Term
| why is it important to watch pts with ulcerative colitis closely through their remissions/exacerbations? |
|
Definition
| there is a risk of adenocarcinoma |
|
|
Term
| why do pts with UC experience predefacatory pain? |
|
Definition
| the L colon is completely inflamed and a fecal bolus will irritate it |
|
|
Term
|
Definition
| bright red blood associated with UC, which there is generally little/no accompanying pain (in the case of UC). |
|
|
Term
| what characterizes diarrhea as seen in UC? |
|
Definition
| diarrhea in UC pts is early/frequent and a source of high nutrient loss. generally there is no fever unless there are complications. |
|
|
Term
| what rate does CD progress at? |
|
Definition
|
|
Term
| what kind of pain is associated with CD? |
|
Definition
| dull, achy pain which can flare |
|
|
Term
| when is diarrhea involved with CD? |
|
Definition
| only when the small bowel is involved |
|
|
Term
| when is steatorrhea associated with CD? |
|
Definition
| only when the small intestine is involved |
|
|
Term
|
Definition
|
|
Term
| are abdominal masses seen in UC? |
|
Definition
|
|
Term
| if you seen pseudopolyps in a pt's colon, what can you determine? |
|
Definition
| they have probably had UC in the past |
|
|
Term
| what is the classic morpholigic presentation of UC as compared to CD? |
|
Definition
| circumferential and continuous ulcerations of the mucosa |
|
|
Term
| does angiography help with a UC dx? |
|
Definition
|
|
Term
| what would you expect to see on a bowel bx taken from a pt with UC? |
|
Definition
| non-specific inflammation of the mucosa |
|
|
Term
| what kinds of lesions characterize bowels in pts affected by CD? |
|
Definition
| aphthoid ulcers - deep penetrating, w/raised margins, extensively placed w/normal mucosa inbetween |
|
|
Term
| why does shortening the colon of crohn's pts not help? |
|
Definition
| the disease can and does reemerge and the pt will then have absorptive problems |
|
|
Term
| what are the only indications for sx in pts w/crohn's disease? |
|
Definition
| hemorrhage, perforation, and obstruction |
|
|
Term
| what part of the colon is more often involved in crohn's disease? |
|
Definition
|
|
Term
| what is the appearance of the terminal ileum/ascending colon in crohn's pts? |
|
Definition
| cobblestone with fissures/fistulas |
|
|
Term
| are granulomas a common finding in CD? |
|
Definition
| yes and microgranulomas are usually composed of langerhans giant cells |
|
|
Term
| how do UC and CD appear differently when scoping pts? |
|
Definition
| UC: circumferential, continous, hemorrhagic mucosa. CD: eccentrically placed, deep/penetrating apthoid ulcers with normal mucosa inbetween |
|
|
Term
| what can happen to pts with UC? |
|
Definition
| initial attack w/risk of toxic megacolon (effect of which is worsened by perforation risk), abscess/stricture/stenosis formation with chronic inflammation, pseudopolyps, and *high CA risk |
|
|
Term
| what can happen to pts with CD? |
|
Definition
| acute fulminating attacks/toxic megacolon are rare, however confined perforations such as fistulas do occur along with abscesses/strictures. CA is rarer than with UC, but it does happen. |
|
|
Term
| what characterizes the pseudopolyps as seen in UC? how do they form? where are they usually found? |
|
Definition
| pseudopolyps are pathognomonic for UC and are often extensive, smooth and raised. pseudopolyps form with small ulcerations where collagen is laid down until sometimes contraction occurs and the mucosa puckers out to form a pseudopolyp. they are most often seen in the sigmoid/descending colon/rectum. |
|
|
Term
| if you see a rectum with circumferential continuous lesions with bleeding can you say you have UC? |
|
Definition
| no, w/out colonic involvement it is simply ulcerative proctitis - which there is no associated CA risk |
|
|
Term
| what happens to bile salts in pts w/CD? why do CD pts usually have low cholesterol? |
|
Definition
| the bacteria de-conjugate bile salts, then they are not reabsorbed = diarrhea. the body compensates for bile loss by making more bile, which draws out cholesterol, leading to hypercholesterolemia in the biliary tree which can lead to stones in the gall bladder (appear as "gravel"). |
|
|
Term
| what dermatologic manifestations are associated with UC? are they seen in CD? |
|
Definition
| erythema nodosum, pyoderma gangrenosum - which are seen also in CD, but less frequently |
|
|
Term
| what rheumatic manifestations are seen in UC? are they seen in CD? |
|
Definition
| ankylosing spondylitis and arthritis pain in knees/hand are seen more commonly in UC, but also less commonly in CD |
|
|
Term
| are pts with UC's livers affected? |
|
Definition
| yes, 50% of UC pts have cirrhosis and some lower % of CD pts |
|
|
Term
| what is the CA risk in UC pts vs normal pts? |
|
Definition
| CA is 5-10% more common in UC pts and comes usually around 10 years after the first onset of UC |
|
|
Term
|
Definition
| bed rest (if inital attack), sedatives, antispasmodics (want to manage not stop diarrhea, and avoid toxic megacolon), fluid replacement (pts lose minerals/vitamins/protein/blood), diet (start w/low residue), antibx (not b/c of infection, but immune-modulating fuction), steroids (enema - very effective), immunosuppressives (pancreatitis risk) |
|
|
Term
| how does amebiasis present? |
|
Definition
| similar to CD, with circumferential inflammation, skip lesions, etc - but the ulcerations are "collar button" |
|
|
Term
| how does radiation colitis appear on a scope? |
|
Definition
|
|
Term
| what are the causes of IBD? |
|
Definition
| idiopathic (UC, CD, colitis of indeterminate origin, proctitis, ileojejunitis), infection (lymphogranuloma venereum, CMV, behcet's, HSV, norovirus, chlamydia, various bacterial infections, fungi, and parasites), motor disorders (diverticulitis, solitary rectal ulcer syndrome), secondary to vascular hypoperfusion (ischemic colitis and colitis complicating colonic obstruction), therapeutic intervention (overuse of enemas/laxatives, clindamyxin -> c. dif, radiation, graft v. host, small intestinal bypass), and misc (collagenous colitis, nonspecific/idiopathic ulcers, necrotixing enterocolitis in CA pts, eosinophilic colitis, allergic proctitis, ischemic colitis, metabolic/fabry's, and hemolytic-uremic syndrome) |
|
|
