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Gastroenterology III

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Inflammatory Bowel Disease
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Terms in this set (75)
-refers to idiopathic bowel disorders, Crohn's dz., ulcerative colitis, celiac
-400,000+ people affected

-more frequently in Jewish people, whites, pt. in higher socioeconomic group, Type A- can't relax, never satisfied, feel inadequate, compulsive about everything

-increased intestinal permeability and an imbalanced microflora may trigger IBD. Healthy gut flora can block translocation of gut pathogens and decrease overactive immune response (J Endotox Res 2000;6(3): 205-212) (specific CHO diet) helps many of these patients - grain restricted/ CHO restricted diet

-antibodies are present to colon epithelium

-psychological stress exacerbates the conditions- always < under stress
-characterized by acute & chronic inflammation
extending through all layers of the intestinal wall and involving mesentery as well as regional lymph nodes.

-early mucosal involvement consists of longitudinal and transverse APHTHOUS ULCERs, which are responsible for COBBLESTONE appearance. As the disease progress, deep FISSURES, SINUSES and FISTULAs develop.

-Can occur anywhere in the GI tract, but is DISCONTINUOUS along the GI tract. (normal tissue -> SKIP LESIONs -> normal tissue)

-Can often first be seen in the mouth in the form of mouth apthous ulcers. These people get apthous ulcers often and they take longer to heal. (whereas in food sensitivities they may get them occasionally or just when eating large amts. Of that food & they heal quicker).

-Age: Bimodeal peak age of onset/diagnosis (15-25 and 55-65)
-largely unknown
-genetic, infectious, immunologic and psychological factors have all been implicated in influencing the development of the disease.

Risk factors
-family history
* associated with HLA-DR1 and DQw5 genes
-use of oral contraceptives
* 2:1 for women who use them
* 2-4X in Jewish population, followed by Caucasians, followed by those in African Americans and Asians
-Age: bimodal distribution.
* One early peak ages 15-25 years, another smaller peak ages 55-65 years.
* in patients <20 years, 88% involve SI, as compared with 58% in those > 40 years.
-usu. primarily the small intestine, esp. the terminal ileum and then the colon and Crohn's colitis (Crohn's disease & ulcerative colitis) is common, but may occur in any part of the GI from mouth to anus
-involves the ileum alone in 35% (ileitis)
-ileum and colon, esp. R side, in 45% (ileocolitis)
-colon alone in 20% (granulomatous colitis)
-entire small bowel occ (jejunoileitis);
-rarely may also affect stomach, duodenum, esophagus

-inflammation involves all layers of intestinal wall, which becomes thickened patchy distribution with areas of normal bowel (skip areas) (normal tissue and
inflam. tissue)
*often patients have sxs for months to years before going to doc to get it diagnosed.

-hx of fatigue, wt. loss, abd. pain, often steady and localized in RLQ

-occult blood loss common (melena), blood in stool if colonic involvement (hematochezia)

-stools usu. formed, mb loose if extensive colonic involvement or terminal ileum (because of bile salt malabsorption)
*If it's more in the colon, they're more likely to have chronic diarrhea. If it's in the SI, they're less likely to have diarrhea

-fat malabsorption increases risk of gallstones, renal oxalate stones