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61 Cards in this Set
- Front
- Back
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What is IBD? |
Inflammatory Bowel Disease (inflammatory disease of GI tract) |
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What is another name for Crohn's disease? |
Regional enteritis |
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What is ulcerative colitis often called? |
UC |
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What is the cause of IBD? |
No one knows, but probably an auto-immune process with environmental factors contributing |
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What is the differential diagnosis of IBD? |
- Crohn's vs UC - Infectious colitis (eg, C. difficile, amebiasis, shigellosis) - Ischemic colitis - Irritable bowel syndrome - Diverticultis - ZE syndrome - Colon cancer - Carcinoid - Ischemic bowel |
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What are the extra-intestinal manifestations seen in both types of IBD? |
- Ankylosing spondylitis - Aphthous ulcers (oral) - Iritis - Pyoderma gangrenosum - Erythema nodosum - Clubbing of fingers - Sclerosing cholangitis - Arthritis - Kidney disease (nephrotic syndrome, amyloid deposits) |
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How can you remember the extra-intestinal manifestations of IBD? |
"A PIE SACK": - Aphthous ulcers
- Pyoderma gangrenosum - Iritis - Erythema nodosum
- Sclerosing cholangitis - Arthritis, Ankylosing spondylitis - Clubbing - Kidney (amyloid deposits, nephrotic syndrome) |
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What is the incidence of Crohn's disease? |
3-6/100,000 |
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What is the at-risk population for Crohn's disease? |
- High in Jewish population - Low in African black population - Similar rates between African American and US white population |
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Are males or females more commonly affected by Crohn's disease? |
Female > Male |
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What is the age distribution of Crohn's disease? |
Bimodal distribution: - Peak incidence at 25-40y - Peak at 50-65y |
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What is the incidence of UC? |
10/100,000 |
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What is the at-risk population for having UC? |
- High in the Jewish population, low in the African American population - Positive family history in 20% of cases |
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Are males or females more commonly affected by UC? |
Male > Female |
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What is the age distribution of UC? |
Bimodal: - 20-35y - 50-65y |
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What are the initial symptoms associated with Crohn's disease? |
- Abdominal pain - Diarrhea - Fever - Weight loss - Anal disease |
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What are the initial symptoms associated with UC? |
- Bloody diarrhea (hallmark) - Fever - Weight loss |
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What is the anatomic distribution for Crohn's disease? |
Classic phrasing "mouth to anus" - Small bowel only (20%) - Small bowel and colon (40%) - Colon only (30%) |
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What is the anatomic distribution for UC? |
Colon only (COLitis = COLon alone) |
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What is the route of spread for Crohn's disease? |
Small bowel, colon, or both with "skip areas" of normal bowel; hence, the name "regional enteritis" |
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What is the route of spread for UC? |
Almost always involves the rectum and spreads proximally always in a continuous route without "skip areas" |
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What is "backwash ileitis"? |
Mild inflammation of the terminal ileum in UC; thought to be "backwash" of inflammatory mediators from the colon to the terminal ileum |
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What is the bowel wall involvement associated with Crohn's disease? |
Full thickness (transmural involvement) |
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What is the bowel wall involvement associated with UC? |
Mucosa / submucosa only |
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What is the anal involvement associated with Crohn's disease? |
Common (fistulae, abscesses, fissures, ulcers) |
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What is the anal involvement associated with UC? |
Uncommon |
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What is the rectal involvement associated with Crohn's disease? |
Rare |
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What is the rectal involvement associated with UC? |
100% |
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What are the mucosal findings with Crohn's disease? |
1. Aphthoid ulcers 2. Granulomas 3. Linear ulcers 4. Transverse fissures 5. Swollen mucosa 6. Full-thickness wall involvement |
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What are the mucosal findings with UC? |
1. Granular, flat mucosa 2. Ulcers 3. Crypt abscess 4. Dilated mucosal vessels 5. Pseudopolyps |
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How can UC and Crohn's anal and wall involvement be remembered? |
"CAT URP": - Crohn's = Anal-Transmural - UC = Rectum-Partial wall thickness |
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What are the diagnostic tests for Crohn's disease? |
Colonoscopy with biopsy, barium enema, UGI with small bowel follow-through, stool cultures |
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What are the diagnostic tests for UC? |
Colonoscopy, barium enema, UGI with small bowel follow-through (to look for Crohn's disease), stool cultures |
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What are the possible complications of Crohn's disease? |
* Anal fistula/abscess * Fistula - Stricture - Perforation * Abscesses - Toxic megacolon - Colovesical fistula - Enterovaginal fistula - Hemorrhage * Obstruction - Cancer |
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What are the possible complications of UC? |
* Cancer * Toxic megacolon * Colonic perforation * Hemorrhage - Strictures - Obstruction - Complications of surgery |
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What is the cancer risk associated with Crohn's disease? |
Overall increased risk, but about 1/2 that of UC |
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What is the cancer risk associated with UC? |
~5% risk of developing colon cancer at 10 years; then, risk increases ~1% per year
Incidence of ~20% after 20 years of the disease; 30% at 30 years |
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What is the incidence of toxic megacolon in Crohn's disease vs UC? |
- Crohn's: ~5% - UC: ~10% |
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What are the indications for surgery with Crohn's disease? |
- Obstruction - Massive bleeding - Fistula - Perforation - Suspicion of cancer - Abscess (refractory to medical tx) - Toxic megacolon (refractory to medical tx) - Strictures - Dysplasia |
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What are the indications for surgery with UC? |
- Toxic megacolon (refractory to medical tx) - Cancer prophylaxis - Massive bleeding - Failure of child to mature because of disease and steroids - Perforation - Suspicion of or documented cancer - Acute severe symptoms refractory to medical tx - Inability to wean off of chronic steroids - Obstruction - Dysplasia - Stricture |
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What are the common surgical options for UC? |
1. Total proctocolectomy, distal rectal mucosectomy, and ileoanal pull through 2. Total proctocolectomy and Brooke ileostomy |
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What is "toxic megacolon"? |
- Toxic: sepsis, febrile, abdominal pain - Megacolon: acutely and massively distended colon |
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What are the medication options for treating IBD? |
- Sulfasalazine, Mesalamine (5-aminosalicylic acid) - Steroids, metronidazole (flagyl), azathioprine, 6-mercaptopurine (6-mp), infliximab |
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What is infliximab? |
Antibody vs TNF-alpha (tumor necrosis factor) |
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What is the active metabolite of sulfasalazine? |
5'-aminosalicylate (5'-ASA) which is released in the colon |
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What is the medical treatment of choice for perianal Crohn's disease? |
PO metronidazole (flagyl) |
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What are the treatment options for long-term remission of IBD? |
6-mercaptopurine (6-mp), Azathioprine, Mesalamine |
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What medication is used for IBD "flare-ups"? |
Steroids |
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What is a unique medication route option for UC? |
Enemas (steroids, 5-ASA) |
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Which disease has "cobblestoning" more often on endoscopic exam? |
Crohn's disease |
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Which disease has pseudopolyps on colonoscopic exam? |
UC - polyps of hypertrophied mucosa surrounding by mucosal atrophy |
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Which disease has a lead pipe appearance on barium enema? |
Chronic UC |
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Rectal bleeding / bloody diarrhea is a hallmark of which type of IBD? |
UC (rare in Crohn's) |
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What is the most common indication for surgery in patients with Crohn's disease? |
Small bowel obstruction |
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What are the intraoperative findings of Crohn's disease? |
- Mesenteric "fat creeping" onto the anti-mesenteric border of the small bowel - Shortened (and thick) mesentery - Thick bowel wall - Fistula(e) - Abscess(es) |
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Why do you see fistulas and absesses with Crohn's disease and not UC? |
Crohn's disease is transmural |
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What is the operation for short strictures of the small bowel in Crohn's disease? |
Stricturoplasty; basically a Heineke-Mikulicz pyloroplasty on the strictured segment (ie, opened longitudinally and sewn closed in a transverse direction) |
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Should the appendix be removed during a laparotomy for abdominal pain if Crohn's disease is discovered? |
Yes, if the cecum is not involved with active Crohn's disease |
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What is pouchitis? |
Inflammation of the pouch of the ileoanal pull through; treat with metronidazole |
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Do you need a frozen section for margins during a bowel resection for Crohn's disease? |
No, you need only grossly negative margins |
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What is it called when the entire colon is involved? |
Pancolitis |
