Chapter 17 Part 7 Flashcards
What are the symptoms of IBS?
- abdominal pain
- bloating
- changes in bowel habits
-chronic, relapsing
True or False: IBS can be seen grossly and histologically
False; endoscopic and microscopic evaluations are normal
What are contributors to the possible pathogenesis of IBS?
- psychologic stressors
- diet
- gut microbiome
- abnormal GI motility
- increased enteric response to GI stimuli
What is the most common patient population for IBS?
- -females aged 20-40
- -high-income countries
What does the Rome Criteria for IBS?
-at least 3 months (with the onset at least 6 months prior) of recurrent abdominal pain/discomfort and two or more of the following:
- improvement w/ defecation
- onset was associated w/ change in stool frequency
- onset was associated w/ change in stool appearance
What are the structures associated with Ulcerative Colitis?
-mucosa and submucosa of the rectum and colon
What are the structures associated with Crohn Disease?
- anywhere in the GI tract, but ileum most frequently
- typically transmural
What is the population normally affected by IBD?
- teenagers and early 20’s
- UC is slightly more common in females
- Caucasians
- 4x more common in Ashkenazi Jews
What is seen at the epithelial surface of IBD?
- disruption of the mucus layer
- dysregulation of epithelial tight junctions
- increased intestinal permeability
- increased bacterial adherence to epithelial cells
Which form of IBD has stronger genetic factors?
-Crohn Disease
–50% concordance in monozygotic twins, whereas there’s only a 15% concordance rate for UC in monozygotic twins
CD or UC: Skip lesions
CD; patchy distribution results in cobblestone appearance of mucosa
CD or UC: continuous diffuse lesions
UC
CD or UC: Which has a thick wall and which has a thin wall?
CD - thick
UC - thin
CD or UC: pseudopolyps
UC; tips of pseudopolyps can fuse to create mucosal bridges
CD or UC: Which has deep, knife-like ulcers and which has superficial, broad-based ulcers?
CD - deep, knife
UC - superficial, broad
CD or UC: fibrosis
CD
CD or UC: granulomas
CD (in approx. 35%)
CD or UC: fistulas
CD
CD or UC: fat/vitamin malabsorption
CD
CD or UC: shows no recurrence after surgery
UC
CD or UC: toxic megacolon
UC
CD or UC: “creeping fat”
CD
True or False: multiple ulcers in CD can coalesce into elongated, serpentine ulcers oriented along the axis of the bowel.
True
-UC ulcers are also aligned along the long axis of the colon, but are not typically serpentine
What are the presenting symptoms of Crohn Disease?
- abdominal pain (RLQ)
- diarrhea
- N/V
- weight loss
CD or UC: which has smoking as a risk factor and which has smoking as a protective factor
CD - risk
UC - protective
True or False: initial attack of UC may be severe enough to constitute a medical or surgical emergency
True
What biliary tract disorder may be seen in UC patients?
-primary sclerosing cholangitis
What is the primary cellular infiltrate in CD?
- neutrophils
- -clusters in a crypt from “crypt abscesses”; repeated crypt destruction gives rise to bizarre branching and unusual orientations
CD or UC: Paneth cell metaplasia
CD
What are the presenting symptoms of Ulcerative Colitis?
- attacks of bloody diarrhea w/ stringy mucoid material
- lower abdominal pain
- relief w/ defecation
CD or UC: perinuclear anti-neutrophil cytoplasmic antibodies
UC
CD or UC: antibodies to Saccharomyces cerevisiae
CD
True or False: IBD can always be diagnosed as either CD or UC
False; 10% of IBD cases are Indeterminate Colitis
CD or UC: perinuclear anti-neutrophil cytoplasmic antibodies
UC
CD or UC: antibodies to Saccharomyces cerevisiae
CD
What three factors play into risk of neoplasia in patients with IBD?
1) duration of disease (increased risk at 9yrs)
2) extent of disease (pancolitis vs. left-sided)
3) nature of inflammatory response (neutrophils)
What is diversion colitis?
-colitis that develops in a diverted segment of bowel
What is microscopic colitis, collagenous type?
- -chronic, watery diarrhea w/o weight loss
- -middle-aged and older women
- -dense subepithelial collagen layer
- -increased intraepithelial lymphocytes
- -mixed inflammatory infiltrate
What is microscopic colitis, lymphocytic type?
- -chronic, watery diarrhea w/o weight loss
- -markedly increased intraepithelial lymphocytes
–strong association w/ celiac disease and autoimmune diseases
What are the GI implications of graft-versus-host disease?
-occurs following allogeneic hematopoietic stem cell transplantation
- epithelial apoptosis of intestinal crypt cells
- watery diarrhea; bloody diarrhea in severe cases
What is sigmoid diverticular disease (diverticulosis)?
-multiple, acquired, pseudodiverticular outpouchings of colonic mucosa and submucosa
What is the most common population for diverticulosis?
- rare in people younger than 30
- 50% of people over 60 in western world have it
- -normally left-sided in the western world
What are complications of diverticulosis (sigmoid diverticular disease)?
- diverticulitis
- -inflammation and increased pressure can lead to perforation because the diverticula is only invested my the mucosa and submucosa
While occurring in only 20% of patients, what are the symptoms of sigmoid diverticular diseases (diverticulosis)?
- intermittent cramping
- continuous lower abdominal discomfort
- constipation
- distention
- feeling of not being able to completely empty rectum
