7. Inflammatory bowel disease

Question 1

What are the main types of IBD

Answer 1

Ulcerative colitis

Crohn’s disease

Question 2

Describe the features of ulcerative colitis

Answer 2

Female > male
Non-smokers
Characterised by inflammatory change in colon
Rectum - variable length of colon
Continguous, circumferential, superficial inflammation
Entire colon - PANcolitis

Question 3

What are some signs of ulcerative colitis

Answer 3

Anaemia - iron deficency
Raised inflammtory markers
Dehydration

Question 4

Describe the histological features of ulcerative colitis

Answer 4

Inflamed mucosal layer
Crypt abscess
Broad based ulcer eroding into superficial submucosa
Remainder of wall spared from inflammation

Question 5

Describe the consequences of ulcerative colitis

Answer 5

Chronic inflammatory change damages cells
This leads to dysplasia - loss of growth control within cells
Increased risk of colonic carcinoma

Question 6

Describe the features of Crohn’s disease

Answer 6

Female > Male
Smokers
Characterised by inflammatory change anywhere in GI tract:
Small intestine alone 40%
Small intestine and colon 30%
Colon alone  30£
Discreety focal ulceration
Skip lesions
Terminal ileitis

Question 7

Describe signs of crohn’s disease

Answer 7

Anaemia - absorption/blood loss
Raised inflammatory markers
Dehydration

Question 8

Compare the symptoms/signs of ulcerative colitis and crohn’s

Answer 8

UC: 
Abdominal pain
Diarrhoea is mucoid and bloddy
Weight loss
Lethargy
Fever
Dehydration
Tenesmus

Crohns"
Abdominal pain after eating
Diahhorea is watery
Weight loss
Lethargy
Fever
Dehydration
Tenesmus if affecting rectum

Question 9

Compare the pathology of UC and crohn’s

Answer 9

UC: 
Involvement is colon only
Extent is rectum to colon
Continous
Mucosa involced
Broad based ulcers
No mesentary involement
No fistulae

Crohn's:
Mouth to anus involvement
Extent is terminal ileum +/-
Skip lesions
Transmural
Linear ulcers
Mesentary thickened/fibrotic
Fistulae

Question 10

Compare the histopathology of UC and crohn’s

Answer 10

UC: 
Crypts are shortened/atrophic
Crypt abscesses
No villi involvment (none in colon)
No granulomas
Cells involved are plasma/neutrophils

Crohn's:
Crupts are shortened/atrophic
Crypt abscesses +/-
Villi are strophic
Granulomas present
Cells involved are neutrophils/lymphocytes