inflammatory bowel disease – Flashcards
Unlock all answers in this set
Unlock answersquestion
ulcerative colitis *who is it seen in and the mechanism
answer
*bowel mucose-idiopathic and diffuse *pathogenesis -? primary immune mechanism *typically begins in adolescence or young adulthood *more prevalent in whites, Jews of eastern european descent *genetic tendency
question
what is the clinical presentation of UC
answer
*bloody diarrhea *abd pain relieved be BM *fever, anorexia, weight loss and anemia *"extracolonic" manifestations -->arthritis -->uveitis -->jaundice -->skin lesion
question
where do you see UC
answer
*almost always involves the distal colon and rectum *chronic, recurrent, and unpredictable
question
describe the disease course of UC
answer
*nearly 90% go into complete remission *chronic cases-75% have disease limited to distal bowel *mortality rates no different than general population (except in extensive disease)
question
what are the three disease severity states for UC and describe them
answer
Mild- fewer than 4 BM's qd, intermittent bleeding, nl. hematocrit and ESR Moderate- 4 to 6 BM's qd, frequent bleeding, HCT drop and ESR 20-30 mm/h Severe- more than 6 BM's, HCT drop, weight loss greater than 10% ESR greater than 30 mm/h
question
what is ulcerative proctitis
answer
*a variant of UC *distinguished by limited extent of inflammation, good prognosis and lack of serious complications *relapses are more common *less than 15% can progress to generalized UC
question
what's crohn's disease
answer
*chronic, relapsing inflammatory disorder *affecting alimentary tract *appears to have autoimmune pahtophysiology *inflammation- "discontinuous" -diseased segments separated by normal bowel *may extend through all layers of bowel wall
question
what is the clinical presentation of Crohn's disease
answer
*peak incidence 20's through 40's *often distal ileum and right colon can involve small bowel frequently (80%) *bottom line -can happen anywhere from buccal mucosa to anus!
question
Crohn's what are the symptoms
answer
*abdominal pain (often RLQ and sometimes relieved by BM) *diarrhea -50% (may be bloody) *weight loss/anorexia *vomiting *fever *preianal discomfort/bleeding *constipation may be early obstruction
question
what are the various disease severities for Crohn's
answer
Mild to moderate - weight loss less than 10 %, no dehydration Moderate to severe- fever, anemia, wt loss greater than 10% Severe-fever, obstruction, abscess
question
what are the physical findings for Crohn's
answer
*may reveal RLQ abdominal mass *may see perianal fistulous tracts (<10%) *"extraintestinal"-joint, (inflammed joints, spina deformities, )skin(erythema nodosum, pyoderma), eye(uveitis), mouth (aphthous ulcers), GU (nephrolithiasis, obstruction), bone (osteoporosis/penia)
question
what tests are done for dx of UC
answer
*based on clinical presentation *sigmoindoscopy/colonoscopy and rectal biopsy *serology- may have elevated C-reactive protein, Leuk's, ESR, platelet count and decreased in Hgb and albumin *pt hx, clinical symptoms, negative stool for bacteria, toxins, O&P
question
what tests are done for dx of crohn's
answer
*clinical presentation, radiologic contrast studies (UGI series, air contrast BE) and endoscopic measures *serology-same as UC *endoscopic-rectal sparing, apthous ulcers, fistulization, and skip lesions
question
what things UC
answer
*sulfasalazine (azulfidine) *sylfapyridine-free 5-Aminosalicylate agents *oral corticosteroids *immunospurressives *opiates *psychologial support *surgery *screening for cancer
question
UC sulfasalazine
answer
*initial treatment for mild to moderate symptoms *given as 4g/day max for 2-4 weeks *usually 80% pt response *may combine with steroids for more sere cases *maintenance dose 2g/day
question
UC ADR for sulfasalazine
answer
*adverse effects-mostly due to sulfapyridine *GI upset (n/v, anorexia, heartburn) *mild hypersensitivity (rash, fever) *serious -agranulocytosis, hepatocellular injury, lupus-like phenomena *anemia *?sperm count decrease
question
UC tx sulfapyridine-free-5-animosalycylates
answer
*can deliver 5-asa without many side effects associated sulfasalizine *mesalamine (pentesas)-especiall coated for delayed release *much more expensive than sulfasalazine
question
UC tx topical 5-asa enemas
answer
*also an alternate to sulfasalazine *offers good option for those with distal colitis *can be used for maintenance *excellent safety profile *no concern about systemic steroid absorption as with hydrocortisone enemas
question
UC tx glucocoticosteroids
answer
*for moderatley severe to severe cases *prednisone-start with 40 qd *hospitalization may be required for those too ill for oral therapy *can gradually taper once symptoms lessen
question
UC tx immunomodulator agents
answer
*for those who require chronic high dose steroid therapy and inadequate response to conventional therapies *natalizumab (tysabri) *given as infusion *potentially serious side effects (infection, hepatotoxicity, bone marrow suppression *monitor blood work
question
UC tx opiates/opiods
answer
*provides symptomatic relief of diarrhea *codeine, tincture of opium, paregoric, loperamide, diphenozylate (lomotil) *watch for addiction
question
UC tx surgery
answer
*last resort! *total colectomy - complete cure of bowel disease and remission of most peripheral manifestations
question
what are the indications for surgery for UC
answer
high grade dysplasia toxic megacolon hemorrhage obstruction unresponsiveness to maximal medical management
question
for pt's with UC what should cancer screening look like
answer
*all pt's with pan colitis of 7 years of more *best method-colonoscopy with multiple biopsies *every 2 to 3 years until 20 yr hx and then annual *more often with worrisome findings (dysplasia and strictures)
question
crohn's disease tx
answer
*diet *antidiarrheal agents *sulfasalazine and other 5-asa preps *metronidazole *ciprofloxin *PPI (gastro/duodenal) *glucocorticosteroids *6-mercaptopurine, azathioprine *other immunomodulating and antiinflammatories *surgery
question
crohn's disease tx diet
answer
*adequate protein and calories *reduce fiber content with flare-ups-cramping and diarrhea *decrease fat intake (steatorrhea)
