appendix and IBD

Question 1

What are causes of appendicitis?

Answer 1

in kids, you may see it with lymphoid hyperplasia (previous GI infection)
or, in adults, a fecolith

Question 2

signs of appendicitis

Answer 2

periumbilical pain, fever, and nausea. pain localized to RLQ.
rupture results in peritonitis that presents with guarding and rebound tenderness.

Question 3

What is a common complication of appendicitis

Answer 3

abscess (periappendiceal abscess)

Question 4

What is IBD? classic presentation

Answer 4

young woman with recurrent bloody diarrhea and abdominal pain. diagnosis of exclusion.
typically, pain improves with defecation, changes in stool frequency and stool appearance are seen.

Question 5

ulcerative colitis: wall involvement, location

Answer 5

mucosal and submucosal ulcers. located in the COLON. it starts in the rectum and works its way up the colon up to any level of the colon. doesn’t affect the rest of the GI tract, but will involve the whole radius of the tube.

Question 6

UC: symptoms and histologic hallmark and gross appearance.

Answer 6

LLQ pain and bloody diarrhea. crypt abscesses with neutrophils. mediated by Th2.
gross appearance: pseudopolyps (ulceration then healing). loss of haustra- lead pipe appearance on X ray.

Question 7

complications of UC; associations

Answer 7

toxic megacolon- massive dilation of the colon/rupture.

carcinoma: increased risk for carcinoma. risk based on extent of colonic involvement and duration of disease (takes about 10 yrs before you really worry about this). they undergo screening colonoscopy.
associations: primary sclerosing colangitis, P-ANCA positivity, (ankylosing spondylitis, apthous ulcers, uveitis)

Question 8

How does smoking related to UC and Crohn?

Answer 8

smoking protects against UC and increases crohn risk

Question 9

wall involvement and location in crohn disease

Answer 9

full thickness disease with knife-like fissures of inflammation through the entire thickness.
anywhere from the mouth to the anus but has skip lesions. terminal ileum is most common site; rectum is the least common.

Question 10

presentation of crohn, histo findings, gross findings

Answer 10

RLQ painwith non bloody diarrhea
lymphoid aggregates with granulomas; (linear ulcers)
cobblestone mucosa and creeping fat and strictures.

Question 11

complications of crohn disease

Answer 11

malabsorption with nutritional deficiency- you may damage the small bowel
calcium oxalate nephrolithiasis. too much inflammation increases oxalate absorption into the blood.
fistula formation
carcinoma if colonic disease is present.
strictures leading to obstruction
gallstones

Question 12

associations of crohn disease

Answer 12

ankylosing spondylitis, sacroiliitis, migratory polyarthritis, erythema nodosum, and uveitis.