GI - Pathology (Inflammatory/Irritable bowel & Appendicitis)

Question 1

What are the types of inflammatory bowel diseases?

Answer 1

Crohn disease & Ulcerative colitis

Question 2

What is the possible etiology of Crohn disease versus Ulcerative colitis?

Answer 2

CROHN: Disordered response to intestinal bacterial; ULCERATIVE COLITIS: Autoimmune

Question 3

What is the location of Crohn disease versus Ulcerative colitis? Include parts of the GI involved and the fashion in which lesions occur.

Answer 3

CROHN: Any portion of GI tract, usually terminal ileum and colon. Skip lesions, rectal sparing; ULCERATIVE COLITIS: Colitis = colon inflammation. Continuous colonic lesions, always with rectal involvement

Question 4

What is the gross morphology of Crohn disease (6 findings) versus Ulcerative colitis (3 findings)? For each disease, give the underlying type of inflammation.

Answer 4

CROHN: Transmural inflammation => (1) fistulas. (2) Cobblestone mucosa, (3) creeping fat, (4) bowel wall thickening (“string sign” on barium swallow x-ray), (5) linear ulcers, (6) fissures. ULCERATIVE COLITIS: Mucosal and submucosal inflammation only. (1) Friable mucosal pseudopolyps with (2) freely hanging mesentery. (3) Loss of haustra => “lead pipe” appearance on imaging.

Question 5

What is the microscopic morphology of Crohn disease versus Ulcerative colitis?

Answer 5

CROHN: Noncaseating granulomas and lymphoid aggregates (Th1 mediated); ULCERATIVE COLITIS: Crypt abscesses and ulcers, bleeding, no granulomas (Th2 mediated)

Question 6

What are the complications of Crohn disease (7 conditions) versus Ulcerative colitis (4 conditions)?

Answer 6

CROHN: (1) Strictures (leading to obstruction), (2) Fistulas, (3) perianal disease, (4) malabsorption, (5) nutritional depletion, (6) colorectal cancer, (7) gallstones; ULCERATIVE COLITIS: (1) Malnutrition, (2) sclerosing cholangitis, (3) toxic megacolon, (4) colorectal carcinoma (worse with right-sided colitis or pancolitis).

Question 7

What is the intestinal manifestation of Crohn disease versus Ulcerative colitis?

Answer 7

CROHN: Diarrhea that may or may not be bloody; ULCERATIVE COLITIS: Bloody diarrhea

Question 8

What are the extraintestinal manifestations of Crohn disease (7 conditions) versus Ulcerative colitis (6 conditions)?

Answer 8

CROHN: (1) Migratory polyarthritis, (2) erythema nodosum, (3) ankylosing spondylitis, (4) pyoderma gangrenosum, (5) aphthous ulcers, (6) uveitis, (7) kidney stones; ULCERATIVE COLITIS: (1) Pyoderma gangrenosum, (2) erythema nodosum, (3) primary sclerosing cholangitis, (4) ankylosing spondylitis, (5) apthous ulcers, (6) uveitis

Question 9

What are the treatments of Crohn disease (5 treatments) versus Ulcerative colitis (4 treatments)?

Answer 9

CROHN: (1) Corticosteroids, (2) azathioprine, (3) methotrexate, (4) infliximab, (5) adalimumab; ULCERATIVE COLITIS: (1) ASA preparations (sulfasalazine), (2) 6-mercaptopurine, (3) infiliximab, (4) colectomy

Question 10

What are mnemonics to remember the 2 forms of IBD?

Answer 10

CROHN: “For CROHN, think of a FAT (creeping) GRAnny (granuloma) and an old CRONE SKIPping (lesions) down a COBBLESTONE road away from the WRECK (rectal sparing).”; ULCERATIVE COLITIS: “Ulcerative colitis causes ULCCCERS - Ulcers, Large intestine, Continuous, Colorectal carcinoma, Crypt abscesses, Extends proximally, Red diarrhea, Sclerosing cholangitis”

Question 11

What imaging finding characterizes Crohn disease, and what causes this?

Answer 11

Bowel wall thickening (“string sign” on barium swallow x-ray)

Question 12

What makes colorectal carcinoma worse in the context of ulcerative colitis?

Answer 12

Colorectal carcinoma (worse with right-sided colitis or pancolitis)

Question 13

What imaging finding characterizes Ulcerative colitis, and what causes this?

Answer 13

Loss of haustra => “lead pipe” appearance on imaging.

Question 14

What defines irritable bowel syndrome?

Answer 14

Recurrent abdominal pain associated with at least 2 of the following: (1) Pain improves with defecation (2) Change in stool frequency (3) Change in appearance in stool

Question 15

What structural abnormalities result from irritable bowel syndrome?

Answer 15

No structural abnormalities

Question 16

In what patient population is irritable bowel syndrome most common?

Answer 16

Most common in middle-aged women

Question 17

Characterize the symptoms of irritable bowel syndrome. How does it present?

Answer 17

Chronic symptoms. May present with diarrhea, constipation, or alternating symptoms.

Question 18

Use one word to describe the pathophysiology of irritable bowel syndrome.

Answer 18

Pathophysiology is multifaceted

Question 19

What is clinical approach to irritable bowel syndrome management/treatment?

Answer 19

Treat symptoms

Question 20

What is appendicitis? What causes it in adults versus children?

Answer 20

Acute inflammation of the appendix due to obstruction by fecalith (in adults) or lymphoid hyperplasia (in children)

Question 21

Characterize the pain of appendicitis.

Answer 21

Initial diffuse periumbilical pain migrates to McBurney point (1/3 the distance from anterior superior iliac spine to umbilicus).

Question 22

Besides pain, what are 2 symptoms of appendicitis? What is a possible complication? What are 3 clinical signs that may be seen?

Answer 22

Nausea, fever; may perforate => peritonitis; may see psoas, obturator, and Rovsing signs

Question 23

What are 2 differential diagnoses related to appendicitis? What is important to note about these that distinguishes appendicitis?

Answer 23

Differential: diverticulitis (elderly), ectopic pregnancy (use Beta-hCG to rule out)

Question 24

What is the treatment for appendicitis?

Answer 24

Appendectomy