Gastrointestinal pathology - Inflammatory Bowel Diseasa Flashcards
A 28 yo patient present to your clinic with left lower quadrant pain with bloody diarrhea. What do you think she has?
Ulcerative Collitis.
A 25 year old Jewish lady who migrated from Eastern Europe comes to your GI clinic complaining of bloody diarrhea and abdominal pain. What do you think she has? What could be the cause?
She has irritable bowel syndrome. It is chronic inflammation of the bowel possibly due to abnormal immune response to enteric flora. It is us classified as UC or Crohn disease.
A 28 yo patient present to your clinic with right lower quadrant pain with non bloody diarrhea. What do you think she has?
Crohn disease
A 28 yo patient present to your clinic with left lower quadrant pain with bloody diarrhea. What do you think she has? Which layers are involved? Where is it usually located? What type of inflammation is present? If you took a biopsy, what would you see? How about on X-ray? What are some of the complications involved? What are the risks involved with smoking?
This is Ulcerative colitis. Mucosal and submucosal ulcers are involved. It is located in the rectum and can extend proximal lay up to the cecum, with continuous involvement. A remainder of the GI tract is unaffected. The inflammation shows crypt abscesses with neutrophils. Gross appearance shows pseudo polyps and loss of haustra “lead pipe sign”. Toxic mega colon and carcinoma are complications and smoking is protective against UC.
A 28 yo patient present to your clinic with right lower quadrant pain with non bloody diarrhea. What do you think she has? Which layers are involved? Where is it usually located? What type of inflammation is present? If you took a biopsy, what would you see? How about on X-ray? What are some of the complications involved? What are the risks involved with smoking?
She has Crohn disease with full thickness inflammation with knife like fissures. It can be located anywhere from the mouth to the anus with skip lesions. Terminal ileum is the most common site, rectum is least common. Inflammation is via lymphoid aggregates with granulomas in 40% of cases. Gross appearance is of cobblestone mucosa. Creeping fat and strictures on imaging. Complications are malabsorption with nutritional deficiency, calcium oxalate nephrolithiasis, fistula formation and carcinoma. Smoking increases risk for Crohn disease.
What disease presents lead pipe on imaging and what presents as creeping fat and strictures?
Lead pipe is UC and creeping fat and string sign is Crohn.
What are some of the extra intestinal manifestations of UC and Crohns?
Arthritis, Uveitis, erythema nodosum, pyoderma gangrenousum, primary sclerosing cholangitis, and P-Anca.
