7. Inflammatory Bowel Disease Flashcards
What is the general description of IBD?
Group of conditions characterised by idiopathic inflammation of the GI tract
What are the 2 common types of IBD?
Crohn’s disease
Ulcerative colitis
Where does Crohn’s disease affect?
Anywhere in GI tract
- terminal ileum involved in most cases
Transmural - can form strictures, fistulas
Skip lesions
Where does ulcerative colitis affect?
Begins in rectum
Can extend to involve entire colon
Continuous pattern
Mucosal inflammation
What are the extra-intestinal problems associated with IBD?
MSK pain - arthritis
Skin - erythema nodosum, psoriasis
Liver/biliary tree - primary sclerosing cholangitis
Eye problems
What are the causes of IBD?
Genetic - 1st degree relative risk
Gut organisms
Immune response - trigger (antibiotics, infections, smoking, diet)
Which IBD has a higher chance of having blood in stool?
UC, less in crohns
Which IBD can have mild perianal inflammation/ulceration?
Crohn’s disease
What is the pathological look of Crohn’s?
Cobblestone appearance Skip lesions Hyperaemia Mucosal oedema Discrete superficial ulcers Deeper ulcers Transmural inflammation - thickening of bowel wall, narrowing of lumen Fistulae
What is the microscopic appearance of Crohn’s disease?
Granuloma formation - organised collection of epithelioid macrophages
How do you investigate Crohn’s disease?
Bloods - anaemia
CT/MRI scans - bowel wall thickening, obstruction, extramural problems
Barium enema/follow through - used les, strictures/fistulaes
Colonoscopy - skip lesions, cobblestone appearance, fistulaes/strictures
How can UC cause weight loss?
Reduced appetite
Inflammation process uses lots of calories
What are the pathological changes in UC?
Chronic inflammatory infiltrate of lamina propria
Crypt abscesses (neutrophilic exudate in crypts)
Crypt distortion - irregular shapes glands with dysplasia, darker crowded nuclei
Reduced numbers of goblet cells
Pseudopolyps
Loss of haustra
What are the investigations for UC?
Bloods - anaemia, serum markers of inflammation
Stool cultures - C. difficile, faecal calprotectin
Colonoscopy
Plain abdominal radiographs
Barium enema (mild cases)
CT/MRI
What are the radiological features in UC?
Double contrast enema - contrast and air
Featureless descending and sigmoid colon - lacking haustral markings
Continuous lesions without skipping
Mucosal inflammation - granular appearance
Whole colon
