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29 Cards in this Set
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31 YOWM physician presents c a 1 month Hx of diarrhea and BRRB. Initially, he tried to ignore the Sx but the diarrhea got more frequent, awakened him at night and was associated c more blood. The blood was mixed c the feces. There was mild cramping which was partially relieved by BM. He saw the GI fellow who gave him a prep kit for a BaE. The patient follows instructions. Within a day, he develops marked, diffuse abdominal pain, fever, and nausea. He was admitted to the hospital.
PMH: Illnesses: none. Surg: none Meds: 0 SH: married; 2 children; 2 beers/day. Occ MJ Exam: T 101 P 98 supine 125 standing; BP 125/88 supine 105/70 standing.Appears moderately ill; Ab: diffuse tenderness c sl hyperactive BS and mod guarding; No rebound; no organomegaly; stool grossly bloody. He is treated c IV fluids, IV corticosteroids and has a plain film of his abdomen. It does not show toxic megacolon. A procedure is done. |
ulcerative colitis
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46 YOWM with pancolitis since age 18. He is a severe alcoholic with depression and is remarkably noncompliant c his medical care. He sees the gastroenterologist and takes his medicine only during the worst episodes of diarrhea and hematochezia. His therapy includes mesalamine, prednisone and corticosteroid enemas. In the last 3 months the colitis has been quite. But he has been very fatigued and complains of intermittent abdominal discomfort. He presents to the ED c 3 days of L lower and S/W diffuse ab pain, anorexia and nausea. He vomited once and has not had a BM in 2 days. An Xray shows a large bowel obstruction. A procedure is done.
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colon cancer- adenocarcinoma. long standing UC
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47 YOF with 4 years of ulcerative colitis. The disease had been under good control but about 3 months ago she lost her health care insurance. In the last several weeks the diarrhea and hematochezia have returned although not as severly as on initial presentation. She has also had 3 weeks of erythematous, raised, tender nodules on her shins, pain and swelling in her R knee and L ankle and redness and discomfort in the left eye. Her family physician admits the patient to the hospital with the Dx of rheumatoid arthritis. Rheumatology is consulted and another Dx is made.
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erythema nodosum- common in IBS. red raised tenter NOT ulcerative
can have eye inflammation |
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24 YOWF admitted to the psychiatry service for somatiform disorder. She has a 4 month Hx of intermittent, diffuse abdominal pain. She has lost about 5 lbs. There have been no changes in her bowel habits. She recently underwent a very ugly divorce where she had affairs with multiple of her husbands friends. She was S/W anxious and depressed but very functional PMH: Illnesses: none Surg: none Meds: OCPs and occ. Tylenol.
SH: divorced; 0 children; smokes 2ppd; 3-4 beers/ day. No drugs. FH: neg Exam: completely normal. She denies significant depression and seems very calm and happy. No lab work or Xrays are done. The M3 student foolishly accepts the Dx and every day on rounds attempts to extract a Hx of severe underlying depression or suicidal thoughts. She is started on imiprimine c no immediate response and discharged to live c her parents. About 6 months later, the same medical student is doing a GI elective. In the OP clinic, he sees this patient. In the interim, her pain became much more frequent and severe and she developed diarrhea c a 15lb wt. loss. She had seen a gastroenterologist and a procedure had been done. |
upper GI series with small bowel follow through, no we would do endoscopy
chrons, RE (regional enteritis) long segment with regional enteritis |
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what is IBD
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inflammatory bowel disease
anything that makes inflammation in the GI mucosa: Infection, toxin, radiation. ex chrons, Ulcerative colitis |
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Chrons or UC
1. transmural 2. involved colon 3. skip lesion 4. continuous 5. bloody diarrhea 6. weight loss 7. smoking 8 old |
1. transmural: chrons. UC is NOT transmural
2. colon: UC (sm more common in chrons) 3. skip- chrons 4. continuous- UC 5. bloody UC 6 weight loss: BOTH 7. smokingL prevents UC and causes chrons 8 UC in older, chrons in youngre |
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how is IBD dx
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1. clinical presentation and hx
2. endoscopy, imaging. skip leisons with chrons. continuous with UC 3. MULTIPLE complications- extraintestinal common |
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tell me about chrons
cause portion of gut infected, depth affected prevalence |
unknown (disordered response to GI bacteria)
Transmural segmented lesions. sm intestine common (can be mouth to anus!) getting more and more common! |
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what age group is affected with chrons
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younger 20's
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your 25 yo comes in with abd sx, fatifue, prolonged diarrhea with pain, fever adn no blood in poo. whats the deal UC or chrons
what will endoscopy show |
chrons
cobblestone in segmented areas anywhere along the GI, mainly in sm intestine. Granulomas (not required for dx) STRING SIGN strictures fistulas |
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what are some complications seen with the IBD that shows cobblestone and granulomas
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1. stricture
2. fistula 3. sinus tract --> perforation 4. abcess 5. INCREASED RISK OF COLON CANCER, if it involves the colon **will see cobblestone and string sign |
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what is teh string sign
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its assocated with chrons
its blunted villi, can also see some sm bowel wall thickening |
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what does chrons look like
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1. cobblestone (skip lesion)
2. string sign 3. villi blunting 4. sm bowel thickening 5. sinus tracts --> perforation (tranmural) |
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whats teh disease course of chrons
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relapse and remit- good spells and worse
**modest decrease in life expectancy (increasd risk of colorectal cacner if involves colon) **surgery is common |
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where is UC, whats the dept involved
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colon
mucosa (not transmural) wont skip lesions, its continuoius and almost always involves the rectum |
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tell me about the mild, moderate, severe dieases of UC
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MILD: rectum, distal colon, continuous. intermittent rectal bleed, mucous, diarrhea, mild cramps, tenesmus
MODERATE: splenic flexure to rectum, loose bloody stools, abs pain. +/- fever SEVERE: extensive colitis, fever, abd pain, loose stool |
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what is teh hallmark histo of UC
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crypt abbcess
gross looks like a lead pipe |
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whats the disease hx like with UC
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periods of exacerbation and remission
single episode then a long sx free period varies based on how much of the colon is affected (recall histo will have crypt abcess, chrons was granilomas) |
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what are the complications of UC
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hemorhage
fulminant colitis that can progress to toxic megacolon (fulminant is like all at once and megacolon is dilated) intestinal perforation/stricture colon cancer (variable) |
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is colon cancer risk increased with chrons or UC
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BOTH, well as long as the chrons affects the colon
**risk occurs about 10 years after disease begins **do a screening colonoscopy q 1-2 years on pts c extensive disease. biopsy each time |
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whats the treatment for pts with colon involved chrons and UC for colon cancer
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risk increases at like 10 years after onset of disease
but in pts with extensive disease lets to colonoscopy q 1-2 years and biopsy for dysplasia each time |
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what are the extracolonic sx of UC
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1. eye- uveitis, episcleritis
2. skin- erythema nodisum, pyoderma gangrene 3. arthritis 4.enthesitis- heel pain 5. Apthous ulcers (cancker sore) 6. thrombophlebitis 7. primary sclerosing colangitis- |
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uvitis is seenwith chrons or UC
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UC
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what skin diseases are associated with UC, chrons
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UC- erythema nodosum, pyoderma gangrene
Chrons- IgA dermatitis herpetiformis |
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whats enthesitis
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heel pain assocaited with UC (get joint pain and sclerosing colangintis)
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whats apthour stomatitis
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canker sore, common around puberty in UC
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whats the tx for IBD
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steroids
immune modulators (autoimmune) anti TNF |
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is chrons autoimmune
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nope, UC is
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does UC affect the enture wall
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nope, just mucosa, chrons was transmural UC is not
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