IBD

Question 1

Answer 1

Question 2

Any Meds/OTCs?

Answer 2

1. IBD (UC or CD)- probably UC given that bleeding is so evident and pain is so minor
2. Infectious Diarrhea (bacteria or parasitic)
3. CRC rarely (2nd degree relative + not all that relavant)
4. STD (unlikely given how long bleeding has persisted)

Question 3

Answer 3

Question 4

Answer 4

So probably UC given the distribution in the rectum, continuously up to the descending colon

Question 5

B: No vasculature (non-specific- ischemia, infection, etc) or ULCERS (its still UC)

Question 6

Question 7

Bloody diarrhea without much pain

He was a non-smoker= **UC is more common in non-smokers actually** (the diagnosis of UC in a smoker is probably wrong). Nicotine doesnt help tx. of UC (neither does smoking)

Question 8

Question 9

Not really ulcerated, just lots of inflammation

Answer 9

Active= neutrophils

Cant distinguish between UC and CD based on active colitis

Question 10

CD will be transmural!

Answer 10

Question 11

Immunostains are available to find CMV

Question 12

One of the long-term complications of ulcerative colitis (and Crohn disease) is dysplastic transformation. What are the risk factors?

Answer 12

• Duration of the disease. Risk increases sharply 8 to 10 years after disease onset.
• Extent of the disease. Patients with pancolitis are at greater risk than those with only left-sided disease.
• Nature of the inflammatory response. Greater frequency and severity of active inflammation (characterized by the presence of neutrophils) confers increased risk.

Question 13

Question 14

Answer 14

Mesalamine may reduce risk of CRC

Question 15

Colicky pain= wave like pain that has mild pain and then bouts of severe pain (non specific)

Answer 15

Question 16

X-ray shows air-fluid levels (Caused by distension)

Answer 16

Could be CD, or something is obstructing the abdomen

Question 17

NPO

Answer 17

Question 18

Pt. 2

Answer 18

Question 19

Ulcereation in the small bowel in pt. 2

Answer 20

Question 21

Answer 21

Question 22

Question 23

Answer 23

Question 24

Question 25

Answer 25

Need to consider Intestinal TB if born elsewhere Meds: NSAIDs can cause ulcers and strictures (pt. will most likely be asymptomatic)

Question 26

Surgery cannot cure CD! It will come back and note that CD can involve any part of the GI tract from the mouth to the anus and unlike UC, can occur any place at any time

Question 27

Smoking in crohns disease= bad prognosis, less likely to respond to therapy