IBD patient with bloody diarrhea and new diagnosis of PSC
Dr. Garrett Lawlor | Morning Report | 06/07/2016
Early onset and colitis are poor prognostic features. Gender; women have better prognosis than men'
Typically rectal sparing indicates Crohn's. However, is patient had previously used rectal enemas of mesalamine etc, this can change appearance of rectum.
Posted 06/07/16 09:08:47 AM by Adam Faye
When examining a patient with IBD always ask about extraintestinal manifestations:
Also always ask if the current symptoms are typical of their usual flare.
Posted 06/07/16 09:10:50 AM by Adam Faye
RIsk of disease in children of patients with IBD:
Crohn's - child with 9% risk of disease
UC - child with 6% risk of disease
Posted 06/07/16 09:14:07 AM by Adam Faye
Disease tends to progress proximally in terms of location. Thus if disease begins in rectum, many years later may involve much of the colon whereas with Crohn's typically disease is localized to specific areas (terminal ileum etc.)
Majority of patients with PSC have underlying UC. Conversely only ~5% of patients with UC have PSC.
mild-moderate disease usually therapy begins with 5-ASA
Posted 06/07/16 09:26:14 AM by Adam Faye
Steroids are usually used for induction of remission. Better prognosis if resolution of symptoms within 72hrs. of starting therapy
For manitenance therapy with TNF-inhibitors can decide between IV formulation and self-injection. IV formulation will begin working right away as opposed to self-injections, but self-injections allow patients to do deliver the medication themselves at home.
Can trend CRP as a prognostic indicator. Rapid reduction in CRP portends good prognosis.
Always consider infections including CMV:
CMV PCR in blood/stool has varied sensitivity/specificity. If high suspicion can get Bx with H&E stain which would show enlarged cells usually with eosinophilic intranuclear inclusions. Can also use immunoperoxidase staining
Posted 06/07/16 09:37:06 AM by Adam Faye
Smooth Muscle Ab- Associated with Autoimmune hepatitis peri-nuclear ANCA - Associated with PSC Anti-mitochondrial Ab - Associated with PBC
Posted 06/07/16 09:42:44 AM by Adam Faye
Consider PSC in IBD patients with elevated Alk Phos.
MRCP typically shows multifocal stricturing and dilation of intra/extrahepatic bile ducts on cholangiography (beads on a string)
Median survival after diagnosis without liver transplantation is ~10-12 years