6: Pathology - IBD

Question 1

Although Crohn’s disease affects anywhere from the mouth to the anus, where is it most commonly seen?

Answer 1

Terminal ileum

Colon

Question 2

Which type of inflammation is seen in Crohn’s disease?

Answer 2

Transmural inflammation

Question 3

Who tends to be diagnosed with Crohn’s disease?

Answer 3

Younger people (10-40 years old)

Question 4

Crohn’s disease tends to ___ over time.

Answer 4

relapse

Question 5

___ mucosa is typical of Crohn’s disease.

Answer 5

Cobblestone

Question 6

Crohn’s disease is (continuous / segmental) with ___ lesions.

Answer 6

segmental , skip

Question 7

What are skip lesions?

Answer 7

Alternating areas of normal and inflamed tract

Question 8

What is a granuloma?

Answer 8

Collection of macrophages surrounding a foreign particle

Question 9

What aspect of the gut tissue is invaded/destroyed/inflamed in Crohn’s disease?

Answer 9

Crypts

Question 10

Crohn’s granulomas are (caseating / non-caseating).

Answer 10

non-caseating

they DON’T look like cheese

Question 11

What drugs are used to treat Crohn’s disease?

Answer 11

Steroids

Immunosuppressants

Question 12

If a Crohn’s disease patient doesn’t respond to treatment, what complication can occur?

Answer 12

Bowel obstruction

Question 13

What rare structures may be seen in the gut wall of a Crohn’s disease patient?

Answer 13

Pseudopolyps

Question 14

In Crohn’s disease, deep fissures form a ___ mucosa.

Answer 14

cobblestone

Question 15

Crohn’s disease inflammation is transmural. What does this mean?

Answer 15

Affects mucosa, lamina propria and submucosa

Question 16

What is a complication of Crohn’s disease?

Answer 16

Malabsorption

Short bowel syndrome due to resection

GALLSTONES

Fistulas

Perianal disease

Question 17

Which gene is involved in the development of Crohn’s disease?

Answer 17

NOD2

Question 18

Smoking (exacerbates / alleviates) the symptoms of Crohn’s.

Answer 18

exacerbates

Question 19

Which immune cells are responsible for Crohn’s disease?

Answer 19

T lymphocytes

Macrophages

too many pro-inflammatory cytokines

Question 20

What is ulcerative colitis?

Answer 20

Chronic inflammation of the rectum and colon only

Question 21

Does ulcerative colitis affect the whole thickness of the gut wall?

Answer 21

No - mucosa only

Question 22

Who tends to be diagnosed with ulcerative colitis?

Answer 22

Tends to be young, but not children

and the elderly as well

Question 23

Crohn’s disease and ulcerative colitis are more common in (males / females).

Answer 23

males

Question 24

Which part of the GI tract is nearly always involved in ulcerative colitis?

Answer 24

Rectum

Question 25

Which parts of the GI tract is ulcerative colitis constricted to?

Answer 25

**Rectum** **Colon**

Question 26

What is the main symptom of UC?

Answer 26

**Diarrhoea +/- blood and mucus**

Question 27

Like Crohn's disease, ulcerative colitis tends to come in \_\_\_.

Answer 27

waves

Question 28

Ulcerative colitis, untreated, causes colon swelling and perforation. What is this called?

Answer 28

**Toxic megacolon** quite uncommon now due to effectiveness of drugs - look out for characteristic features on AXR

Question 29

Ulcerative colitis is a (continuous / segmental) disease.

Answer 29

**continuous**

Question 30

What is the **only** example of a skip lesion seen in UC?

Answer 30

**Caecal patch** for some reason

Question 31

Under the microscope, the tissue of someone with UC will be infiltrated by ___ cells.

Answer 31

**inflammatory**

Question 32

What is it called when neutrophils infiltrate and destroy a gland?

Answer 32

**Cryptitis**

Question 33

When crypts are full and distended due to neutrophil accumulation, what is this called?

Answer 33

**Crypt abscess**

Question 34

If a patient with UC fails to respond to antibiotics, what procedure is performed?

Answer 34

**Colectomy**

Question 35

# May lead to anaemia, shock Ulcerative colitis causes a lot of \_\_\_.

Answer 35

**bleeding**

Question 36

Fat wrapping around the bowel wall is indicative of (Crohn's disease / ulcerative colitis).

Answer 36

**Crohn's disease**

Question 37

Are granulomas seen in UC?

Answer 37

**No**

Question 38

A complication of UC is toxic megacolon - massive swelling of the bowel. What can occur as a result of this? How is it treated?

Answer 38

**Perforation**, **peritonitis**, **sepsis**, **death** ## Footnote **Total colectomy**

Question 39

Ulcerative colitis is associated with the development of ___ \_\_\_. Why?

Answer 39

**colorectal cancer** **Chronic inflammation progresses to dysplasia and then carcinoma**

Question 40

Why type of cancer can develop following ulcerative colitis?

Answer 40

**Colorectal carcinoma**

Question 41

Which immune cells are vital to the development of UC?

Answer 41

**T cells** **Macrophages**

Question 42

Is smoking associated with UC?

Answer 42

**No** - Crohn's is though