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