Lec 28

Question 1

What are some things you see in IBD but not IBS?

Answer 1

• anemia
• increased platelets, increased ESR, decreased albumin
• weight loss, fever
• perianal disease
• bloody stool, tenesmus
• fecal WBC, occult blood

Question 2

How do you differentiate acute infection from IBD?

Answer 2

acute infection:
< 2 wks duration; abrupt onset; normal platelets; normal Hbg; neutrophils see in biopsy

IBD: > 4 wks, insidious, high platelets, low Hgb, mixed infiltrate and abnormal architecture

Question 3

Where do you primarily see crohns in the GI tract?

Answer 3

• can see any portion of GI tract
• usually terminal ileum and/or colon
• have skip lesions and usually rectal sparing
• transmural inflammation

Question 4

What is typical patient who presents with IBD?

Answer 4

teens to 30s; pretty even men/women

Question 5

What are 2 factors that protect against ulcerative colitis

Answer 5

• smoking

- appendectomy

Question 6

What are 4 factors that put you at risk for crohns?

Answer 6

• smoking
• high sanitation level in childhood
• high intake of refined carbs
• perinatal infection

Question 7

How does smoking affect risk for crohns vs UC?

Answer 7

protective against UC; significantly increases risk for crohsn

Question 8

Is genetic influence stronger in crohns or UC? Example of an implicated gene?

Answer 8

stronger in crohns –> NOD2/CARD15 mutation of chr 16

Question 9

What is the role of bacteria in development of IBD?

Answer 9

if you remove bacteria –> no immune activation and no IBD

if you add in resident bacteria –> get macrophage and TH1 immune activation leading to colitis

Question 10

Where does UC localize?

Answer 10

• mucosal inflammation limited primarily to colon
• continuous lesion
• always involves the rectum

Question 11

What is the hallmark symptoms of ulcerative colitis?

Answer 11

bloody diarrhea

Question 12

What extra-intestinal manifestations of ulcerative colitits?

Answer 12

• ankylosing spondylitis
• peripheral arthritis
• erythema nodosum
• pyoderma gangrenosum = ulcers in legs
• uveitis
• primary sclerosing cholangitis

Question 13

What are some possible complications of ulcerative colitis?

Answer 13

• toxic megacolon
• sclerosing cholangitis
• colorectal carcinoma
• cholangiocarcinoma

Question 14

What are some possible complications of crohns?

Answer 14

• strictures –> obstruction
• fistulas
• ## perianal disease

Question 15

What is primary presentation of crohns?

Answer 15

chronic inflammation –> diarrhea, ab pain, fever, tender RLQ fullness

Question 16

What do you see on endoscopy in crohns?

Answer 16

transmural inflammation leading to fistulas; cobblestone mucosa; creeping fat; linear ulcers; strictures

Question 17

Is crohns or UC associated with granuloma formation?

Answer 17

crohns

Question 18

What are smptoms of strictures in crohns?

Answer 18

• post prandial cramps
• distension
• borboyrgmi = hear bowel sounds across the room
• vomiting
• weight loss / food avoidance

Question 19

What two diseases can a confined perforation in crohns mimic?

Answer 19

appendicitis if in terminal ileum

diverticulitis if in sigmoid colon

Question 20

What are symptoms of enteroenteric fistula?

Answer 20

may be asymptomatic

Question 21

What symptoms of enterovesical fistula?

Answer 21

recurrent UTI

pneumaturia = peeing bubbles

Question 22

What symptoms of retroperitoneal fistula?

Answer 22

psoas abcess signs = back, hip, thigh pain

Question 23

What symptoms of rectovaginal fistula?

Answer 23

feces and/or air drainage

Question 24

Is UC or crohns associated with perianal disease?

Answer 24

crohns

Question 25

What are features that distinguish crohns from UC?

Answer 25

- granulomas - focal lesions - fistulization - perianal disease - rectal sparing - small bowel involevement - skip lesions - strictures

Question 26

What are extraintestinal manifestations of crohns?

Answer 26

``` migratory polyarthritis erythema nodosum ankylosing spondylitis pyoderma gangrenosum apthous ulcers uveitis kidney stones ```

Question 27

Which joints involved in IBD associated peripheral arthritis?

Answer 27

- large > small | usually asymmetrical; no senovial destruction or subcutaneous nodules

Question 28

What childhood presentation of IBD?

Answer 28

fever anemia arthritis failure of growth/development

Question 29

What are treatments for IBD?

Answer 29

5-aminosalicylates immune suppressants anti_TNFs = infilixmab

Question 30

Is surgery a better choice for UC or crohns?

Answer 30

UC -- crohns have high rate of recurrence