Gastroenterology Book

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Inflammatory Bowel Disease

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  1. Differential Diagnosis
    1. Lower GI Bleeding
      1. Diverticulitis (most common cause)
      2. Angiodysplasia (Arteriovenous malformation)
      3. Neoplasm
      4. Inflammatory Bowel Disease
      5. Ischemic Colitis
      6. Anorectal Disease
        1. Hemorrhoids
        2. Anal Fissures
    2. Diarrhea
      1. Infectious Diarrhea
      2. Pseudomembranous colitis
      3. Non-Infectious Osmotic Diarrhea
      4. Non-Infectious Secretory Diarrhea
      5. Inflammatory Bowel Disease
      6. Fecal Impaction
  2. History
    1. Travel
    2. Contaminated intake
      1. Foodborne Illness
      2. Waterborne Illness
    3. Immunodeficiency risk
    4. High risk sexual behavior
    5. Family History of Gastrointestinal disease
    6. Medications in the last 6 months (e.g. antibiotics)
  3. Symptoms
    1. Pain
      1. Ulcerative Colitis
        1. Lower abdominal cramps
        2. Relieved with Bowel Movement
      2. Crohn's Disease
        1. Constant pain often in right lower quadrant
        2. Not relieved with Bowel Movement
    2. Stool Blood
      1. Grossly bloody stool in Ulcerative Colitis
  4. Signs
    1. Abdominal Mass
      1. Ulcerative Colitis: No abdominal mass
      2. Crohn's Disease: Mass often at Right lower quadrant
    2. Gastrointestinal Tract Affected
      1. Ulcerative Colitis
        1. Affects only colon
        2. Continuous from rectum
      2. Crohn's Disease
        1. Mouth to anus potentially affected
        2. Discontinuous, "Skip" lesions
    3. Bowel Tissue affected
      1. Ulcerative Colitis: Mucosal disease (no granuloma)
      2. Crohn's Disease: Transmural disease (granulomas)
  5. Labs: Stool Studies
    1. General Stool studies
      1. Stool Culture
      2. Ova and Parasites
      3. Clostridium difficile Toxin
      4. Fecal Leukocytes
    2. Additional Stool studies
      1. Yersinia enterocolitica culture
      2. Toxigenic Escherichia coli isolation
      3. Entamoeba histolytica serologic titers
  6. Labs: Immunocompromised Patient Evaluation
    1. Chlamydia trachomatis
    2. Cryptosporidium
    3. Neisseria gonorrhoeae
    4. Herpes Simplex Virus (HSV)
    5. Cytomegalovirus (CMV)
    6. Isospora belli
    7. Mycobacterium tuberculosis
  7. Labs: Underlying Nutrition and Disease Severity
    1. C-Reactive Protein
      1. Correlates with severity
    2. Serum Protein level
      1. Albumin
      2. Transferrin
      3. Prealbumin
    3. Hemoglobin
  8. Diagnosis
    1. Endoscopy with mucosal biopsy
  9. Radiology
    1. Barium Enema
    2. Abdominal XRay
      1. Perforation signs (i.e. Free air in peritoneum)
      2. Toxic Megacolon
      3. Thumbprinting
  10. Resources
    1. Crohn's and Colitis Foundation of America
      1. http://www.ccfa.org
    2. Cedars-Sinai Inflammatory Bowel Disease Center
      1. http://www.csmc.edu/ibd

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