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IPFC 5 > Crohn's and Ulcerative colitis Pathophysiology > Flashcards

Crohn's and Ulcerative colitis Pathophysiology Flashcards

1
Q

What does IBD increase risk of getting (i.e complications) (5)

A
  • bowel cancer
  • liver disease
  • VTE
  • CV disease
  • premature death
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2
Q

What is the etiology of IBD dsiease (3)

A
  1. Infectious agents
    - microorgnaisms prob play a role
    - maybe viruses, protozoa, mycobacteria, listeria, chlamydia
    - bacteria produces toxins -> cause mucosal damage -> influx of inflammatory cells + T-cell activation
  2. Genetic predisposition
    - common in monozygotic twins (60%)
    - 20x risk if 1st degree relatives have it
    - common races: eastern european, jewish, south asians
  3. Environmental factors
    - diet
    - norther climates
    - urban areas, developed countries
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3
Q

Differentiate between the infiltration location of CD and UC. What does it infiltrate with

A

Infiltration: lymphocytes, plasma cells, mast cells, macrophages, neutrophils

CD:
- Effects are transmural (throughout all the tissue layers)

UC:
- Effects are only in the mucosa and submucosa

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4
Q

Differentiate between Crohn’s and UC in terms of presentation and inflammation effects

A

CD
- Inflammation causes fissures into tissues
- DIScontinuous segments “skip lesions” of large intestine
(can occur in ANY part of GI, from mouth-anus)

UC
- Inflammation causes missing segments of tissue (pseudopolyp)
- CONTinuous segments affected
- usually descending colon to rectum
- sometimes short segment of terminal ileum (backwash ileitis)

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5
Q

Differentiate between the cytokine dysregulation of CD and UC (2)

A

CD
- Th1 cytokine excessive production
- mediates responses against PATHOGENS

UC
- Th2 cytokine excessive production
- mediates responses against ALLERGENS

TNFa expression increased in both

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6
Q

What are other lifestyle factors than cause flare ups in IBD (3)

A
  1. Psychological
    - stress
  2. Diet
    - avoid over-restrictive diets
  3. Smoking
    - Protective for UC, exacerbates CD
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7
Q

What does the clinical presentation of UC look like? (5)

A
  • Diarrhea (often w/ blood), cramping. can lead to weight loss
  • Fever, tachycardia (due to severe diarrhea)
  • blurred vision, eye pain, photophobia
  • arthritis
  • raised red tender skin nodules
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8
Q

T/F Fistulas, perforation, or obstruction are common in UC

A

False

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9
Q

What do primary lesions look like in UC

A

Crypt abscesses
- goblet cells and crypts within mucosal layer get effected

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10
Q

What are common complications of UC

A
  • Extension and coalescence (merge) of ulcers
  • Pseudopolyps: areas of uninvolved mucosa
    Local:
  • hemorrhoids
  • perirectal abscesses
  • anal fissures
  • colonic hemorrhage
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11
Q

What do typical lab values look like in UC?
Severe diseases

A

Low hematocrit
Low hemoglobin
Increased ESR (indicator of inflammation)
Leukocytosis - severe
Hypoalbuminemia - severe

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12
Q

Define what mild, mod, severe, fulminant UC looks like

A

Mild
- up to 3 stools/day (+/- blood)
- No systemic disturbances
- Normal ESR

Moderate
- 4-6 stools per day
- minimal systemic disturbances

Severe
- 7-10 stools/day
- Fever, tachycardia, anemia
- ESR over 30 mm/h

Fulminant
- 11+ stools/day
- continuous bleeding
- toxicity
- abdomen tenderness, needs transfusions
- Colonic dilation

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13
Q

What are poor prognostic features for UC? (5)

A
  • Diagnosed at 41+
  • Low hemoglobin
  • Low albumin
  • Extensive disease
  • Elevated inflammatory markers CRP, ESR
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14
Q

T/F Crohn’s can narrow then lumen

A

True (cobblestone appearance)
- Mesentery becomes thickened and edematous and eventually fibrotic

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15
Q

Which clinical presentation is more unique to Crohn’s and more common in Crohn’s

A
  • Malaise, fever
  • Abdominal pain
  • fistula
  • weight loss and malnutrition
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16
Q

Is bleeding more common in UC or CD

A

UC
- Crohn’s is not that severe

17
Q

What are the 3 distinct disease courses that a Crohn’s patient can have

A
  1. Inflammatory
  2. Strictures/obstruction
    - Abnormal narrowing of intestine (due to muscle hypertrophy/scarring)
    - May lead to fistulas or perforation of bowel
  3. Fistulas
    - crack going from one part of the body to another (eg. from the intestine through mucosa/muscle/skin)
    - Essentially bowel contents are leaking out onto the skin, leading to infection
    - must be covered with a hydro conductive wick to minimize flow of enteric contents
18
Q

What are lab values indicative of CD?

A
  • Increased ESR
  • increased WBC
  • Increased CRP
19
Q

What is the target CDAI score for CD?
What does it look at? (6)

A

Target: <150

Looks at
- frequency of stools
- severity of abdo pain
- overall wellbeing
- complications (arthritis, eye)
- Hematocrit
- Weight loss

20
Q

Define a mild, moderate-severe, severe- fulminant CDAI score in CD

A

Mild: CDAI 150-220
- ambulatory
- no evidence of dehydration, systemic toxicity, obstruction etc..

Moderate- severe: CDAI 220-450
- failed mild treatment
- fever, weight loss, abdo pain,
- obstruction, tenderness, vomiting
- sig. anemia

Severe-fulminant: CDAI 450+
- Persistent sx despite corticosteroid or biologic treatment
- presence of cahexia, rebound tenderness, intestinal obstruction
- abscess

21
Q

What does the mayo clinic score look at? (3)

A

In the past 3 days:
- Frequency of stools
- Rectal bleeding

Physician assessment

22
Q

What mayo clinic score indicates
Remission
Mild disease
Moderate disease
Severe disease

A

Remission = 0-1
Mild disease = 2-4
Moderate disease = 5-6
Severe disease= 7-9

23
Q

What are the systemic complications of IBD (6)

A
  1. Arthritis
    - asymmetrical (unlike RA) common in small joints of hands, knees, elbows
  2. Eye manifestations
    - iritis, episcleritis
  3. Skin lesions
    - erythema nodosum (knee spots)
    - pyoderma gangrenosum (outside ulcer)
    - Apthous ulcer (canker sore)
  4. Liver disease
  5. Renal stones
  6. Gallstones
  7. Malnutrition
    - B12, folate, iron deficiency
    - hypokalemia
    - low albumin

IPFC 5 (10 decks)

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