Gastroenterology
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| show | 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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| show | Any part of GI tract (most commonly terminal ileum); skip lesions; transmural
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| Features of UC | show 🗑
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| show | Proctitis: tenesmus; bloody diarrhea more common; high risk of CRC
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| Specific clinical features of CD | show 🗑
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| Extra intestinal manifestations of IBD: | show 🗑
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| EIM: arthralgia Type 1: | show 🗑
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| show | multiple joints, can be migratory, can be more chronic; NOT associated with disease flares.
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| show | 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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| show | erythema nodosum; sx of Crohn dz. May require steroids
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| Pyoderma gangrenosum | show 🗑
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| IBD eye complications | show 🗑
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| IBD: DDx includes: | show 🗑
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| IBD dx/ eval: | show 🗑
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| show | 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 | show 🗑
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| Defn Mild UC: | show 🗑
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| Defn Moderate UC: | show 🗑
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| show | 5-ASA; corticosteroids; 6MP/AZA; anti-TNF Ab
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| show | impair T cell fn; slow onset of action; AE pancreatitis, liver tox, cytopenia;
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| show | 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: | show 🗑
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| show | necessitate segmental resection in CD (try to avoid surg if poss in CD)
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| IBD: Worrisome signs | show 🗑
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| show | Similar to previous flares? Worrisome features; R/O infxn; labs (WBC, H/H); 5ASA (UC) or budesonide (ileal CD)
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| show | CD
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| CT scan for CD may show: | show 🗑
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| show | Hourly BMs; toxic appearance, fever, tachy, Hct <25; 10-20lb wt loss
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| show | sigmoidoscopy
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| show | Barium enema: may -> toxic megacolon
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| UC treatment | show 🗑
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| UC tx if intractable: | show 🗑
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| show | smoking decreases UC sxs; increases Crohn dz sxs
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| show | fistula: abscesses; more common at anus; strictures of the intestine; CRC risk increased if >1/3 colon involved; macro anemia
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| show | wide spectrum of necrotic inflam; IBD tx, topical tx, or poss colectomy; DO NOT Bx
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| show | episcleritis; uveitis: refer to Ophtho (blindness risk)
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| show | 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: | show 🗑
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| show | spoon nails, may be sx of iron deficiency
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