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. Ulcerative Colitis (Blood Diarrhea distinguishes from Crohn's Disease)
      5. Ischemic Colitis (Older patients with sudden onset pain)
      6. Anorectal Disease
        1. Hemorrhoids
        2. Anal Fissures
    2. Diarrhea
      1. Infectious Diarrhea (Sudden onset and often painful)
      2. Pseudomembranous colitis (recent antibiotic use)
      3. Non-Infectious Osmotic Diarrhea
      4. Non-Infectious Secretory Diarrhea
      5. Ulcerative Colitis (bloody Diarrhea)
      6. Crohn's Disease
      7. Irritable Bowel Syndrome (diagnosis of exclusion)
      8. 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. Stool for Ova and Parasites
      3. Clostridium difficile Toxin and culture
      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 or Erythrocyte Sedimentation Rate
      1. Correlates with severity
    2. Serum Protein level
      1. Serum Albumin
      2. Serum Transferrin
      3. Serum 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

IBD5 gene (C1415836)

ConceptsGene or Genome (T028)
EnglishIBD5 gene, inflammatory bowel disease 5
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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