Internal medicine notes

Apr 16th, 2015
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Inflammatory Bowel DiseaseDR ANN MULI.Introduction & epidemiology.Two major types of IBDCrohns disease Young jewish females Ulcerative colitisIncidence - 10 per 100,000 person Affects young white females.cont.,Age distribution-UC - peaks at 20-30yrs-Crohns - bimodal distribution withpeak at 10-30 yr & 50-70yrs.Etiology IdiopathicPossible combination of geneticpredisposition and environmentalexposures.Crohns Disease - affects mouth to anusand has transmural involvementUlcerative colitis - strictly affects the colonand has mucosal involvementCrohnsPatternIleocecal diseaseSmall bowel onlyColon only% at presentation40-5030-4020Crohns DiseaseSymptoms Right lower quadrant pain Long standing hx of mucoid diarrhea thatwaxes & wanes Hematochezia occurs in a minority of patients Low fever and weight loss also possible High fever and pain may be indicative of acomplication, e.g., perirectal abscess.CONT,Commonly found in distal ileum thereforemay mimic acute appendicitis.Trasmural ( entire wall thickness of thebowel) Inflammation occurs and may leadto stenosis & intestinal obstruction ormalabsorptionCrohns DiseaseSigns Abdominal Pain, especially Right LowerQuadrant(RLQ) Palpable mass in RLQ is possible Rectal exam may reveal a perirectal mass Abdominal distention Peritoneal signs in patients who haveintestinal fistula or rupture Aphthous ulcersCrohns D

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