Coeliac Disease + Inflammatory Bowel Disease (L11)

Question 1

What is coeliac disease?

Answer 1

Auto-immune disease of the small intestine which is triggered by the ingestion of gluten.

Question 2

What is the consequence of coeliac disease?

Answer 2

Malabsorption

Question 3

What is gluten?

Answer 3

A protein found in wheat, rye and barley

Question 4

What can lead to a cessation of the symptoms of coeliac disease?

Answer 4

Gluten-free diet

Question 5

What are the microscopic features of coeliac disease?

Answer 5

• Villous atrophy
• Crypt hyperplasia
• Increase in lymphocytes in the small intestine
• Inflammation of the small intestine

Question 6

Examples of three inflammatory bowel diseases

Answer 6

• Ulcerative colitis
• Crohn’s disease
• ## Ischaemic colitis

Question 7

What is Crohn’s disease?

Answer 7

An idiopathic, chronic inflammatory bowel disease - meaning its cause is unknown. There is evidence that suggests that it is linked to genetics because relatives of sufferers have an increased risk of developing it.

Question 8

What is the difference between IBS and IBD?

Answer 8

• IBS is inflammatory bowel syndrome

- IBD is inflammatory bowel disease

Question 9

What is the the improved hygiene hypothesis?

Answer 9

• Improved hygiene in susceptible individuals leads to a reduction in enteric infections
• As a result, they are less immune to pathogen
• Therefore, they display an exaggerated immune response which damages the mucosal surface.

Question 10

What increases the risk of having Crohn’s disease?

Answer 10

• Migration from a low risk population to a high risk population
• Western countries have higher risk than Asian and African countries
• Smoking

Question 11

What are the clinical features of Crohn’s disease?

Answer 11

• Abdominal pain (relieved by opening bowels)
• Prolonged non-bloody diarrhoea
• Weight loss

Question 12

What does Crohn’s disease affect?

Answer 12

Any part of the GI tract (mouth to anus)

Question 13

Microscopic features in Crohn’s disease

Answer 13

• Inflammation
• Mucosal ulceration
• Granulomas (collection of macrophages)
• Fibrosis

Question 14

What complications can be caused by Crohn’s disease?

Answer 14

• Fistula (passage between two structures).
• Abscess (swollen area and contains pus)
• Obstructions caused by adhesions and fibrosis

Question 15

What is ulcerative colitis?

Answer 15

• Chronic inflammatory bowel disease that only affects the large intestine (caecum to rectum)
• The inflammatory process is limited to the mucosa and submucosa

Question 16

When does UC arise?

Answer 16

It can arise at any age but is rare to be before the age of 10

Question 17

What causes UC?

Answer 17

Unknown cause but it can be linked to genetics

Question 18

What are the clinical features of UC?

Answer 18

• Bloody diarrhoea
• Mucoid diarrhoea (lots of mucus)
• Weight loss

Question 19

What are the microscopic features of UC?

Answer 19

• Inflammation confined to the mucosa (acute and chronic)

- Crypt architectural distortion

Question 20

What is toxic megacolon?

Answer 20

Complication of UC and the bowel becomes dilated and haemorrhagic

Question 21

What is transmural inflammation?

Answer 21

• Inflammation that spans the whole depth of the intestinal wall
• The type of inflammation that occurs in Crohn’s disease