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CM IBD
Inflammatory Bowel Disease
| Question | Answer |
|---|---|
| Two types of IBD | Crohn's and ulcerative colitis |
| Common age at diagnosis | 20 |
| IBD epidemiology | CD is more common in Whites, especially Ashkenazi Jews. Low Hispanic and Asian incidence. |
| IBD pathophysiology | The exact cause is unknown, but the working hypothesiss is that this is an abnormal immune response to bacteria within the gut. |
| Common Symptoms of IBD | Diarrhea (often bloody), fatigue (can be from anemia, but not necessarily), weight loss, anorexia, N/V, Crampy abdominal pain |
| ___ is a dz that tends to skip areas of the bowel and is transmural | Crohn's Disease |
| __ is a dz limited to the colon, starts in the rectum, is generally continuous and is more superficial | Ulcerative colitis |
| Ulcerative Colitis Symptoms | Proctitis (inflammation of the rectum lining) often results in tenesmus and possibly lower abdominal/pelvic cramping. b/c the rectum is almost universally involved, bloody diarrhea is a hallmark sx. High risk for colon CA |
| __ dz is associated with fistula, both around the anus and internally | Crohn's dz |
| Fibrotic strictures are associated with | Crohn's dz, seen at ileocecal junction. Leads to blockages |
| What habit must be stopped in Crohn's? | Smoking. It is strongly associated with the development of Crohn's Dz, resistance to medical therapy and early disease relapse |
| Extra-intestinal manifestations of IBD | In general EIMs are limited to the eye, skin, liver, mouth, and joints – but be aware that there are rare associations with multiple organ systems. |
| Most common EIM of IBD | primary biliary cirrhosis (UC>CD). Pruritis may be present. Primarily manifest as stricturing of the bile ducts so be aware of the risk for cholangitis |
| Anti-mitchondrial antibody is seen in | primary biliary cirrhosis. No effective therapy, refer to a hepatologist |
| Fever, RUQ pain and Jaundice | may be a stricture from primary biliary cirrhosis. |
| Which arthralgia is not associated with disease flares? | Type 2 multiple joints, can be migratory, can be more chronic. (Type I - self limited, short lived, affecting 6 or fewer joints and is associated with disease flares) |
| Type of Arthritis commonly seen in IBD | Spondylitis and sacroilitis. Tx: underlying dz, infliximab and methotrexate, PT |
| Erythema nodosum is seen | on the extensor surfaces of extremities in IBD. Responds to IBD therapy. |
| Necrotic inflammation in IBD | Pyoderma gangrenosum. Do NOT biopsy, send to dermatology. Some people get a colectomy to deal with this (then they have to have a stoma, and they may have pyoderma gangrenosum around the stoma!) |
| Symptoms of Uveitis | Eye pain, blurred vision, photophobia, HA. Send to Opthalmologist IMMEDIATELY |
| Superficial inflammation of the sclera | Episcleritis. |
| What can distinguish between infectious diarrhea and IBD? | Chronicity. Short duration (<2-3 weeks) should be approached as infectious, but be sure to have follow up. Tenesmus is suggestive of proctitis |
| Differential for IBD | Infectious diarrhea, Ischemia of bowel, Medication related (NSAIDs, Penicillins, mycophenolate), Diverticular dz, Perianal fistula are more commonly idiopathis, but do raise suspicion for Crohn's |
| Diagnostic Evaluation for IBD | Diagnosis relies on a combination of endoscopy, histology, radiography, laboratory, and clinical dataColonoscopy with ileal intubation & biopsy (should see chronic colitis/enteritis),Small bowel follow-through, enteroclysis (+/- CT), MR enterography |
| What is important to see in a colonscopy eval for IBD? | ileal intubation |
| Labs in IBD patient | Often anemia (iron deficiency and chronic dz), leukocytosis, elevated CRP with CD |
| What labs should you not order in IBD evaluation? | Serologies |
| Number one risk factor for IBD | Family history. But only 10% have a positive history in first degree relative |
| UC tx | 5-ASA (work differently than aspirin), Corticosteroids, 6-MP/azathioprine, Infliximab (remicade - anti-TNF antibody |
| CD tx | 5-ASA, corticosteroids, 6-MP/azathioprine, Methotrexate, Infliximab (remicade), adalimumab (humira) - anti -TNF, Natalizumab (Tysabri) |
| Budesonide (entocort) is used for | ileal Crohn's disease. Fairly benign |
| 5-ASA | effective and benign. Mesalamine has specific location formulations |
| AE's of corticosteroids | cataracts, hyperglycemia, weight gain, loss of bone density, easy bruising, striae |
| 6-MP AE's | Cytopenias (any of the blood cell lines), liver toxicity, pancreatitis (usually an allergic rxn that occurs within the first 6 weeks of initiation) |
| Which tx option has a risk of granulomatous disease? | Anti-TNF antibodies. Associated with TB. Get a Quantiferon test (b/c PPD may be false negative) prior to initiation |
| TNF and steroids are | immunosuppressants |
| Surgery in IBD | Avoid if possible, b/c dz tends to reoccur, plus there are often adhesions (thus risk for fistulas). Generally try to avoid surgery in CD unless absolutely necessary |
| Strictures are often seen in | Crohn's Dz |
| Colon cancer surveillance | q 1-2 year colonoscopy after 8-10 years of UC or colonic CD (regardless of age) |
| N/V can be a sign of | obstruction |
| high fever/abdominal mass may suggset | abscess, liver abscess |
| Frequent UTIs/pneumoaturia may suggest | fistula to bladder |
| What should be monitored in pts taking steroids? | bone density, blood glucose, eye exams |
| Alkaline phosphatase levels may be off b/c of | Primary biliary cirrhosis in someone with UC |
| What should you rule out in IBD flares? | infection. C. diff, SSYC (salmonella, shigella, yersinia, campylobacter) |
| Left Lower Quadrant pain is associated with | Ulcerative Colitis |
| When should colonoscopy be avoided in UC? | in patients with severe disease b/c of risk of perforation |
| Absolute indications for surgery in UC | Severe hemorrhage, perforation or documented carcinoma. |
| Right lower quadrant mass and tenderness is associated with | Crohn's Dz |
| Fecal urgency is associated with | Ulcerative Colitis |
| Perianal disease with abscess, fistulas is associated with | Crohn's Disease |
| Granulomas on biopsy are highly suggestive of | Crohn's Disease |
| Test to differentiate between Crohn's and Ulcerative Colitis | when diagnosis remains uncertain, a panel of 7 tests that measures autoantibodies to P-ANCA as well as other bacteria |
| Presence of a tender abdominal mass with fever and leukocytosis suggests | an abscess. Emergent CT of the abdomen is necessary to confirm diagnosis |
| Severe hemorrhage is more likely in Crohn's or Ulcerative Colitis? | Ulcerative Colitis |
| Indications for surgery with Crohn's | Intractability to medical therapy, intra-abdominal abscess, massive bleeding, symptomatic refractory internal or perianal fistulas, and intestinal obstruction |
| Bloody Diarrhea is more commonly seen in | Ulcerative Colitis |
| ___ is associated with strictures of the intestines which can lead to blockages | Crohn's Disease |
| Elevated C-Reactive Protein is seen in CD or UC? | Crohn's Disease |
| Tx for UC and CD | Is identical. Except that Methotrexate can be given in CD |
| Mild UC Definition | No more than 4BMs/day, no signs of systemic toxicity (fever, tachycardia, anemia), and normal ESR |
| Severe UC | greater than 6 BM/d adn evidence of systemic toxicity |
| Which medication tx is associated with Cytopenias? | 6-MP/Azathioprine |
Created by:
ltm12