Inflammatory bowel disease: Difference between revisions

Latest revision as of 15:22, 19 February 2022

	Ulcerative colitis	Crohn disease
Location	Pancolitis (30%) Proctosigmoiditis (50%) Includes PSC (5%)	Terminal ileum (80%) Ileocolonic (50%) Isolated ileal (30%) Isolated colonic (20%)
Distribution	Continuous from rectum	Skip lesions, often rectum-sparing
Histology	Mucosal inflammation without granulomas	Transmural inflammation, granulomas, cobblestone
Serology	p-ANCA	Anti-Saccharomyces cervisiae IgG
Complications	Toxic megacolon Colorectal cancer	Intraabdominal abscess, perforation, fistulae, strictures, perianal disease, obstruction, colorectal cancer

Extraintestinal Manifestations

MSK
- Seronegative spondyloarthritis
- Osteopenia
Dermatologic
- Erythema nodosum
- Pyoderma gangrenosum
Opthalmologic
- Episcleritis
- Uveitis
Clubbing
Renal
- Kidney stones
Hepatobiliary
- Gallstones
- Primary sclerosing cholangitis
Hematologic
Aphthous ulcers

Arthritis

Type 1: Pauciarticular

<5 joints
Large joints
Short duration
Correlates with disease activity

Type 2: Polyarticular

>5 joints
Small joints
Months to years
Independent of disease activity

Differential Diagnosis

Infectious mimics (see below)
Radiation colitis
Diversion colitis
Solitary rectal ulcer syndrome
Graft versus host disease
Diverticular colitis
Medication-induced colitis, including NSAIDs, retinoic acid, checkpoint inhibitors, mycophenolate, and gold
CVID

Colitis or Ileitis

Bacterial: Shigella, enterohemorrhagic Escherichia coli, enteroinvasive Escherichia coli, Campylobacter jejuni, Salmonella, Yersinia enterocolitica, Mycobacterium tuberculosis, Clostridioides difficile, Vibrio parahaemolyticus, Chlamydia trachomatis (lymphogranuloma venereum)
Parasitic: Entamoeba histolytica, Schistosoma, Balantidium coli, Trichinella spiralis
Viruses: cytomegalovirus

Proctitis

@@ Line 1: / Line 1: @@
+{| class="wikitable"
-* [[Ulcerative colitis]]
-* [[Crohn disease]]
-{|
 !
-! Ulcerative colitis
+![[Ulcerative colitis]]
-! Crohn disease
+![[Crohn disease]]
 |-
-| Location
+|Location
-| Pancolitis (30%)<br/>Proctosigmoiditis (50%)<br/>Includes PSC (5%)
+|[[Pancolitis]] (30%)<br />[[Proctosigmoiditis]] (50%)<br />Includes [[PSC]] (5%)
-| Terminal ileum (80%)<br/>Ileocolonic (50%)<br/>Isolated ildeal (30%)<br/>Isolated colonic (20%)
+|Terminal ileum (80%)<br />Ileocolonic (50%)<br />Isolated ileal (30%)<br />Isolated colonic (20%)
 |-
-| Distribution
+|Distribution
-| Continuous from rectum
+|Continuous from rectum
-| Skip lesions, often rectum-sparing
+|Skip lesions, often rectum-sparing
 |-
-| Histology
+|Histology
-| Mucosal inflammation without granulomas
+|Mucosal inflammation without granulomas
-| Transmural inflammation, granulomas, cobblestone
+|Transmural inflammation, granulomas, cobblestone
 |-
-| Serology
+|Serology
-| p-ANCA
+|p-ANCA
-| Anti-Saccharomyces cervisiae IgG
+|Anti-Saccharomyces cervisiae IgG
 |-
-| Complications
+|Complications
-| Toxic megacolon<br/>Colorectal cancer
+|[[Toxic megacolon]]<br />[[Colorectal cancer]]
-| Abscesses, perforation, fistulae, strictures, perianal disease, obstruction, colorectal cancer
+|[[Intra-abdominal infections|Intraabdominal abscess]], perforation, fistulae, strictures, perianal disease, obstruction, [[colorectal cancer]]
 |}
-== Extraintestinal Manifestations ==
+==Extraintestinal Manifestations==
+*MSK
+**[[Seronegative spondyloarthritis]]
+**[[Osteopenia]]
+*Dermatologic
+**[[Erythema nodosum]]
+**[[Pyoderma gangrenosum]]
+*Opthalmologic
+**[[Episcleritis]]
+**[[Uveitis]]
+*[[Clubbing]]
+*Renal
+**[[Kidney stone|Kidney stones]]
+*Hepatobiliary
+**[[Gallstone|Gallstones]]
+**[[Primary sclerosing cholangitis]]
+*Hematologic
+**[[DVT]]
+**[[Amyloidosis]]
+**[[Anemia]] ([[Iron-deficiency anemia|iron-deficiency]], [[Anemia of chronic inflammation|chronic inflammatory]], [[Vitamin B12 deficiency|B12 deficiency]])
+*[[Aphthous ulcer|Aphthous ulcers]]
+===Arthritis===
+====Type 1: Pauciarticular====
+*&lt;5 joints
+*Large joints
+*Short duration
+*Correlates with disease activity
+====Type 2: Polyarticular====
+*&gt;5 joints
+*Small joints
+*Months to years
+*Independent of disease activity
+== Differential Diagnosis ==
-* MSK
-** Seronegative spondyloarthritis
-** Osteopenia
-* Dermatologic
-** Erythema nodosum
-** Pyoderma gangrenosum
-* Opthalmologic
-** Episcleritis
-** Uveitis
-* Clubbing
-* Renal
-** Kidney stones
-* Hepatobiliary
-** Gallstones
-** Primary sclerosing cholangitis
-* Hematologic
-** DVT
-** Amyloidosis
-** Anemia (iron-deficiency, chronic inflammatory, B12 deficiency)
-* Aphthous ulcers
+* Infectious mimics (see below)
-=== Arthritis ===
+* Radiation colitis
+* Diversion colitis
+* Solitary rectal ulcer syndrome
+* Graft versus host disease
+* Diverticular colitis
+* Medication-induced colitis, including [[NSAIDs]], retinoic acid, checkpoint inhibitors, [[mycophenolate]], and [[gold]]
+* [[CVID]]
-==== Type 1: Pauciarticular ====
+=== Colitis or Ileitis ===
+* Bacterial: [[Shigella]], enterohemorrhagic [[Escherichia coli]], enteroinvasive [[Escherichia coli]], [[Campylobacter jejuni]], [[Salmonella]], [[Yersinia enterocolitica]], [[Mycobacterium tuberculosis]], [[Clostridioides difficile]], [[Vibrio parahaemolyticus]], [[Chlamydia trachomatis]] ([[lymphogranuloma venereum]])
-* &lt;5 joints
+* Parasitic: [[Entamoeba histolytica]], [[Schistosoma]], [[Balantidium coli]], [[Trichinella spiralis]]
-* Large joints
+* Viruses: [[cytomegalovirus]]
-* Short duration
-* Correlates with disease activity
-==== Type 2: Polyarticular ====
+=== Proctitis ===
+* [[Neisseria gonorrhoeae]]
-* &gt;5 joints
+* [[Herpes simplex virus]]
-* Small joints
+* [[Chlamydia trachomatis]]
-* Months to years
+* [[Treponema pallidum]]
-* Independent of disease activity
+* [[Cytomegalovirus]]
 [[Category:Gastroenterology]]