Appendix inflammatory bowel disease Flashcards
What causes appendicitis in children and adults?
@Kids = GI infection – >
LYMPHOID HYPERPLASIA =obstruct appendix
@Adults fecalith
What is the most common cause of acute abdomen
Appendicitis = acute inflammation of appendix
When the appendix ruptures What’s do you get?
Explain the five Clinical features
Peritonitis
- pain increase = guarding
- rebound tenderness
- Rovsing sign positive
- obturator sign positive
- Psoas positive
Causes of inflammatory bowel disease
Idiopathic
Possibly due to abnormal immune response to enteric flora
A young woman presents with a recurrent bouts of bloody diarrhoea abdominal pain and happens to be a Jewish Caucasian. What's the DDX
Inflammatory bowel disease
What must you do before reaching a diagnosis of inflammatory bowel disease
Exclude other diseases e.g. ischaemia
What eighth things can we look at to compare ulcerative colitis and Crohn’s disease?
Complications,
GRoss appearance, Location, Symptoms,
Wall involvement, Associations, Smoking, Histology
C GrLS WASH
See girls wash!!!!
In ulcerative colitis How are the walls involved
Mucosal + submucosal ulcers
In ulcerative colitis What location Is involved
Restricted to colon. Small intestine not involved
Rectum – > up colon – >
extend anywhere up to cecum only
Involves entire radius of tube + CONTINUOUS
Symptoms of ulcerative colitis
Left lower quadrant pain + bloody diarrhoea
Histology of the ulcerative colitis
Crypt abscess with neutrophils inside crypts
T-helper 2 cells
Gross appearance of the ulcerative colitis
Free hanging mesentery + Friable Pseudopolyps – numerous bumps at colon surface in response to healing of ulceration
Loss of haustra –> LEAD PIPE @imaging
What are the complications of ulcerative colitis
Toxic mega: – >increased risk of rupture
Increased extent of colonic involvement
+
Increased duration e.g. 10 years
– >
Increased p(cancer) - worse with right sided colitis/pancolitis
What are the associations of ulcerative colitis
Primary sclerosing cholangitis
p-ANCA
What is the relationship between smoking and ulcerative colitis
Protects against ulcerative colitis
Explain The wall involvement in Crohn’s disease
TRANSMURAL inflammation =
Large fissures of inflammation
through FULL thickness of wall
Explain the location of Crohn’s disease
Anywhere from the mouth to the anus with skip lesions
Where is the most + least common site in Crohn’s disease
Terminal ileum
Rectum
Symptoms of Crohn’s disease
Right lower quadrant pain + non-bloody diarrhoea
What does histology in Crohn’s disease reveal?
Noncaseating granulomas with lymphoid aggregates
Gross appearance of Crohn’s disease
FUCCS
Healing process –>
Fissures, linear Ulcers, Cobblestone mucosa,
Creeping fat + strictures:
Full/TRANSMURAL thickness inflammation – > healing = knock stem cell out – >
granulation tissue + fibrosis – >
Myofibroblasts contract – >
narrow lumen forming a stricture = obstruct = STRING SIGN @imaging + pull fat up creeping into serosa
What are the complications of Crohn’s disease
GaStric MaNuFiSto CoPe
GAllstones + STRICtures
MAlabsorption due to small intestine damage –> NUtritional deficiency
transmural full thickness damage – > rupture – > entire tube plug into another tube = FISTula (enterovesical fistulae –> recurrent UTI’s)
bowel inflammation –> can’t excrete oxalate – > oxalate into blood – > bind to calcium –>
calcium kidney STOne
⬆️p(COlorectal cancer/PErianal disease )
Where in the gastrointestinal tract do you need to have Crohn’s disease for there to be a high risk of carcinoma
Colon
What diseases is Crohn’s AND ulcerative colitis associated with
U An APE
Uveitis Ankylosing spondylitis Apthous ulcers Pyoderma gangrenosum Erythema nodosum
