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IBD&IBS
CM1-Fall 2011
| Question | Answer |
|---|---|
| What are the most common causes of IBD? | Ulcerative Colitis Crohn's Dz |
| IBD prevalence is increased in which populations? | -Northern countries -Higher SES populations -Jewish populations (esp. Ashkenazi) -Urban areas |
| IBD prevalence is decreased in which populations? | -Southern countries -Lower SES populations -Non-Jewish caucasions, African- Americans, Hispanic, Asian -Rural areas |
| When does IBD commonly present? | 15-30 years old -No significant gender differences bw UC and CD |
| What can reduce the risk of UC? | Smoking, appendectomy |
| What may ^the risk of developing IBD in women? | OCP use |
| Etiology of IBD? | -Genetic fxs -Immunologic mechs -Infectious |
| Ulcerative colitis always involves the? | -Rectum (&can extend proximally) ~(Can be pan-colitis and may extend to ileum=called "backwash ileitis") |
| What is the involvement and lesions like, in UC? | -Lesions are mucosal or submucosal (=superficial) -Involvement is continuous |
| Where are the lesions located in Crohn's Dz (CD)? | -Anywhere in the GI tract (rarely affects the rectum;more likely to see in both SI and colon) |
| Where is the MOST COMMON site for Crohn's dz? | Terminal ileum |
| Describe the lesions and inflammation of CD? | -Inflammation is full-thickness (aka transmural) -Skip lesions (discontinuous) |
| Cobblestone appearance of intestine is characteristic of what? | CD (from submucosal edema) |
| What is the hallmark of dx for UC? | Bloody diarrhea |
| May see altered bowel patterns w/UC, what are some symptoms? | -Fecal urgency -Tenesmus (urge to defecate) -Incomplete evacuation *MAY have LLQ abd pain |
| Symptoms of CD? | *Depends on location affected -Non-bloody diarrhea -May have RLQ abd pain,epigastric pain, malabsorption |
| What are some labs that you should collect in IBD? | CBC(wbc#),CRP,ESR,Albumin,Stool culture, ova,parasites,ASCA, pANCA |
| ASCA test useful for? | Crohn's dz (+in 60-80% of CD pts) |
| pANCA test useful for? | UC (+60-70% of UC pts) |
| pANCA and ASCA have very high? | Specificity, for each respectively |
| Which endoscope test is usually used w/a flare-up and views the lower 1/3 of colon? | Sigmoidoscopy |
| Which endoscope method is used to view the entire colon? | Colonoscopy |
| What is an EGD? | EsophoGastroDuodenoscopy |
| What is an ERCP? | Endoscopic Retrograde Cholangio- pancreatography (Biliary ducts) |
| In which condition would you maybe see linear ulcers &/or fistulas? | Crohn's dz |
| In which condition might you see ulceration of terminal ileum? | Crohn's dz |
| In which condition do you usually see diffuse erythema, mucosal granularity, no fistulas and a NL terminal ileum? | UC |
| CD presents w/a cobblestone appearance, how does UC present (via endoscope)? | Erythematous, friable (fragile) |
| An abd radiograph can be done, more so to rule out other things besides IBD, what should you look for? | -Toxic megacolon (life-threatening rapid widening of LI) -SBO -String sign w/CD -Loss of haustral markings w/UC |
| What may an abd CT show in IBD? | Verify the presence and location of inflamm |
| What are some dx complications w/IBD? | SBO, abscess formation,fistulas, perforations |
| What are some complications of CD? | -Ulcers -Fistulas (bw intestine&adjacent organs) -Obstruction (may be d/t inflamm leading to fibrosis&obstrux) -Malnutrition (diarrhea may decrs absorption of nutrients d/t inflamm) |
| What are some complications of UC? | -Toxic megacolon -Hemorrhage -Obstruction (may be from strictures around rectum) |
| What is toxic megacolon? | -Assoc w/UC -Assoc w/severe inflamm w/wkness of colon wall - risk of perforation and peritonitis (serious complication) |
| What is the treatment for toxic megacolon? | -Decompression of bowel (if doesn't improve w/this, then surgery) |
| What is the IBD assoc w/colon cancer? | -Both UC & CD ^the risk -Slightly more^^risk w/UC and if more involvement of GI tract and if longer duration of illness |
| Colon CA risk ^es w/IBD how much each year after having the dx for 10 yrs? | ^0.5-1%/year |
| Up to 1/3 of IBD pts have extra- intestinal complications, what are some examples? | -Dysregulation of immune system -Hepatobiliary,joint,ocular,skin,urological systems are commonly involved |
| What are some extra-intestinal complications assoc w/UC? | ^rate of colon CA, pericholangitis (inflamm around GB), pyoderma gangreosum (skin ulceration w/ necrotic center on LE) |
| What are some extra-intestinal complications assoc w/CD? | ^risk of colon CA (not as much as UC, tho), fistulas,gallstones, renal stones, erythema nodosum, aphthous stomatitis (canker sores) |
| What are some nutritional recommendations for managements of IBDs? | -Limit caffeine -Limit gas-producing veggies -Iron supps if chronic blood loss -B12 supplementation if terminal ileum dz -Parenteral nutrition if severe exacerbations or evidence of growth of delay in children |
| What are the pharmacological categories of treatment for IBD? | -5-ASA (for mild to mod) -Corticosteroids for inflamm (for mod to severe) -Abx (no role in UC) -Immunomodulators |
| 5-ASA agents are used for mild to mod IBD, what do they do? | -Antibacterial, anti-inflamm (enema form for proctitis) |
| Corticosteroids bring many systemic side effects, what supplements should be considered? | Vitamin D and Ca2+ |
| Antibiotics don't play a role in which IBD? | UC |
| What role do abx's play in IBD? | For CD-control ileocolitis, perianal dz, fistulas |
| What role do immunomodulator drugs play in IBD? | -Reduce freq of exacerbations -Reduce need for steroids -Fxn to inhibit immune response |
| Which drug is indicated for IBD if severe or fulminant or not responding to 5-ASA or immunosuppressive therapy? | Cyclosporine (alters immune response, but no role in chronic therapy) |
| What is the flow of treatment for active IBD? | 1. 5-ASA (oral &/or enema) 2. Abx for perianal dz in CD 3. Add corticosteroids for acute flairs 4. If steroid dependent-add immunosuppressant 5. For fulminant IBD-Cyclosporine or IV steroids |
| What are the surgical options for IBD treatment? When are they indicated? | 1.Intestinal resection (Strictures,abscess,obstruction,toxic megacolon,fistulas) 2. Proctocolectomy (may be curative in UC; indicated for severe and uncontrollable dz) |
| What is a syndrome? | -Subset of symptoms that when characterized together may look like a certain dz |
| What is the GI d/o characterized by altered bowel habits&abd pain in absence of structural or biochemical abn? | IBS |
| Risk fxs for IBS? | -Young adults, female, underlying psychological condition, stress assoc w/exacerbations, prior bacterial gastroenteritis |
| What are some possible causes of IBS? | -Abn gut motor and sensory activity -Central neural dysfxn -Psych disturbances -Prior bacterial infex -Stress |
| What are some symptoms of IBS? | -Abd pain (episodic) -Altered bowel habits (diarrhea or constipation) -Gas -N/V, dyspepsia, hrt burn |
| Pts w/IBS will have symptoms resembling many other conditions, and lab tests will usually be NL, but what are some lab tests that are usually ran? | CBC, Stool study (O&P), Thyroid studies, electrolytes, endoscopy, radiographic images |
| Rome III dx of IBS involves recurrent abd pain/discomfort at least 3 days per mo during the previous 3 mo's that is assoc w/2 or more of the following? | -Relieved by defecation -Onset assoc w/change in stool freq -Onset assoc w/change in stool form or appearance |
| What are some supporting symptoms for a Rome III dx of IBS? | -Altered stool freq -Altered stool form -Altered stool passage (straining or urgency) -Mucorrhea -Abd bloating or subjective distention |
| True or false: Symptoms in IBS are progressive? | FALSE: symptoms persist over a long pd of time, but do not progress |
| What are some diet changes that can help with IBS? | -Avoid triggers, such as: Caffeine,fatty foods, gas producing veggies, gum, carbonated beverages |
| What kind of meds are used to relieve intes spasm or cramping by relaxation and times of stress, etc, in IBS? | Anti-spasmodics (anticholinergics) *Dicyclomine is commonly used |
| T or F: Anti-depressants may be used to help w/ IBS? | TRUE: May help reduce pain, and if there is an underlying psych dx causing the IBS-it usually relieves it |
| Who can use Tegaserod (5-HT4) agonists or Alosetron (5HT-3) anatagonist? | Women w/IBS -Agonist for constipation IBS -Antagonist for diarrhea IBS |
Created by:
ferrier.kath
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