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DU PA IBD
Duke PA Inflammatory Bowel Disease
| Question | Answer |
|---|---|
| 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
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