Resident Report 2/24 -IBD

Teaching Pearls:

  • Inflammatory Bowel Disease consists of both Crohn’s disease and ulcerative colitis
  • Crohn’s Disease
    • Bowel Involvement
      • Patchy skipped lesions with transmural involvement
      • Any portion of the alimentary tract can be involved
    • Onset
      • Chronic (insidious) onset of symptoms
    • Complications
      • Fissures, fistulating disease, abscess, strictures
    • Extraintestinal Manifestations
      • Uveitis, arthritis, erythema nodosum, pyoderma gangrenosum
  • Ulcerative Colitis
    • Bowel Involvement
      • continuous pattern involving the rectum
      • Patients experience tenesmus as a result of rectal involvement
    • Onset
      • Subacute presentation (more acute than crohn’s diseas
    • Complications
      • Toxic megacolon
    • Extraintestinal Manifestations
      • Uveitis, arthritis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
      • Primary sclerosing cholangitis occurs in approximately 10-15% of patients with UC.
  • Work-up
    • Always rule out infectious etiologies. Patients with IBD flares tend to have higher incidence of infectious flares
    • Rule out CMV colitis
  • Treatment
    • Crohn’s Disease
      • 5-ASA medications have little role in treatment. May be used in mild CD flare
      • Steroids for flares
      • For fistulating disease, go straight to infliximab agents.
    • Ulcerative colitis
      • 5-ASA are good therapies for ulcerative colitis (enema, suppository, PO)
      • Steroids for flares

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