7. Colon and Anorectal Disorders

Inflammatory bowel disease (IBD) includes...

Ulcerative colitis and Crohn's disease

Ulcerative colitis

Chronic inflammation with diffuse mucosal and submucosal inflammation ONLY involving colon/rectum CONTINOUSLY extending proximally

Crohn's disease

Chronic inflammation with patchy transmural inflammation of any region MOUTH to ANUS

Demographic associated with onset of IBD (UC and Chohn's)

Age 15-35

Inflammatory bowel disease (IBD)

AI condition with relapsing/remitting inflammation of GI

Extraintestinal manifestations of IBD (MC)

Arthritis

Anklyosing spondylitis

Skin & ocular manifestations

Smoking & ulcerative collitis

DECREASED risk in ACTIVE smokers vs. non/former

What before age 20 decreases risk of UC?

Appendectomy due to acute apendicitis

Ulcerative proctitis

Disease limited to rectum

Ulcerative proctosigmviditis

Disease of rectum and sigmoid colon

Left-sided colitis

Extends beyond rectum proximally to splenic flexure

Pancolitis

Extends beyond splenic flexure to cecum

S/S of UC

LLQ pain, tenesmus, bloody/mucoid/pussy stool (+ extraintestinal)

Diagnostic workup & findings of acute UC

Flexible sigmoidoscopy — Edema, friability of mucosa, erosions

What diagnostic methodologies should be avoided in acute UC flares? Why?

Colonoscopy — Risk of perforation

Barium enema — Risk of toxic megacolon

Diagnostic workup & findings of UC (after acute flare)

Colonoscopy with biopsy — Determines extent of disease

Double-contrast barium enema — Lead pipe sign

Diagnostic workup to RULE OUT causes of colitis with diagnosis of UC

Stool culture, O&P, STD