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G.I. – Awesome

UC vs Crohn's disease

Rectal involvement UC
Rectal ulcer that spreads proximally UC
Superficial inflammation in anal canal away from the 6 o'clock position UC
peri-rectal fistulas CD
skip lesions CD
no rectum involvement CD
ulcers anywhere in the GI tract CD
involvement of terminal ileum CD
tenesmus at night UC
terminal ileitis CD
RLQ mass CD, maybe that's ileum involvement?
transmural inflammation CD, heal with fibrosis
small bowel strictures CD transmural involvement heals with stricture leading to fibrosis; if strictures leading to small bowel obstruction, then surgery
ulcers on tongue CD, use infliximab
What do you find on pathology for CD? deep ulcers with granulomas, transmural involvement
What do you find on pathology for UC? superficial ulcers with crypt abscess
If fistula, what to treat with in CD, first treat with metronidazole; if complex fistula, then infliximab
hematochezia more with UC
toxic megacolon with both, but more with UC.
string sign CD - narrowing of the distal ileum
what to do if you have extra-intestinal manifestations if IBD? rare in CD, if UC then tx UC more aggressively
Name the extra-intestinal manifestations that would mirror the colitis erythema nodosum, pyoderma gangrenosum, Rh negative arthritis
Name the extra-intestinal manifestations that would NOT mirror the colitis ankylosing spondylitis and primary sclerosing cholangitis (q1yr surveillance for polyps > 1cm, if yes, then cholecystectomy)
more likely to lead to cancer UC
how often colonoscopy for UC/CD 8 years after onset should get first colonoscopy, then every 1 to 3 years
What to do if dysplasia on path from colonoscopy? proctocolectomy (colon + rectum)
What antibody with UC? What antibody with CD? pANCA (myeloperoxidase) with UC and ASCA (anti-saccharomyces cerevisiae) with CD
what counts as mild disease in UC? - BMs per day, blood in stool, VS, Hb, ESR < 4 BMs per day, occasional blood in stool, NORMAL: VS, Hb, ESR
what do you treat MILD UC with? 5-ASA like mesalamine (releases depending on pH of colon) or sulfasalazine (released by action of bacteria therefore wouldn't be good in small bowel since not as much bacteria in there)
what counts as severe disease in UC? - BMs per day, blood in stool, VS, Hb, ESR > 6 BMs per day, ++ blood in stool, VS: fever HR>90, Hb anemia, ESR>30
what do you treat MODERATE UC with? Prednisone to induce remission, maintenance with either 5-ASA or 6-MP or azathioprine
what do you treat SEVERE UC with? IV corticosteroids ---not effective---> cyclosporine or infliximab ---refractory---> surgery
What counts as mild to moderate disease for CD (VS, abd pain, wt, Hb) VS no fever, no abd pain, <10% weight loss, Hb nl
What counts as moderate to severe disease for CD (VS, abd pain, wt, Hb) VS fever, + abd pain (+n/v), >10% weight loss, Hb anemia
What counts as severe to fulminant disease for CD (VS, abd pain, wt, Hb)? Despite oral steroids, VS high fever, + rebound tenderness (+n/v), >10% weight cachexia, Hb anemia. Also, obstruction or abscess.
How to treat fistula in CD? infliximab, then metronidazole and 5-ASA for maintenance
How to treat mild to moderate CD? What if ileal or R colon disease? 5-ASA. If ileal or R colon disease, then tx with budesonide
How to treat moderate to severe CD? Prednisone for remission. Maintenance: 6-MP or azathioprine or MTX. If refractory then infliximab or adalimumab.
How to treat severe to fulminant CD? IV corticosteroid for remission, infliximab or adalimumab if steroid-refractory, if doesn't get better with meds or if pt is toxic then colectomy
Can UC/CD patients take NSAIDs? no
what is toxic megacolon defined as? diameter > 6cm
How to treat toxic megacolon? What to do if it doesn't get better? Tx first with steroid and abx. If not better in 24h or if pt gets hypotensive, then surgery.
Side effect of the sulfapyridine component of Sulfasalazine reversible infertility and leukopenia
Tx of perianal abscess in CD infliximab, then 5-ASA for maintenance
Tx of peritonitis in UC infliximab, then 5-ASA for maintenance
If treating UC flare and don't want to use steroids in UC, what can you use? 6-MCP and azathioprine
Do drugs cure UC? No. reduces relapse only.
continuous mucosal inflammation UC
smoking relieves symptoms UC
microscopic (collagenous vs lymphocytic) colitis chronic diarrhea, NO abd pain or weight loss; tx with supportive care or loperamide or bismuth salicylate
what study do you NOT want to do with UC if moderate to severe UC, do NOT do barium enema because it may precipitate toxic megacolon
what should you rule out if you have a CD pt with cystitis consider the possibility of enterovesical fistula
friable mucosa in distal colon UC
first thing you need to r/o in IBD pt who presents with diarrhea c.diff and other infectious diarrhea
Created by: christinapham



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