What country has highest IBD rates in the world
Canada
When is IBD most common?
What other trends/risks are seen?
- Most common in 15-30yrs, then 50-70yrs
- High risk r/t family hx (largest independent risk factor for IBD)
- Equal in men and women; prevalent in Jewish individuals
- Cause unknown – triggered by environmental factors such as pesticides, food additives, tobacco, and radiation; allergies and immune disorders suggested as causes as well
What classification of drugs exacerbate IBD?
NSAIDs
When is crohns often diagnosed?
in adolescents and young adults
According to Day et al, what layers of the GI tract are affected by Crohn’s?
extends through all layers
Crohn’s area of GI most affected?
o Changes most common in distal ileum and ascending colon
Do you see exacerbations and remissions characteristically in Crohns?
Yes
this is also said to be true of UC…thought it was more a thing in UC?
How does the bowel change with Crohn’s initially?
How/why does lumen size change overall?
o Begins with edema and thickening of mucosa, ulcer begins to appear in inflamed mucosa
o Intestinal lumen narrows as bowel wall thickens
How are the lesions described in Crohn’s?
Lesions not continuous, occur in “cobblestone” clusters
What complication is common in Crohns?
o Fistulas, fissures, and abscesses form as inflm extends into peritoneum
50% have granulomas
What type of onset is seen in Crohns?
Insidious
Where is pain seen in Crohns?
Characteristic of diarrhea in this condition?
lower right quadrant abdominal pain
diarrhea unrelieved by defecation
Why are crampy pains seen in Crohns?
Scar tissue and granulomas obsruct lumen so contents can’t pass properly, resulting in crampy abdominal pains
Why does anemia result form Crohns?
Not eating
and probably some minimal blood loss?
In which kind of IBD do you seen intestinal weeping?
Crohn’s
What occurs with perforation of lesions in Crohns?
intrabdominal and anal abscesses → Fever and leukocytosis
Manifestations of Crohn’s in other systems?
joint disorders, skin lesions, ocular disorders, oral ulcers
What characteristic of stool is seen in Crohns?
Steatorrhea
What does a barium show in Crohns?
study of upper GI tract shows “string sign” of terminal ileum (constriction of segment)
Barium enema shows ulcerations, fissures, etc
Diagnostic procedures used in Crohns?
o Proctosigmoidoscopy performed to see if rectosigmoid area inflamed
- Stool sample - blood & steatorrhea
- Endoscopy, colonoscopy, and intestinal biopsies to confirm dx
o Ct shows bowel thickening
How would labs be seen to be impacted in Crohns?
Hct and Hb down, WBC may be elevated, albumin and protein dec (d/t malnutrition)
What layers are most effected in UC?
Characteristics of the lesions?
- Affects superficial mucosa of colon
- Characterized by multiple ulcerations, diffuse inflammation, and shedding of colonic epithelium
- Bleeding d/t ulcerations
- Mucosa = edematous and inflamed
- Lesions are continuous, occuring one after the other
Are abscesses common in UC?
What about fistulas and fissures?
Abscesses yes
• Fistulas, fissures not common because inflm process affects inner lining only
How do the lesions in UC typically spread?
How does the lumen change?
- Begins in rectum, spreads proximally to entire colon
* Lumen narrows and shortens with fat deposits and muscular hypertrophy
