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30 Cards in this Set
- Front
- Back
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what are the three etiologic theories for IBD?
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genetic susceptibility + environmental triggers + immune dysregulation
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what are the genetic factors associated with IBD?
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15-25% of IBD pts have an abnormality of one locus on chromosome 16 referred to as the IBD1 locus.
in crohn's dz--- HLA gene locus on chromosome 6 has a 59% occurrence rate in monozygotic twins compared to 10% in UC. |
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what immunologic factor is increased in activity in IBD?
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Th1 cells-- Crohns (Il-2, INF-gamma, TNF-alpha)
Th2 cells (IL-4,5, & 13) + Th1 cells --> responsible for UC. |
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what affect does smoking have on UC? Crohns?
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UC- decreased incidence & severity in smokers
Crohns- increased incidence in severity in smokers. |
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what is the MC site for crohn's disease? what percentage involve small bowel only? what type of inflammation is associated w/ Crohn's disease?
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terminal ileum; 33%; transmural inflammation
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skip lesions are associated w/ which dz?
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Crohn's
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nonbloody diarrhea, loud borborygmi & aphthous ulcers are associated with?
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Crohns
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Cobblestoning & string sign are associated w/ what disease?
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Crohn's
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when is doing a scope in a crohn's pt CI?
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during acute flairs bc it will perforate
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what are the long term complications of crohns?
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-extensive ileal mucosal dz leading to malabsorption & weight loss
-fistulas w/ or w/o infection d/t transmural inflammation/ abscess--> colonicperitoneal fistula -obstruction - Ca oxalate stones - colon carcinoma IF COLON INVOLVED |
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what are the extraintestinal manifestations associated w/ Crohn's?
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- peripheral arthritis (asymm, seroneg, nondeforming)- 20%
- central arthritis ( sacroileitis and/ or ankylosing spondylitis)- 10% - hepatobiliary tract dz - pyoderma gangrenosum (5%)& erythema nodosum (10%) - iritis & episcleritis - anemia, thromboembolic dz & amyloidosis. |
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which extraintestinal manifestation directly mirrors colon involvement?
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Peripheral arthritis
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what is on the ddx for Crohns?
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- IBS
- appendicitis - enteritis/ colitis - intestinal lymphoma - diverticulitis - undiagnosed AIDS |
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what are the 4 main indications for surgery for Crohn's pts?
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- disease intractavle to medical thx & include intra-abdominal abscess
- sympatomatic refractory fistulas - intestinal obstruction - massive bleeding |
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what is the clinical recurrence pot surgery in a Crohn's pt at 1 year? 10 years?
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1 year- 20%
10 years- 80% |
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what area does UC generally affect?
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colon only w/ diffuse friability & erosions leading to chronic bleeding
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what are the 3 major characterizations of UC?
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proctitis-- rectum involved only (50%)
left sided colitis - descendning colon (30%) entire colon- pancolitis (20%) |
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T/F
in UC there is a correlation btwn extent & severity |
true
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in which populations is UC more common?
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nonsmokers & those who quit smoking during the disease.
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what surgical procedure is associated w/ a decreased occurrence of UC?
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appendectomy b4 age 20.
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what is the hallmark of UC? what is a common repercussion of this hallmark?
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bloody diarrhea; anemia
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what type of inflammation would you see on endoscopy of a pt w/ UC?
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edematous mucous that is friable w/ mucous & generalized continuous erosions. Disease confined to mucosa only w/ rectum always involved. Lesions are NOT TRANSMURAL.
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what can a plain film show in a pt w/ UC? what can a Barium enema show in the same pt?
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plain film- toxic megacolon
BE- loss of haustral folds |
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what is the most worrisome long term complication associated w/ UC? what might decrease this risk? what are other long term complications?
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marked increase in colon CA in pts w/ dz proximal to the sigmoid colon. 1% / year increased risk starting at 10 years after diagnosis
- folic acid decreases risk - other LT complications: colon obstruction w/ toxic megacolon & perforation. Anemia & dehydration. |
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how do the extraintestinal manifestations of UC differ from Crohn's?
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they don't (as far as kalekas is concerned)
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what is the ddx for UC?
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colitis
crohn's ds confined to colon only appendicitis, diverticulitis |
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If your UC pt comes in with a toxic megacolon for >48 hours, what are you suspecting?
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obstruction
CA severe hemorrhage or perforation |
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t/f
In both UC & Crohn's, post surgery there is a recurrence at the surgical anastomosis |
FALSE
in crohn's there is a recurrence at the surgical site (80%- 10 years) in UC, there is no recurrence. |
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How do you cure UC?
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Total colectomy & you have decreased the risk of colon CA.
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how do you tx UC? Crohns?
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UC: 5-aminosalicylic acid derivatives, CS, immunomodoulating agents, nicotine patch & antibiotics for acute exacerbations
CD: same first 3 + infliximab, probiotics (if in small bowel) & antibiotics during acute exacerbations difference: nicotine path (UC), probiotic (small bowl CD) antibiotics: cipro/ metronidazole |
