, Corticosteroids, 6-MP/azathioprine, methotrexate, infliximab, natalizumab
with IBD use as little __ as possible steroids
mild ulcerative colitis no more than 4 BM/d (with/without blood) no signs of systemic toxicity (i.e. fever, tachycardia, anemia), and normal ESR
severe ulcerative colitis >6 BM/d and evidence of systemic toxicity.
goal of corticosteroids in IBD is to use sparingly and for a limited time (to induce remission during a flare)
drug that impairs T cell function, Slow onset of action (3-6 months), often introduced with steroids and steroids are then weaned off, AE's-cytopenia, liver toxicity, pancreatitis 6-MP/Azathioprine
high risk for tuberculosis with __ for IBD. Must have a PPD before onset of medication anti-TNF antibodies
__ may necessitate colectomy dysplasia, cancer, or toxic colitis
__ may necessitate segmental resection in Crohn's fibrotic strictures, obstruction, fistulae
generally try to avoid __ in Crohn's unless absolutely necessary surgery
air in pee(pneumaturia) makes you think __ fistula to bladder
high fever/abdominal mass with IBD = abscess, liver abscess
severe abdominal pain with IBD = perforation
N/V with IBD = obstruction
severe rectal pain with IBD = perirectal abscess
frequent UTI's/pneumaturia with IBD = fistula to bladder
in the case of flares with IBD steroids should work quickly, if things aren't improving __ may be warranted endoscopy
Created by: bwyche