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G.I. – Awesome
UC vs Crohn's disease
| Question | Answer |
|---|---|
| Rectal involvement | UC |
| Rectal ulcer that spreads proximally | UC |
| Superficial inflammation in anal canal away from the 6 o'clock position | UC |
| peri-rectal fistulas | CD |
| skip lesions | CD |
| no rectum involvement | CD |
| ulcers anywhere in the GI tract | CD |
| involvement of terminal ileum | CD |
| tenesmus at night | UC |
| terminal ileitis | CD |
| RLQ mass | CD, maybe that's ileum involvement? |
| transmural inflammation | CD, heal with fibrosis |
| small bowel strictures | CD transmural involvement heals with stricture leading to fibrosis; if strictures leading to small bowel obstruction, then surgery |
| ulcers on tongue | CD, use infliximab |
| What do you find on pathology for CD? | deep ulcers with granulomas, transmural involvement |
| What do you find on pathology for UC? | superficial ulcers with crypt abscess |
| If fistula, what to treat with | in CD, first treat with metronidazole; if complex fistula, then infliximab |
| hematochezia | more with UC |
| toxic megacolon | with both, but more with UC. |
| string sign | CD - narrowing of the distal ileum |
| what to do if you have extra-intestinal manifestations if IBD? | rare in CD, if UC then tx UC more aggressively |
| Name the extra-intestinal manifestations that would mirror the colitis | erythema nodosum, pyoderma gangrenosum, Rh negative arthritis |
| Name the extra-intestinal manifestations that would NOT mirror the colitis | ankylosing spondylitis and primary sclerosing cholangitis (q1yr surveillance for polyps > 1cm, if yes, then cholecystectomy) |
| more likely to lead to cancer | UC |
| how often colonoscopy for UC/CD | 8 years after onset should get first colonoscopy, then every 1 to 3 years |
| What to do if dysplasia on path from colonoscopy? | proctocolectomy (colon + rectum) |
| What antibody with UC? What antibody with CD? | pANCA (myeloperoxidase) with UC and ASCA (anti-saccharomyces cerevisiae) with CD |
| what counts as mild disease in UC? - BMs per day, blood in stool, VS, Hb, ESR | < 4 BMs per day, occasional blood in stool, NORMAL: VS, Hb, ESR |
| what do you treat MILD UC with? | 5-ASA like mesalamine (releases depending on pH of colon) or sulfasalazine (released by action of bacteria therefore wouldn't be good in small bowel since not as much bacteria in there) |
| what counts as severe disease in UC? - BMs per day, blood in stool, VS, Hb, ESR | > 6 BMs per day, ++ blood in stool, VS: fever HR>90, Hb anemia, ESR>30 |
| what do you treat MODERATE UC with? | Prednisone to induce remission, maintenance with either 5-ASA or 6-MP or azathioprine |
| what do you treat SEVERE UC with? | IV corticosteroids ---not effective---> cyclosporine or infliximab ---refractory---> surgery |
| What counts as mild to moderate disease for CD (VS, abd pain, wt, Hb) | VS no fever, no abd pain, <10% weight loss, Hb nl |
| What counts as moderate to severe disease for CD (VS, abd pain, wt, Hb) | VS fever, + abd pain (+n/v), >10% weight loss, Hb anemia |
| What counts as severe to fulminant disease for CD (VS, abd pain, wt, Hb)? | Despite oral steroids, VS high fever, + rebound tenderness (+n/v), >10% weight cachexia, Hb anemia. Also, obstruction or abscess. |
| How to treat fistula in CD? | infliximab, then metronidazole and 5-ASA for maintenance |
| How to treat mild to moderate CD? What if ileal or R colon disease? | 5-ASA. If ileal or R colon disease, then tx with budesonide |
| How to treat moderate to severe CD? | Prednisone for remission. Maintenance: 6-MP or azathioprine or MTX. If refractory then infliximab or adalimumab. |
| How to treat severe to fulminant CD? | IV corticosteroid for remission, infliximab or adalimumab if steroid-refractory, if doesn't get better with meds or if pt is toxic then colectomy |
| Can UC/CD patients take NSAIDs? | no |
| what is toxic megacolon defined as? | diameter > 6cm |
| How to treat toxic megacolon? What to do if it doesn't get better? | Tx first with steroid and abx. If not better in 24h or if pt gets hypotensive, then surgery. |
| Side effect of the sulfapyridine component of Sulfasalazine | reversible infertility and leukopenia |
| Tx of perianal abscess in CD | infliximab, then 5-ASA for maintenance |
| Tx of peritonitis in UC | infliximab, then 5-ASA for maintenance |
| If treating UC flare and don't want to use steroids in UC, what can you use? | 6-MCP and azathioprine |
| Do drugs cure UC? | No. reduces relapse only. |
| continuous mucosal inflammation | UC |
| smoking relieves symptoms | UC |
| microscopic (collagenous vs lymphocytic) colitis | chronic diarrhea, NO abd pain or weight loss; tx with supportive care or loperamide or bismuth salicylate |
| what study do you NOT want to do with UC | if moderate to severe UC, do NOT do barium enema because it may precipitate toxic megacolon |
| what should you rule out if you have a CD pt with cystitis | consider the possibility of enterovesical fistula |
| friable mucosa in distal colon | UC |
| first thing you need to r/o in IBD pt who presents with diarrhea | c.diff and other infectious diarrhea |
Created by:
christinapham
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