IBD and IBS

Ulcerative colitis presents with inflammation of? begins where in intestines? continuous up to?

Innumerable ulcerations with diffuse, superficial, confluent inflammation of the colonic mucosa(*mucosa and submucosal only*). Begins in the rectum and extends proximally to involve any contiguous length of colon.

UC Toxic Megacolon what happens to colon? heightens risk of?

Colonic dilation of > 6 cm on radiographs with signs of toxicity, occurring in < 2%, heightens risk of perforation.

Perianal Disease and Recurrent Abscesses are common in which IBD? uncommon in which?

common in Crohns Disease and uncommon in UC

stricture and fistulae are common in which IBD? uncommon in which?

common in Crohns Disease and uncommon in UC

Complications of IBD, both UC and CD ... causes what to colon what is common in severe first attack? what blood changes? fistuale and perianal disease present? cancer present?

Acute dilatation and perforation of colon. Common in first attack and if the disease is severe. Severe hemorrhage. Colon cancer. Fistulae and perianal disease

Crohn's Disease affects where?

Affects any part of the gut

Ulcerative colitis affects where primarily?

Affects primarily large intestines

Irritable Bowel Syndrome what happens to bowel habits? abdomen? what is found in stool? complete defecations felt? pain exacerbated by? improved by?

Altered bowel habit. Abdominal distension. Feeling of incomplete defecation. Passage of mucus per rectum. Pain is often exacerbated by eating or emotional stress and improved by passage of flatus or stools.

Ulcerative Colitis on barium enema?

Barium enema - Featureless descending and sigmoid colon with loss of normal haustral pattern and multiple ulcera and pseduopolyps

Ulcerative Colitis what type of diarrhea? diarrhea w/ or w/o? what happens with bowel movements? what happens in the blood? weight changes? abdominal involvement?

Bloody diarrhea with or without mucus. Lower abdominal cramps, tenesmus. Anemia, low serum albumin, unintended loss of weight.

Cancer is common in which IBD?

Cancer is common in UC but not common in Crohn's Disease

Irritable Bowel syndrome treatment?

Change in some dietary habit. Avoid insoluble fibers (wholegrain bread, bran, cereals, nuts and seeds (except golden linseeds). Antidiarrheal agents, like loperamide. Antispasmodic, like, dicyclomine. Tricyclic antidepressants like amitriptyline. 5-HT4 agonists. 5-HT3 antagonists (Alosetron)

Inflammatory Bowel Disease definition? refers to what 2 diseases? what two kinds of courses? where does each disease affect?

Definition - Any disease that causes inflammation of the bowel. Usually it refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis (UC) and Crohn's disease (CD). Both purse protracted and remittent course. UC only affects the large gut but CD may affect any part of the gut; common location being Ileo-colic, only small intestine and only large intestine.

Ulcerative Colitis Surgery indications include what change to colon? what types of diseases? what findings on colonoscopy? patients with severe?

Diseases refractory to treatment, specially especially after high continuous dose of corticosteroid for 2-3 days or long-term corticosteroids to control symptoms. Acute dilatation of colon with or without perforation. Severe dysplasia or carcinoma on surveillance colonoscopy. Patients with severe disease (eg, severe hemorrhage) who do not improve at 7-10 days.

Irritable Bowel Syndrome presents structural abnormalities? starts at what age? onset uncommon after? which sex is more affected? how long does it stya for?

GI disorder with absence of structural pathology. Clinical features - Starts around 20, stays more than 3 months. Women are far more commonly affected. Onset is uncommon after the age of 45.

Crohns Disease

Endoscopy - inflammation, thickening, and ulceration (white areas) of the transverse colon.

Pancolitis extends to where? part of what disease?

Extending into the transverse colon or more proximally in UC

Left-sided colitis extends to where? part of what disease?

Extending up to the splenic flexure in UC

major extraintestinal complications of Crohn Disease?

Eye lesions - Episcleritis, Uveitis. Skin lesions- Erythema nodosum, Pyoderma Gangrenosum. Arthritis- Migratory monoarticular arthritis, Ankylosing spondylitis, Sacroiliitis. Thromboembolism - DVT, PE, Cardio Vascular Accidents. Purpura- ITP Osteoporosis. *Gall stones for CD* Sclerosing cholangitis for UC

Irritable Bowel Syndrome female patients have worse symptoms when?

Female patients with_________ commonly report worsening symptoms during the premenstrual and menstrual phases. Bleeding per rectum, loss of weight nocturnal diarrhea, severe constipation or diarrhea, hematochezia, fever, precludes diagnosis. In a patient with___________- Diarrhea is more common in man, constipation is more common in woman.

Crohns Disease has fistula where? what does it lead to?

Fistula between small and large intestine leads to malabsorption

Crohn's Disease hallmark location? what % in terminal ileum&cecum? what % in small intestine? what % in large intestine?

In 35% of cases the disease in confined to terminal ileum and cecum. In 30% of cases the disease in confined to small intestine only. In 30% of cases the disease in confined to large intestine only. Rarely other parts of GI tract are involved. Terminal ileum is the hallmark location.

Crohn's Disease presents with (3)? pain due to (3)?

It primarily presents as pain abdomen, diarrhea and weight loss. Pain is mainly due to acute or subacute obstruction, inflammatory mass or abdominal abscess.

Proctosigmoiditis occurs where? part of what disease?

Limited to rectum and sigmoid in UC

Proctitis occurs where? part of what disease?

Limited to the rectum in UC

5-HT4 agonists stimulate what? facilitate?

May involve stimulation of peristalsis, facilitation of myenteric acetylcholine release or direct effects on smooth muscle.

Inflammatory Bowel Disease most common in which ethnic group? religious group? mean age onset? UC is disease of what non-activity? what weird thing happens with UC? which IBD has increasing incidence?

More common in Caucasians than other racial groups. Common in Jewish population. Mean age of onset is 15-35 years. Both ulcerative colitis (UC) and Crohn's disease (CD) are very common. UC is the disease of non-smokers. Severity may worsen if the smoker patient stops smoking. Incidence of CD is increasing in number.

Ulcerative Colitis stool culture result? course is characterized by?

Negative stool cultures. Course is unpredictable, characterized by periodic exacerbations and periods of complete remission.

Alosetron approved for? causes what 3 things?

Now approved for use in women with severe IBS-D who have failed conventional therapy. slows colonic transit, decreases rectal urgency, and decreases abdominal pain.

Toxic Colitis presents with? Megacolon with? Perforation in both causes what? What 2 things are needed to dx UC?

Patients with a toxic colitis have severe pain and bleeding, and those with megacolon have hepatic tympany. Both may have signs of peritonitis if a perforation has occurred. Sigmoidoscopy and biopsy are the key to dx UC.

Crohns Disease

Perianal absess fissures. what disease? Water campanian?

Proctitis signs include? more extensive disease presents with tenderness to?

Physical signs of proctitis include a tender anal canal and bright red blood on rectal examination. With more extensive disease, patients have tenderness to palpation directly over the colon.

Ulcerative Colitis presence of blood where? what happens to intestinal loops? what values increase? what values decrease?

Presence of blood in the colonic lumen. Dilated intestinal loops. Increased ESR & CRP, decreased Albumin, Hb%

Ulcerative colitis fulminant disease presents with what 3 symptoms? rapid or slow?

Rapid progression of symptoms and signs of severe toxicity (hypovolemia, hemorrhage requiring transfusion, and abdominal distention with tenderness) over 1-2 weeks.

Irritable Bowel Syndrome what are the 2 most common presentations? how and and what frequency? improved with? onset associated with (2)?

Recurrent abdominal pain or discomfort is the most common presentation and altered bowel motion. It lasts at least 3 days per month in the last 3 months (Key symptom) associated with two or more of the following: 1. Improvement with defecation, 2. Onset associated with a change in frequency of stool. 3. Onset associated with a change in appearance of stool. Two of them are usually present. Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.

Crohn's Disease Surgery indications ... intestinal what? continuous what 3 things? failure of? what types of changes? diseases of what area? fulminating?

Recurrent intestinal obstruction. Protracted bleeding, perforation, *fistula* Failure of medical treatment. Malignant or premalignant changes. Fulminating colitis. Perianal diseases.

Ulcerative Colitis sigmoidoscopy features?

Sigmoidoscopy - symmetrical, circumferential, and uninterrupted, multiple, superficial ulcers.

Ulcerative Colitis Severe Disease what happens to body? abdomen? fever? bowel movements? is there fluid loss? how many bowel movements classifies it?

Signs and symptoms of severe disease - Anorexia, weight loss, impaired nutrition, abdominal pain, fever. Increased bowel frequency & fluid loss -> hypovolemia. > 6 bloody bowel movements per day and more blood in stool.

Crohns's Disease

String Sign seen in what disease?

Inflammatory Bowel Disease treatment includes?

Supplementation, Mesalazine, Corticosteroids, Cyclosporine/Infliximab or Surgery

Irritable Bowel Syndrome pathophysiology?

The pathophysiology of this condition is not clear; it appears to result from a varying combination of disturbances in visceral motor and sensory function, often associated with significant affective disorders.

Ulcerative Colitis does not affect what part of intestine? except in what scenario? what happens? what is it called?

The small intestine is not involved, except in the setting of extensive colitis, in which the most distal terminal ileum may exhibit similar superficial inflammation, termed *backwash ileitis.*

Ulcerative colitis lesions continuous or skip lesions?

The ulcerative colitis usually remains constant from the onset because of its extent.

Crohn's Disease, what happens to wall and mesentery of bowel? what type of lesions presnt? what happens to lymph nodes?

Thickening of the entire wall and mesentery of the bowel with deep ulceration, skip lesions, enlargement of the local lymph nodes are the characteristic feature.

Complications of IBD include what changes to colon? what blood changes? what type of cancer? what 2 diseases?

acute dilation and perforation of colon, severe hemorrhage, colon cancer, fistulae and perianal disease

Resection is curative in which IBD? not curative in which?

curative in UC but nor curative in Crohn's Disease

Crohn's Disease, inflammatory mass palpated where? extension of mass causes and how does it manifest? what is seen in radiography? how it it accounted for?

inflammatory mass in RLQ of abdomen. Extension of the mass can cause obstruction of the right ureter or bladder inflammation, manifested by dysuria and fever. Edema, bowel wall thickening, and fibrosis of the bowel wall within the mass account for the radiographic "string sign" of a narrowed intestinal lumen.

Crohn's Colitis what type of diarrhea? what happens to body (3)?

may present diarrhea with blood and mucus, loss of weight anorexia and weakness