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CM1-Fall 2011

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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