Gen Med: GI > IBS > Flashcards

IBS Flashcards

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1
Q

Define IBD

A
  1. Autoimmune disease of the gastrointestinal (GI) tract characterized by
    A. Mucosal inflammation
    B. Recurrent diarrhea & abdominal pain
  2. Chronic & relapsing
  3. Idiopathic
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2
Q

What is ulcerative colitis?

A
  1. Affects colon & rectum
  2. Diffuse mucosal inflammation
  3. Involves the rectum ≈ 95% of cases
  4. Extends proximally in continuous pattern
  5. Rarely involves anus
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3
Q

What is crohn’s dz?

A
  1. Can involve any part of GI tract (mouth to anus)
  2. Transmural inflammation
  3. Most commonly affects ileum & proximal colon, extends distally
  4. Interrupted or “skip lesions”
  5. Perianal involvement
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4
Q

What asst. comorbidities may be present with IBD?

A
  1. Gallstones
  2. Malnutrition
  3. UTI
  4. Kidney stones
  5. Amyloidosis
  6. Arthritis
  7. Uveitis
  8. Episcleritis
  9. Aphthous stomatitis
  10. Erythema nodosum
  11. Pyoderma gangrenosum
    A. (red-blue pus containing sores)
  12. Ankylosing spondylitis
  13. Sacroiliitis
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5
Q

What are the ddx for IBD?

A
  1. IBS

2. Celiac dz

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6
Q

What is IBS?

A
  1. GI syndrome characterized by chronic abdominal pain & altered bowel habits w/out organic cause
  2. NOT associated w/ inflammation
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7
Q

What is celiac dz?

A
  1. Small-bowel disorder characterized by mucosal inflammation, villous atrophy & crypt hyperplasia
  2. Sx’s occur w/ingestion of dietary gluten
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8
Q

What is the etiology of Crohn’s dz?

A
  1. Idiopathic
  2. Disruption of immune homeostasis of intestine
    → overreacts to environmental, dietary, infectious agents
  3. Hereditary predisposition
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9
Q

What is the pathogenesis of crohn’s dz?

A
  1. Edema w/ linear ulcerations of mucosal surface
    A. “Cobblestoning”
  2. Noncaseating granulomas - pathognomonic
  3. Hypercoagulable state
    A. Stroke, retinal thrombus, DVT, PE
  4. Extra-intestinal manifestations
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10
Q

What are ppl with crohn’s dz at risk for?

A
  1. Scarring
  2. Obstruction
  3. Penetrating ulcers
  4. Abscesses
  5. Fistulas
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11
Q

What are the sxs of crohn’s dz?

A
  1. Chronic diarrhea
  2. (+) blood if Crohn’s colitis
  3. Crampy abdominal pain
  4. Fever
  5. Anorexia
  6. Wt loss
  7. Fatigue
  8. Anemia
  9. Sx’s wax & wane
    A. “Flares” mild/brief → severe/prolonged
  10. N/V w/ partial or complete bowel obstruction
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12
Q

What are the ddx for crohn’s dz?

A
  1. Appendicitis
  2. Diverticulitis
  3. IBS
  4. UC
  5. Bacterial/viral gastroenteritis
  6. Food poisoning
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13
Q

What are the dx studies for crohn’s dz?

A
  1. Stool guaiac
  2. CBC w/ diff
    A. Microcytic/hypochromic
  3. B12, Fe, TIBC, folate
    A. ↓ Iron
    B. ↓ B12
  4. Stool for WBC, O&P, C. diff, Cx
  5. ↑ ESR
  6. ↑ CRP
  7. CMP
    A. ↓ Albumin
  8. (+) ANCA (Anti-Saccharomyces CerevisiaeAb)
  9. (-) pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Ab)
  10. KUB
    A. Air-fluid levels (obstruction), pneumoperitoneum (perforation)
  11. CT abdomen/pelvis (procedure of choice)
    A. Dx Crohn’s (“string sign” in terminal ileum) & manage abscesses
    B. Wall thickening, abscess
  12. Barium enema
    A. Fistula, inflammation, skip lesions
  13. UGI w/SBFT
    A. Inflammation, stricture
  14. Colonoscopy
    A. Evaluate severity, location, tissue Bx
  15. Upper endoscopy
    A. Upper GI evaluation
  16. MRI
    A. Routine assessment of pelvis fistulae & sinus tracks
  17. Capsule enteroscopy
    A. Swallow encapsulated video camera w/ specific indications
    B. Avoid w/ known strictures, fistulas
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14
Q

What is string sign?

A
  1. Seen on CT w/contrast or UGI w/SBFT
  2. Narrowing & stricturing in terminal ileum
  3. Seen in Crohn’s dz
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15
Q

What is the Step 1 management in Crohn’s dz?

A
  1. Acute/maintenance

2. Aminosalicylates – Asacol/Lialda/Pentasa/Rowasa/Apriso (mesalamine), Azulfidine (sulfasalazine) PR

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16
Q

What is the Step 1-A management in Crohn’s dz?

A
  1. Antibiotics – Metronidazole (Flagyl) or Ciprofloxacin (Cipro) prn fistula/abscess as seen on CT or MRI
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17
Q

What is the Step II management in Crohn’s dz?

A
  1. Corticosteroid – Solu-Medrol/Cortef IV, Prednisone PO, Cortenema (Hz) enema PR,
  2. Entocort EC (budesonide) PO or PR prn exacerbation
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18
Q

What is the Step III management in Crohn’s dz?

A
  1. Immune modifiers – Imuran (azathioprine), methotrexate, cyclosporine
  2. Use if difficult to maintain remission w/ aminosalicylates alone
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19
Q

What is the Step III-A management in Crohn’s dz?

A

TNF inhibitors – Remicade (infliximab), Humira (adalimumab)

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20
Q

What are the meds for symptomatic treatment of crohn’s dz?

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A
  1. Antidiarrheal agents – Lomotil, Imodium
  2. Bile sequestrants – Questran
  3. Antispasmodics – Bentyl, Levbid
  4. Acid suppressants – H2 blockers, PPI’s
  5. Parenteral nutrition if severe
21
Q

When are crohn’s pts hospitalized?

Study These Flashcards
A
  1. Failed OP Tx
  2. Dehydration
  3. Uncontrolled diarrhea/pain
22
Q

When should a specialty consultation be ordered for a crohn’s dz pt?

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A
  1. Extra-intestinal manifestations

2. Surgical indications

23
Q

When is surgery indicated for crohn’s pts?

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A
  1. Not curative - high recurrence
  2. Mostly for complications (strictures, fistulas, bleeding, abscess, dysplasia/CA)
    A. CT percutaneous abscess drainage has shown great success w/↓ rate of recurrence, as compared to surgery
24
Q

What are the surgical options for crohn’s dz pts?

Study These Flashcards
A
  1. Segmental resection w/ re-anastomosis
  2. Stricturoplasty
  3. Diverting ileostomy/colostomy (severe perianal disease allowing healing for 6-12 mo)
  4. Fistula resection
  5. Perirectal abscess drainage
25
What are surgical emergencies in crohn's pts?
1. Toxic 2. Obstruction 3. Hemorrhage 4. Peritonitis
26
What is emergency treatment for crohn's pts?
1. Steroids 2. Bowel rest 3. NG suction 4. IV hydration A. Electrolytes prn
27
What diet should a crohn's pt consider?
1. Low residue | 2. Lactose avoidance if intolerant
28
What supplements should a crohn's pt consider?
1. Probiotics, Ca/Vit D if steroid use | 2. Vit A, D, E, K, Fe, folic acid if taking sulfasalazine
29
What other supportive measures can a crohn's pt consider?
1. Sitz baths/soap & water after stooling if perianal sx | 2. Psych support
30
What is the prognosis foe crohn's dz?
1. Prognosis A. 10% w/prolonged remission B. 75% w/chronic intermittent Dz C. 12% w/unremitting Dz 2. Obstruction occurs in 20-30% of cases 3. Intestinal perforation in 1-2% of cases 4. Fistulas w/ abscess in 50% of cases
31
What is the leading cause of mortality in Crohn's dz?
1. GI cancer (Adenocarcinoma) | 2. Occurs in small & large intestine in areas of chronic Dz
32
What is ulcerative colitis?
1. Chronic inflammation & ulcerative disease of colonic mucosa & submucosa 2. Main sx of active disease is usually diarrhea mixed w/ blood 3. Gradual onset 4. Systemic disease affecting many parts of the body
33
What is the epidemiology of ulcerative coilitis?
1. M = W 2. Most people Dx’d in mid-30’s 3. Older men > older women 4. Tends to run in families, but no clear pattern of inheritance 5. Inc Risk: A. European caucasians B. Jewish heritage
34
What is the etiology of ulcerative coilitis?
1. Undetermined etiology | 2. Autoimmune inflammatory colitis
35
What is the pathogenesis of ulcerative coilitis?
1. Usually begins in rectum, may remain there or spread proximally 2. Severe disease causes large ulcers & purulent exudate 3. Pseudopolyps or hyperplastic tissue growth at sites of previous ulceration 4. Stricture formation
36
What can ulcerative coilitis develop into?
10-20% develop adenoCA after 10 yr
37
What are the sxs of ulcerative coilitis?
1. Exacerbations alt. w/remissions 2. Bloody diarrhea 3. Absent or minimal pain 4. Fatigue 5. Urgency to defecate 6. Mild lower abdominal cramping 7. Mucus &/or blood in stool 8. May follow intestinal infection 9. Loose/frequent (≥ 10) stools/day 10. Tenesmus A. feeling of needing to pass stool when the rectum is empty 11. Systemic sx’s w/ severe disease A. Malaise, fever, anemia, anorexia, wt loss
38
What are the dx studies for ulcerative coilitis?
1. (+) pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Ab) > 45% of cases 2. (-) ANCA (Anti-Saccharomyces Cerevisiae Ab) 3. Stool guaiac 4. CBC w/ diff A. Microcytic/hypochromic anemia 5. Stool for WBC, O&P, C. diff, Cx 6. ↑ ESR 7. CMP A. ↓ Albumin , ↓ K, ↓ Mg, ↓ Ca
39
what imaging studies are used for ulcertive coilits?
1. Imaging generally not indicated 2. Barium enema w/ rectal involvement, “stove-pipe” appearance due to loss of haustrae 3. UGI w/SBFT if unable to perform complete BE due to stricture 4. CT w/o abscesses or fistulas
40
When is a colonoscopy indicated in ulcerative coilitis?
Colonoscopy w/ Bx when not acute
41
What is the medical management for ulcerative coilitis?
1.  Tx  acute symptoms w/ goal to induce remission, then maintain   2. Anemia often requires the use of parenteral iron 3. Low residue diet 4. Correct nutritional deficiencies A. Folic acid B. TPN w/ bowel rest if severe
42
What is the Step I management in UC?
1. Aminosalicylates A. Acute/maintenance Asacol/Lialda/Pentasa/Rowasa/Apriso (mesalamine) PO or PR, Azulfidine (sulfasalazine) PR, Dipentum (olsalazine) PO, Giazo/Colazal( balsalazide) PO
43
What is the Step II management in UC?
1. Corticosteroid A. Solu-Medrol/Cortef IV, Prednisone PO, Cortenema (Hz) enema PR, Entocort EC (budesonide) PO or PR prn exacerbation
44
What is the Step III management in UC?
1. Immunosuppressive drugs | A. Mercaptopurine ( Purinethiol), Azathioprine (Imuran) ,Methotrexate (inhibits folic acid)
45
What is the Step IV management in UC?
1. TNF inhibitors | A. Infliximab (Remicade)
46
When are UC pts considered for colectomy or IV cyclosporine?
Those with less severe disease but do not respond to IV steroids w/in 7–10 days should be considered for colectomy or IV cyclosporine
47
What is the hygiene hypothesis in UC?
1. Low incidence of autoimmune Dz in less developed countries 2. ↑ autoimmune Dz in industrialized countries 3. Suggests helminthic infections protect individuals from developing autoimmune Dz
48
What is helminthic therapy in UC?
1.  Inoculation of pt w/ specific parasitic intestinal helminths 2. Experimental Tx to reduce the severity of autoimmune response in IBD
49
What are the dietary recommendations for UC?
``` 1. Lactose intolerance common in UC A. Lactose breath hydrogen test B. Ca supplement to avoid bone loss 2. If (+) cramping or diarrhea A. Avoid fresh fruit, caffeine, carbonated drinks, high fructose corn syrup & sorbitol 3. ”Specific Carbohydrate Diet” A. Avoid disaccharides & polysaccharides B. Monosaccharides  allowed ```
Gen Med: GI
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