IBD -Davis

Question 1

What is the MOST definitive test for IBD?

Answer 1

biopsy

Question 2

Is there visible damage found in IBS? Should a biopsy be performed to diagnose IBS?

Answer 2

NO! and NO!

Question 3

Which chromosomes are involved in the genetic component of Crohn’s? Which genes are involved?

Answer 3

chromosomes: 16, 5, 10

genes:
- CD 19 (B-lymphocyte function)
- Sialophorin (leukocyte adhesion)
- CD11 integrin cluster (microbacterial cell)
- IL-4 receptor

Question 4

What is the most common form of Crohn’s disease? What kind of pain does this present with and what can this be confused for?

Answer 4

Ileocolitis

RLQ pain

appendicitis

Question 5

What do UC lesions look like?

Answer 5

• Large mucosal ulcers with copious purulent exudate (diarrhea)
• affect only the mucosa and submucosa
• Mucous membrane is erythematous, finely granular, and friable, with scattered hemorrhagic areas.

Question 6

When is surgery indicated for IBD?

Answer 6

ONLY if non-responsive to medical management or experience recurring problems

Question 7

What are the surgical options for UC? What % of people with UC will need surgery at some point?

Answer 7

• Bowel resection- Removes a portion of the large intestine
• Resection of the entire large intestine- removes the entire large intestine including rectum–> make a J pouch

15-40% need surgery

Question 8

*What is a rare complication of UC that can be life threatening?

Answer 8

Toxic megacolon involves widening of the colon often with overwhelming bacterial infection (sepsis).

–> loss of blood flow==> ischemic or dying tissue

-30% mortality if the colon ruptures

Question 9

What are the signs of toxic megacolon?

Answer 9

• Abdominal pain and tenderness
• Distended abdomen (colon diameter >8cm)
• Rapid heart rate
• Decreased blood pressure
• Leukocytosis (high white blood cell count)
• Evidence of colonic distension on abdominal x-ray
• High fever (40° C [104° F])
• Dehydration

Question 10

What percentage of people with Crohn’s need surgery at some point? Is this curative?

Answer 10

65-75% (strictures, fistula, bleeding in the intestine)

*NOT curative

Question 11

When should you begin screening IBD patients for Colorectal cancer?

Answer 11

8 years after diagnosis

screen every 1-3 years