ibd

ibd

chronic inflammation of the digestive tract causing recurrent disease, crohns disease and ulcerative colititis

crohns disease

patchy transmural inflammation involving any segment of the gi tract from mouth to anus, ileocecal region most common

ulcerative colitits

colonic inflammation which extends proximally from the anal verge in a continuous pattern, crypt abscesses and goiblet cell mucin depletion commonly seen on pathology

ibd patho

genetics, microbial - tb, pseudomonas, listeria, covid, tobacco, processed food, fatty foods, depression, anexity, ocps, nsaids

crohns clinical presentation

low grade fever, abdominal pain, diarrhea, wieght loss, fatigue, mucous, blood or pus in stool, fecal urgency, n/v, anorexia, symtpoms vary depending on location

crohns on colonoscopy

diffuse colititis, transmural inflamamtion with granulomas typically seen on pathology, skipped lesions, aread of erythema and ulceration surrounded by normal tissue

crohns complications

arthritis, erythema nodosum, pyoderma gangrenosum, uveitis, gallstones, fatty liver, psc, aphthous ulcers, fistulas, abscess, bowel obstruction, nutritional decifincies, osteoporosis/osteopenia, colon cancer, small bowel cancer, naal cancer

pyoderma gangrenosum

small, red papule or pustule changing into larger, ulcerative lesion

erythema nodosum

acute, nodular erythematous eruption that usually is limited to extensor aspects of the lower legs

uveititis

inflammation of the middle pigmented layer of the eye

fistulas

chronic inflammation causes a tunnel to form between affected portion of gi tract and surrounding area, perianal is most common

nutritional deficiencies

ileal disease or patients with ileal resection are at risk for fat malabsorption, which can lead to deficiences of fat soluble vitamins, a, d, d, k, and b12

osteopenia/osteoporosis

mild osteopenia in 50%, osteoporosis in 15%, more common with vitamin d deficiency and those who have been on prolonged courses of steroids

colon cancer

increased risk in patients with crohns, suveillance colonscopies every 1-2 years

small bowel cancer

extremly rare, usually with lonf standing small bowel disease

anal cancer

rare, usually with long standing perianal disease

mild uc

moderate uc

4 stools daily, minimal systemic toxicity

severe uc

6 bloody stools per day, signs of systemic toxicitiy - over, tachycardia, anemia

fulminant uc

10 10 stools per day with continuous rectal bleeding, signs of systemic toxicity, may require blood transfusion

proctitis

inflmmaiton of he rectal muscosa, least severe form of the disease

left sided colitis

inflammation that extends from the rectum to sigmoid or descending colon

extensive colitis

inflamamtion that extends to the transverse colon or proximal ascending colon

pancolitis

inflammation involving the enetire colon

uc complications

same as crohns, toxic megacolon, anklylosing spondylititis

toxic megacolon

acute toxic clitis with dialtion of the colon, colonic dilation on xray, evidence of systmic toxicitiy,

ibd goals of tx

induce and maintain clinical remission, enhance qol, avoid long term toxicitiy

ibd tx

5asa agents first line, corticosteroids, abx, immunomodulators, biologics

crohns surgery

resection not curative, only used to treat complications and refractory symptoms

uc surgery

total colectomy is curative, but last resort

uc indications for emergent surgery

toxic megacolon, fulminant flare up, intractable hemorrhage, perforation

uc indications for elective surgery

long term steorid dependence, dysplasia or adenocarcinoma of the colon found on colonoscopy

conventional ileostomy

colon and rectum removed with the end of the ileum brought through abdominal wall

continent ileostomy

colon and rectum is remeoved and an internal pouch formed using the end of ileum

ileoanal anastamosis

colon and rectum is removed and the end of ileum is used tp create a pouch which attaches the anus

crohns prognosis

chronic disease that can cause intermittent flare up of symptoms, appropriate medical management results in good overall prognosis and low risk of disease related mortality, proximal small bowel crogn has a higher mortaltiy rate than ileal/colonic disease

ulcerative colitis prognosis

chronic disease that can cause intermittent flare up of of symptoms, appropriate medical management resuts in good overall orognosis and low risk of disease related mortality, higher mortality in elederly and toxic megacolon, most common cause of death is adenocarcinoma