Gastro - Epi And path of IBD Flashcards
Gender discrepancy in IBD
Age distribution of IBD
M=F
Peak incidence 15-30yrs
Second peak at 60-80 yrs
Ethnicity RF for IBD?
Greatest incidence in Caucasian and Jewish
African American: more likely: - oesophageal CD - colorectal Disease - perianal Disease - uveitis - sacroiliitis LESS likely to get ileal Disease
Hispanic more likely:
- perianal Disease
- more proximal Disease
- erythema nodosum
Geography RF in IBD?
Increased risk in northern climates
IBD has increase and decrease risk in which infections?
Increased risk of:
- salmonella and shigella
- campylobacter
- clostridium dificille
- E. coli
- measles
Decreased risk of:
- faecalibacterium prausnotzil
Dietary RF for IBD
Increased risk if:
- high protein, high sugar
- shellfish
- w-6 fatty acids
Decreased risk if:
- w3 fatty acids
Medication RFS for IBD?
Aspirin and NSAIDS
OCP increases CROHNS risk
Misc RFs for IBD
SMOKING
- increases risk of Crohns
- decreases risk of UC
PSYCHOLOGICAL STRESS
APPENDECTOMY
- decreases risk of UC
BREASTFEEDING
- decreases risk of BOTH
Risk if BOTH parents have IBD?
36%
Susceptibility genes in IBD and their significance?
NOD2/CARD15
- on Ch16
- in 30-60% of Crohns
- 15% of UC and general population
In Crohns the NOD2 variant:
- especially in small bowel
- increased risk of early surgery
- younger age of onset
- structuring phenotype
- early Surgical recurrence
Associated genetic conditions with IBD?
Turner Syndrome:
- associated with UC and colonic CD
Wiscott-Aldrich Syndrome
- x linked, recessive loss of WAS protein
- colitis, immunodeficiency and thrombocytopenia
Hermansky-Pudlak
- autosomal recessive Ch10
- grabulomatous colitis with oculocutaneous albinism
- pulmonary fibrosis
- platelet dysfunction
Location of ulcerative colitis
Begins in rectum then extends proximally
- 25% proctitis
- 25% left sided colitis up to splenic fissure
- pancolitis in 50%
Location of Crohns
Can affect any part of GIT
small bowel in 30%
iliocolic in 40%
Isolated colonic location in 25%
Upper GI or perianal in 5%
Microscopy of UC
Diffuse mucosal oedema and erythema
More severe are granularity, friability, ulceration and bleeding
Altered crypt architecture
Crypt abscesses
Goblet Cell depletion
Microscopy of Crohns
Superficial to Deep apthous ulcers
Stellate or serpiginous or linear ulcers
Cobblestone
Patchy transmural inflammation
Granuloma in 50%
