*IBD 2 (Lecture 2) Flashcards
Where is Crohn’s disease most commonly found?
Terminal ileum and colon
Does Crohn’s disease occur in children?
More common in males or females?
Yes - occurs in young patients (50% are 20-30 with 90% being 10-40)
Males
What is the clinical course of Crohn’s disease?
Chronic
Exacerbation and remissions
Unpredictable response to therapy
Subgroup of patients who go into lasting remission within 3 years of diagnosis
How are patients with Crohn’s disease diagnosed pathologically?
Endoscopy and mucosal biopsy
What type of -omas form in Crohn’s disease?
Granulomas
What causes chronic active inflammation with crypt branching and granulomas?
Crohn’s disease
Are the granulomas in Crohn’s disease caseating?
No
Why do patients with Crohn’s disease get a bowel obstruction?
Due to stricture formation (or inflammation)
What produces the cobble stoning of mucosa in Crohns disease?
Deep fissures
Can you get pseudo polyps in Crohns disease?
Yes (not common)
Does Crohn’s disease cause transmural or superficial inflammation?
Transmural
What complications of Crohns can occur in the crypts?
Cryptitis
Crypt abscesses
What are the major complications of Crohn’s disease?
Malabsorption (can be iatrogenic - short bowel syndrome) Gallstones Fistulas Anal disease Intractable disease Bowel obstruction Perforation Malignancy Amyloidosis Extra-intestinal manifestations Rarely toxic megacolon
What are signs of malabsorption?
Vitamin deficiency
Anemia
Hypoproteinemia
What is the name for a fistula between the colon and small intestine?
Enterocolic fistula
What is blind loop syndrome?
n blind loop syndrome a portion of the small intestine becomes bypassed and thus cut off from the normal flow of food. This may lead to malabsorption and small intestinal bacterial overgrowth syndrome (SIBO). It may also be associated with short bowel syndrome.
What kind of anal disease can occur with Crohn’s diseases?
Sinuses Fissures skin tags Abscesses Perineum falls apart
What is intractable disease?
Disease that doesn’t respond to therapy meaning the patient continues to experience symptoms
What is amyloidosis?
Amyloidosis is a group of rare but serious conditions caused by deposits of abnormal protein, called amyloid, in tissues and organs throughout the body.
What could explain the segmental distribution of Crohn’s disease?
Vasculitis
How is the immune system related to Crohn’s disease?
Persistent activation of T cells and macrophages (failure to switch off)
Excess pro-inflammatory cytokine production
Is ulcerative colitis more common in males or females?
Males
Can you get Crohn’s disease in children?
Yes but not nearly as much as you get Crohn’s disease in children
Do patients who get UC tend to be older or younger than those who get Crohns?
A bit older but still young (can get it in children or elderly people too)
Clinical course of UC?
Chronic course with exacerbation and remission
Can have continuous low grade activity
Can have a single attack
Can cause toxic megacolon
Basal lymphoplasmacytic infiltrate with irregular shaped branching crypts?
Ulcerative colitis
What disease has severe ulceration with fibrinopurulent exudate?
Ulcerative colitis
Why do you get diarrhoea with UC in chronic active disease?
Crypts burn themselves out meaning there is not enough crypts to absorb the fluid
Does UC causes superficial or transmural inflammation?
Superficial inflammation
What is the only time with UC when the inflammation is not confined to the mucosa and submucosa?
Toxic megacolon
Do you get granulomas with uc?
No
Complications of UC?
Intractable disease Toxic megacolon Colorectal carcinoma Blood loss Electrolyte disturbance (hypokalaemia) anal fissures Extra GI manifestations
What causes flares of UC in intractable disease?
Intercurrent infection by enteric bacteria
CMV
How can intractable UC be treated?
Total colectomy
Treatment for toxic megacolon?
Emergency colectomy
How UC lead to colorectal carcinoma?
Chronic inflammation leads to epithelial dysplasia and then carcinoma
Immune system role in ulcerative colitis?
Persistent activation of T cells and macrophages
Autoantibodies e.g. ANCA present
Excess proinflammatory cytokine production and bystander damage due to neutrophilic inflammation
Are fistulae more common in Crohns or UC?
Crohns
Are extra GI manifestations more common is Crohns or UC?
UC
Is the cancer risk higher in Crohns or UC?
UC
