December Week 1: Inflammatory Bowel Disease

Article:

Peds In Review: Inflammatory Bowel Disease, Glick et al. 2011

Questions/Cases:

1. What are the two main types of inflammatory bowel disease?
2. What are the risk factors associated with IBD?
3. What are the major pathogenic mechanisms underlying IBD.
Can you name a couple of genes involved with the process?
4. What would be your differential diagnosis for IBD (or a child presenting with abdominal pain and bloody diarrhea)?

Case 1

A 17-year-old girl comes to the clinic because she noticed bright red blood per rectum and she has been having loose stools for about 2 weeks. She associates the rectal bleeding with 5-6 loose stools per day and lower abdominal discomfort. She has been afebrile; she has no history of recent antibiotic use or travelling. CBC shows anemia and ESR is elevated.

5. What is the most likely diagnosis?
6. What other symptoms can be associated with the diagnosis?
What are the most common extraintestinal manifestations?
7. What diagnostic tests would you order to confirm the diagnosis?
What would the imaging studies show?
What would the gold standard endoscopy reveal?
What would the pathology report say?
8. What are the most common complications?

Case 2

A 10-year-old boy presents to the GI clinic with 3-month history of non-bloody diarrhea, cramping abdominal pain malaise, and temperatures up to 380C. Examination of the abdomen reveals a palpable mass in the right lower quadrant, palpation causes local tenderness without guarding. He also has oral aphthous lesions. Laboratory studies show anemia, elevated ESR and WBC, and hypoalbuminemia.

9. What is the most likely diagnosis?
10. What other symptoms can be associated with the diagnosis?
What are the most common extraintestinal manifestations?
11. What diagnostic tests would you order to confirm the diagnosis?
What would the imaging studies show?
What would the gold standard endoscopy reveal?
What would the pathology report say?
12. What are the most common complications?
 

13. How would you treat these kids?
Based on the severity of the IBD, what other medical or surgical treatment can be considered?
14. What would you tell parents about the prognosis of IBD?

Case/Questions written by Dr. Luca Szalontay