IBD Risk Factors:

- First-degree relative
- Caucasian
- 15-40 y/o
- Smoker (Crohn’s)
- Non-smoker (ulcerative colitis)
- Altered immune response
- Altered response to gut microorganism
Crohn’s (Regional Enteritis) Ulcerative Colitis
Features: Features:
- Affects all layers (transmural lesion) - Affects mucosa and submucosa only
- Usually affects distal ileum and - Starts at rectum and progresses proximally
ascending colon through the colon
- Skipping lesions observed - Pain (LLQ)
- Cobblestone appearance in endoscopy - Tenesmus (due to stomatic
- Pain (RLQ, after meals) hyperstimulation)
- Toxic megacolon (muscularis not
contracting and keeps bowel distended)
Diagnostics: Diagnostics:
- CT scan shows bowel wall thickening - Colonoscopy shows exudates and
- MRI may show abscesses and fistulas ulceration (definitive)
- CBC (low Hgb/Hct, high WBC) - Biopsy (extent of disease)
- Protein/albumin (low due to - CT, MRI (perirectal involvement)
malnutrition) - Fecalysis (+) for blood
Management:
1. Pharmacologic
- Aminosalicylates (sulfasalazine): anti-inflammatory, for induction and remission maintenance.
Oral, rectal, enema. More effective in ulcerative colitis
- Antibiotics (metronidazole, ciprofloxacin): for abscess and fistulas. Oral
- Corticosteroids: prednisone (oral), hydrocortisone (parenteral), budesonide (rectal, topical)
- Immunomodulators (azathioprine, methotrexate, mercaptopurine): alter pathologic immune
response. Takes 2 months to show effects (maintenance). Depresses bone marrow,
hepatotoxic, risk for infection (vaccinated by PCV)
- Antitumor necrosis factor: last resort (infliximab, adalimumab) (more on Crohn’s) golimumab
for UC. Administered SQ

2. Nutritional Therapy
- Supplemental calcium and Vit D (for bone marrow depression)
- IV therapy, oral fluids (diarrhea)
- Probiotics (lactobacillus) (more on UC)
- Enteral feedings

3. Surgery
- Due to bowel obstruction, fistula, or abscess
- Laparoscope strictureplasty (widening)
- Small bowel resection and anastomosis: up to 80% removed
- Proctocolectomy w/ ileostomy: for UC
Peptic Ulcer Disease Erosion of the stomach, duodenum, or esophagus
Diagnostics Upper endoscopy (shows ulcers and lesions)
Biopsy (detects H. pylori)
Urea breath test (detects H. pylori)
FOBT
CBC
Management Pharmacologic
1. Antibiotics: metronidazole, amoxicillin, clarithromycin
2. PPI: omeprazole, pantoprazole, lansoprazole
3. H2-blockers: cimetidine, ranitidine

Lifestyle
1. Smoking cessation
2. Alcohol cessation
3. Limit acidic beverages (caffeine)
4. Regular meals

Surgery: for intractable ulcers

1. Vagotomy w/ or w/o pyloroplasty, antrectomy (then
anastomosis via gastroduodenostomy or
gastrojejunostomy): may be done via open laparoscopy or
open abdominal approach
Functions of the Digestive system 1. Ingestion
2. Digestion
3. Absorption
4. Elimination
Saliva function and secretion 1. Salivary amylase
2. Lysozyme
3. Mucin
4. pH alkalinity

*stimulated by PNS
Soluble vs insoluble fiber Soluble: binds fats and cholesterol

Insoluble: provides bulk

DIAGNOSTICS
Common pathogen in fecalysis Clostridium difficile
Most common stool test Guaiac-based FOBT
- no red meat, aspirin, Vit C for 72 hrs prior
How often is FIT-fecal DNA
performed?
What does hydrogen breath test
measure
What does urea breath test
indicate
Abdominal UTZ preparation
Bowel cleansing agents
Hirschsprung Disease
Von Gierke Disease
Pompe Disease
Zellweger Disease
Fabry Disease
Celiac Disease
Barett esophagus
Every 3 years
Hydrogen expelled via fermentation
Screening for H. pylori
- no antibiotics for 1 month
- no PPI for 2 weeks
- no H2-bloockers for 24 hrs
- NPO 8-12 hrs prior
- Fat-free meal on the night before
- Barium studies performed after not before
1. Polyethylene glycol
2. Sodium phosphate
3. Magnesium citrate
Stricture due to metaplasia of esophageal lining
Symptoms similar to PUD
Managed with ablation therapy