Case 12- SAP Flashcards
What is included in IBD (inflammatory bowel disease)
Ulcerative Colitis (UC) and Crohn’s disease
Inflammatory bowel disease
A chronic inflammatory disorder of the intestinal tract with a remitting and relapsing course
Summary of differences- Crohn’s
1) Involves any part of the GI
2) Disease is patchy- skip lesions
3) Strictures are common
4) Cobblestone appearance
5) Can lead to fistula
6) Unusual to get Toxic megacolon
7) Ulcers are fissuring
8) Transmural lymphocytes
9) Marked fibrosis which leads to strictures
10) Granulomas (round collection of Macrophages)
11) Malignancy potential is low
Summary of differences- UC
1) Colon only
2) Diffuse and continuous
3) From the anus upwards
4) Strictures are rare
5) No fistula
6) More likely to get toxic megacolon
7) Pseudopolyps- normal mucosa that looks like mushrooms
8) The ulceration is undermining- not that deep
9) Mild fibrosis
10) No granulomas
11) High malignancy potential
UC (Ulcerative colitis
A diffuse chronic condition which repeated episodes of inflammation in the rectum and colon cause ulcers and irritation
Pancolitis
Entire colon affected
Distal colitis
Only descending colon and rectum affected
Proctitis
Only rectum affected
Causes of IBD
Genetic factors- family history, more important in Crohn’s than UC
• Protective lifestyle factors- breastfeeding, smoking (in UC)
• Lifestyle risk factors- adverse life events, stress, deression
Smoking (in Crohns)
GI infection
Excessive sanitation
Crohn’s disease
A discontinuous inflammatory condition that affects any part of the GI tract, but mainly affects the ileum, colon and perianal region. There will be skip lesions i.e. part of the bowel which is healthy in-between parts with inflammation
Pathology of IBD
- Decreased gut bacterial diversity
- Inappropriate response of mucosal immune system to flora and luminal antigens
- Triggers an inflammatory response
Examination findings of someone with IBD
End of bed = weight loss, pain, fever, anaemia Finger clubbing Vitamin deficiencies Ulcers Bloating PR examination could see blood/soreness
Lab diagnostics for IBD
FBC = Increased WCC
Hb = Low due to anaemia of chronic disease
CRP = high
Faecal calprotectin = high, neutrophil migration to intestinal mucosa
Main regions which Crohn’s affects
The ileum, colon and perianal regions
History of someone presenting with IBD
Diarrhoea, often bloody (>6 weeks) Abdominal pain Fever Perianal lesions Weight loss Failure to thrive Arthritis Epsicleritis Clubbing
Microscopic pathology changes in Crohn’s disease
Lymphoid aggregates i.e. lymphocyte patches proceeding all the way through the tissues as it is transmural
Fibrosis
Transmural inflammation- inflammation extends through all layers of the bowel wall
Granulomas i.e. large groups of macrophages
Fissuring ulcers - resulting in the loss of the mucosa - resulting in granulation tissue instead - leading to blood due to haemorrhaging
Microscopic pathology changes in UC
Pseudopolyps
Gland destruction - forming crypt abscesses i.e. collection of neutrophils on the gland
Crypts can get worse and become fibrous tissue
Vascular congestion
Loss of mucosal folds
Macroscopic changes in Crohn’s disease
Cobblestoning i.e. ulcers separated by normal mucosa
Ulcers in the mouth
Skip lesions as the pathology is discontinuous
The affected areas - commonly the ileum, colon and anus - will be red and inflamed
Complications of Crohn’s disease
Strictures- wall of the affected area thickens due to fibrosis
Fistulas- abnormal connections between 2 organs, because the bowel is inflamed it presses on and breaks down nearby structures i.e. rectum connects to skin. Increases infection risk
Malabsorption- fistulas can cause protein loss. B12 deficiencies. Problems with bile salts, less fat absorption
Perforation- infection is transmural so bowel contents can enter the sterile abdominal cavity
