Gastro

Question 1

Inflammatory bowel disease: Ulcerative colitis vs crohns general

Answer 1

> 15y , genetic,immune,microbial, enviromenral

UC: without leaving healthy tissue, superf. Mucosa involvement

Crohns: mouth to anus in segments, transmural involvement

Etiologic:
1.abnormal mucosal immune response: CD:tnfa,il-1/6, UC:basophil,eosinophil, b lymphocyte
2.bowel inflammation
3.improper immune response: ibd

Question 2

Genetic factors of ibd

Answer 2

HLA class 2 genes:

Multifactorial, non medelian
CROHNS> UC
#!NOD2 genes on 16th chromosome, expressed in monocytes, related to IL-4

!DRB1 01/07:susceptibity to cd
!Drb1 0103: severity in cd and uc

Question 3

Enviromenral factors of ibd

Answer 3

High socioeconomic status, industrialized/ big cities, high stress

CD: diet, smoking, oral contraceptive,excessive sanitation

UC:diet. Apendectomy and smoking decreases risk of disease

Mothers milk decreases both

Question 4

İnfectious factors of ibd

Answer 4

Measles !
M.tuberculosis
E. Coli
Streptococcus
Maternal neonatal infections

Question 5

IBD Pathologic

Answer 5

Etiologic: abnormal mucosal immune response: APC
CD:TH1:tnf,il
UC:TH2:eosinophil, basophil,b lymphocyte

Anatomic: CD: ilioceccal,but mouth to anus, part part, transmural involvement

UC: left colon, proctosigmoiditis, proctic, pancolitis

Question 6

Macroscopy IBD

Answer 6

Crohns: ! Cryptic,crypt abcess, fibrosis, granuloma. Also histocyte proliferation,lymphoid aggregate

UC: limited to mucosa, neutrophil infiltration in mucosa,lymphocyte infiltration to lamina propria, crypt abcess,distortional crypts, paneth cell metaplasia
-abscence of goblet cells, crypt distortion and abscess

Question 7

Clinical finding IBD

Answer 7

UC: bloody diarrhea, rectal bleeding/hematechezia, periumbilical/ LLQ pain,
! Weight loss, extra intestinal findings !

CD: diarrhea, abd. Pain, fever, ! Short stature!, pubertal delay, fissure/fistula/skin tag, less/ no extraintestinal findings

Extra-intestinal findings: kidney stones, hydronephrosis, uti, liver steatosis,gallstones, sclerosing cholangitis, spondylitis, arthritis,sacroilitis, phlebitis, ağthous ulcers, erythema rodosum, episcleritis,uveitis

Complications: anorectal ulcers, fistula,stenosis,inflammation

Question 8

Endoscopy, lab IBD

Answer 8

Crohns: cobble stoning,thickened wall,fissure
Uc: ulceration, pseudopolyps,crypt distortion

UC: ANCA
CD: ASCA
Crp/esr increased,
Pt,ptt
Calprotectin: colons esr

For Uc: mre: mr enteroscopy

Question 9

Trx İBD

Answer 9

5- aminosalicylic acid, azathioprine(children), anti Tnfa

5-ASA+ AZA

+ aminosalicylates: sulfasalazine
ımmunosupressive: corticosteroids,methotrexate,cyxlosporine,tacrolimus
Ab: metronidazole,ciprofloxacin
Dietary:crohns
Surgical