Gastroenterology
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| IBD common sx | Diarrhea (often bloody); Fatigue (poss rel to anemia, not nec); wt loss; anorexia; N/V; crampy abdominal pain (d/t obstructive sx?)
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| Features of CD | Any part of GI tract (most commonly terminal ileum); skip lesions; transmural
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| Features of UC | Limited to colon; starts in rectum; usually continuous; superficial; resulting in erosions, friability, bleeding
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| Specific clinical features of UC | Proctitis: tenesmus; bloody diarrhea more common; high risk of CRC
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| Specific clinical features of CD | fistula: abscesses; more common at anus; strictures of the intestine; CRC risk increased if > 1/3 colon involved; smoking & CD: bad
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| Extra intestinal manifestations of IBD: | may involve any area; usu eye, skin, liver, and joints (arthralgias, AS)
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| EIM: arthralgia Type 1: | self limited, short lived, affecting 6 or fewer joints. Associated with disease flares
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| EIM: arthralgia Type 2: | multiple joints, can be migratory, can be more chronic; NOT associated with disease flares.
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| Primary sclerosing cholangitis (PSC) | UC>CD; stricture of biliary ducts; Dx high alk phos; LFT, anti-mito Ab; ERCP/MRCP; risk for CRC; refer to hepatologist
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| Raised tender red-purplish nodules, on extensor surfaces of extremities, are called ____ and can be a sign of: | erythema nodosum; sx of Crohn dz. May require steroids
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| Pyoderma gangrenosum | wide spectrum of necrotic inflam; IBD tx, topical tx, or poss colectomy; DO NOT BX
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| IBD eye complications | episcleritis; uveitis: refer to Ophtho (blindness risk)
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| IBD: DDx includes: | infxs diarrhea; ischemia (elderly, PVD, thrombosis); meds (PCN, NSAID, CellCept); diverticular dz; perianal fistula
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| IBD dx/ eval: | Combo of endoscopy, histology, radiography, labs & clinical data; Colonoscopy with ileal intubation & bx (should see chronic colitis/enteritis); Small bowel follow-through, enteroclysis (+/- CT), MR enterography
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| IBD labs | often anemic (Fe def & chronic dz), leukocytosis, elevated CRP (CD); DO NOT ORDER serologies (ASCA, Cbir, OmpC & Crohns; p-ANCA & UC)
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| Genl principles of tx of IBD | Tx affected area (enema/supp: mild-mod proctitis; budesonide: ileal CD); use as little steroid as poss; not everyone needs tx or responds to same tx
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| Defn Mild UC: | ≤5 BM/day; no sx systemic toxicity; normal ESR
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| Defn Moderate UC: | >5 BM/day and <10lb wt loss; no sx systemic toxicity
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| IBD tx options | 5-ASA; corticosteroids; 6MP/AZA; anti-TNF Ab
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| 6MP/AZA MOA: | impair T cell fn; slow onset of action; AE pancreatitis, liver tox, cytopenia;
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| IBD colon ca risk/surveillance | CD/UC colitis >1/3 colon: colonoscopies starting 8 yrs from sx onset; q1-3 years; if comorbid PSC: immed start annual colonoscopy; FH also inc CRC risk
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| Dysplasia, cancer, or toxic colitis may: | necessitate colectomy.
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| Fibrotic strictures, obstruction, fistulae may: | necessitate segmental resection in CD (try to avoid surg if poss in CD)
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| IBD: Worrisome signs | frequent UTIs/pneumaturia (fistula to bladder); High fever/abd mass (abscess, liver abscess); severe abd pain (perf); N/V (obstruction); severe rectal pain (perirectal abscess)
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| Managing IBD flares | Similar to previous flares? Worrisome features; R/O infxn; labs (WBC, H/H); 5ASA (UC) or budesonide (ileal CD)
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| Granulomas on bx are highly suggestive of: | CD
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| CT scan for CD may show: | thickened, matted bowel loops, intra-abdominal abscess
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| Defn Severe UC: | Hourly BMs; toxic appearance, fever, tachy, Hct <25; 10-20lb wt loss
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| Test of choice for UC | sigmoidoscopy
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| Contraindicated in eval of acute UC: | Barium enema: may -> toxic megacolon
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| UC treatment | Distal: topical mesalamine; systemic steroids if tx failure. Acute dz above sigmoid: PO sulfasalazine & mesalamine
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| UC tx if intractable: | C-steroid enema trial; cyclosporine IV 4mg/kg/day; inflixamab
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| IBD and smoking | smoking decreases UC sxs; increases Crohn dz sxs
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| Crohn Dz findings | fistula: abscesses; more common at anus; strictures of the intestine; CRC risk increased if >1/3 colon involved; macro anemia
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| Pyoderma gangrenosum = | wide spectrum of necrotic inflam; IBD tx, topical tx, or poss colectomy; DO NOT Bx
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| IBD eye complications | episcleritis; uveitis: refer to Ophtho (blindness risk)
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| IBD colon ca risk/surveillance | CD/UC colitis >1/3 colon: colonoscopies starting 8 yrs from sx onset; q1-3 years; if comorbid PSC: immed start annual colonoscopy; FH also inc CRC risk
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| Pseudopolyps in CD: | Chronic damage & ulceration can lead to excess granulation tissues that protrudes into the intestinal lumen
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| Koilonychia = | spoon nails, may be sx of iron deficiency
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