Term
| Inflammatory bowel disease most commonly applies to what 2 condition? |
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Definition
| Ulcerative colitis and Crohn's disease |
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Term
| The highest incidence of IBD occurs in what ages? |
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Definition
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Term
| Is there an increased risk of developing IBD if there is a family history of the condition? |
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Definition
| Yes - 10X greater risk if sibling has IBD |
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Term
| What race is IBD most prevalent? |
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Definition
| White - American Jews of European descent 4-5X greater |
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Term
| What are risk factors for IBD? |
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Definition
| Smoking, urban, developed nations, Northern climates |
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Term
| An abnormality in what gene occurs 2X as often in pts w/ Crohn's? |
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Definition
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Term
| What % of cases of colitis can't be defined as UC or CD? What are these cases called? |
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Definition
| 10%. Indeterminent colitis. |
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Term
| An idiopathic inflammatory condition that involves the mucosal surface of the colon. |
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Definition
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Term
| What portion of the bowel is affect by UC? |
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Definition
| Colon - starts at rectum and may move proximally in a continuous fashion |
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Term
| What is the hallmark sx of UC? |
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Definition
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Term
| Describe the clinical presentation in a mild case of UC. |
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Definition
| Intermittently bloody, mild diarrhea (<4-5), LLQ cramping relieved by defecation, tenesmus, periods of constipation |
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Term
| Describe the clinical presentation in moderate UC. |
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Definition
| Frequent bloody diarrhea (10), mild anemia, non-severe abd pain, low grade fever, low alb |
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Term
| Describe the clinical presentation of severe UC. |
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Definition
| >10 loose stools, abd pain/tenderness, severe anemia, fever, low alb, hypovolemia (high PR) |
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Term
| A subset of severe UC characterized by rapidly worsening sx and signs of toxicity. |
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Definition
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Term
| What portion of the colon is affected in mild, moderate, and severe UC? |
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Definition
| Mild - rectum or rectosigmoid. Mod - inflammation extending to splenic flexure. Severe - extensive colonic involvement. |
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Term
| A condition in which inflammation extends beyond the mucosa to the muscle of the colon causing impaired mobility and dilation of the colon poss. leading to perforation. |
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Definition
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Term
| What test is diagnostic for acute UC? |
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Definition
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Term
| What test should be avoided during an acute episode of UC? Why? |
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Definition
| Colonoscopy - very painful and risk for perforation |
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Term
| Name 4 complications of UC. |
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Definition
| 1)Massive hemorrhage 2)Fulminant colitis 3)Benign stricture 4)Colon CA |
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Term
| What are the first line med. to tx UC? |
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Definition
| 5-ASA - anti-inflammatory (Sulasalazine, mesalamine) |
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Term
| Other than first line meds, what other drugs are used to tx UC? |
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Definition
| COrticosteroids and immunomodulating drugs (methtrexate) |
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Term
| What is the drug of choice to tx distal colitis? Second choice? |
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Definition
| Topical Mesalamine (suppository). Top. corticosteroid or oral 5-ASA |
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Term
| What is the tx for severe colitis? |
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Definition
| Hospitalization, NPO X 24-48hrs, IV corticosteroids |
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Term
| When would you consider surgery to tx severe UC? |
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Definition
| /p 7-10days if IV tx has failed |
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Term
| What is Crohn's disease? What portion of the GI tract does it involve? |
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Definition
| Transmural inflammatin of the GI tract from mouth to anus. |
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Term
| What is the most common presentation of CD? Describe it. |
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Definition
| Ileitis or ileocolitis. Nonbloody diarrhea, low grade fever, malaise, wt loss, RLQ tenderness and palpable tender mass |
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Term
| How does CD cause intestinal obstruction? |
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Definition
| Narrowing of the SB d/t inflammation, spasm, or fibrotic stenosis |
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Term
| Describe the sx in a pt w/ intestinal obstruction d/t Crohn's dz. |
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Definition
| Postprandial bloating, cramping, and loud borborygmi |
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Term
| Name 2 types of penetrating dz that occur in CD as a result of its transmural nature. |
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Definition
| Sinus tracts and fistulas |
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Term
| What portion of CD pts have perianal disease? How is it manifested? |
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Definition
| 1/3. Painful skin tags, fissures, abscesses, and fistulas. |
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Term
| Name 6 extraintestinal manifestations of CD. |
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Definition
| Arthralgia, arthritis, uveitis, aphthous ulcers, gallstones, and nephrolithiasis |
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Term
| What are the dominant features on endoscopy in CD? |
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Definition
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Term
| Describe the visual appearance of ulcers on endoscopy in CD. |
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Definition
| linear and discontinuous - "skip lesions", early may be erythema and apthoid ulcers |
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Term
| Describe the visual appearance of CD on barium enema. |
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Definition
| Cobblestone - diffuse thickening of SB mucosa |
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Term
| Describe s/sx in a pt w/ CD and abscess. What would you need to do if abscess is suspected? |
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Definition
| tender abd mass, fever, leukocytosis. Emergent CT |
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Term
| When are abx used for CD? |
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Definition
| W/ active inflammatory, fistulous, and perianal CD, /p surgery to tx complications and prevent recurrence |
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Term
| What meds are used in the maintenance of glucocorticoid dependent IBD? |
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Definition
| Azathriopine and 6-Mercaptopurine - immunosuppressant of leukocytes |
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Term
| What med used for CD alters immune response by inhibiting T cell responses and helps maintain remission w/ Azathioprine and 6-Mercaptopurine? |
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Definition
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Term
| What med used for CD is a potent anti-folate drug used for CA tx d/t its immune effect? |
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Definition
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Term
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Definition
| Blocks action of TNF which is a key inflammatory cytokine, used to tx CD |
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