GI Packet 6

What is the definition of ulcerative colitis?

Disease of the colon (colitis) that includes inflammation and ulceration involving the rectum and moving proximally (closer to trunk - makes it as far as the distal ileum (not usual) and does not extend into the small intestine)

Where can the inflammation be in ulcerative colitis?

Rectum to distal ileum

What are the causes of IBDs?

No definite cause

Can be

Overactive immune system

Genetics

Environment (what we eat, lifestyle, toxins, etc.)

May be birth control, high fat diet, chronic use of NSAIDs, chronic use of antibiotics, and the disease could be infectious

What are the symptoms of ulcerative colitis?

Diarrhea with blood or pus

Abdominal pain

Rectal urgency

Weight loss

May have fever

How do we diagnose ulcerative colitis?

History (especially including family)

Medical history

Physical exam

Endoscopic and/or colonoscopic exam with biopsy

Lab work to evaluate anemia, infection, and inflammation

What is the treatment for mild ulcerative colitis and Crohn’s disease?

Over-the-counter antidiarrheal (Imodium)

Steroids (Prednisone but can lead to bone loss with chronic use)

Aminosalicylates (Such as Azulfidine - can be used with steroids and used to treat flare-ups)

Immunomodulators (methotrexate)

Azathioprine (interferes with DNA synthesis in immune system)

Biologics (TNF-inhibitors which neutralize TNF (tumor necrosis factor) and reduce inflammation)

Fecal transfer

What is the treatment for severe ulcerative colitis?

Surgical excision (Colectomy) (May be necessary if meds fail; colostomy may be necessary with excision)

What are some complication of ulcerative colitis?

Colon cancer (usually greater than 10 years with the disease)

Toxic megacolon (spreads to all sides of the colon wall; expanding and leading it to stop working and possible perforation with result of sepsis; paralysis of colon wall)

What is Crohn’s disease?

Chronic inflammatory condition which occurs most commonly in distal ileum or it can be colon, esophagus, or stomach

What groups of people most often get IBDs?

20-30 and 50-70 (Ulcerative colitis)

15-30 and 50-70 (Crohn’s disease)

Caucasians and specific Jews

How do symptoms work for IBDs?

Symptoms fluctuate between active or unactive episodes

True or false; Ulcerative colitis and Crohn’s disease have the same possible causes?

True

What are the symptoms of Crohn’s disease?

Diarrhea

Crampy pain

Weight loss

Sometimes bleeding

Maybe fever

How does Crohn’s differ from ulcerative colitis?

Location and pattern of inflammation

UC is superficial layers of bowel; appearing to be diffuse (spread out over a large area) and uniform

CD can be deep and superficial; and is not continual nor uniform

What are the complication of Crohn’s disease?

Colon cancer is still there but less high of a chance than ulcerative colitis

Fistulas (connection when there shouldn’t be one leading to an opening between them)

Strictures (tightening in the wall itself, narrowing the passage)

Abcesses

How do we diagnose Crohn’s disease?

History

Physical exam

Colonoscopy (probably endoscopy as well) with a possible biopsy

ASCA-antibody test (frequently found in Crohn’s disease and when biopsy doesn’t show good results)

CBC (for infection and anemia)

True or False; The treatment for mild ulcerative colitis is the same as Crohn’s disease (not including fecal transfer)?

True

What is one new treatment that can be done to treat ulcerative colitis?

Fecal transfer (transfer of healthy feces to restore microbes; can be done in capsules, IV, into intestines)

What are some symptoms of a fecal transfer?

Mild cramping and bloating