IBD Flashcards
Inflammatory Bowel Disease
Ulcerative Colitis
Chrons Disease
Bloody Diarrhea/Disentery
May be a symptom of UC and CD, but there are many causes other than IBD. If you have a patient presenting with bloody diarrhea the first thing in your head shouldn’t be IBD, you should want to rule out other infectious causes like E coli 0157, salmonella, shigella, campylobacter, yersinia, c diff, ova and parasites
Ulcerative Colitis.
- Involves ulcers in intestinal tract, specifically in the colon (hence colitis). Inflammation of MUCOSA, NOT full thickness inflammation.
- Always starts in rectum and goes upward. ALWAYS has rectal involvement, pt often p/w left lower quadrant pain bc thats where your rectum is
- NEVER involves small intestine, JUST COLON
Ulcerative Colitis Morphology
- Pseudopolyps formed by healed ulcers
- Loss of haustra that leads to “Lead pipe” appearance on X-ray/ct
Extra intestinal Features of UC
- Pyodermic gangrenous, ulceration of skin
- Primary sclerosing cholangitis- biliary disorder where strictures form in bile tree only happening to pt with UC
- Ankylosing spondylitis- Inflammation of spine leading to back pain
- Uveitis-inflammation of middle of the eye, common in autoimmune disorders
Feared Complication of UC
_Toxic Megacolon
-colon stops contracting, rapid intestinal dilation, walls thin and are prone to rupture, and then PERF
Toxic Megacolon
- P/w abdominal pain, distention, FEVER, diarrhea, SHOCK
- You can see it on xray
UC- Adenocarcinoma
- Need to have disease for 10 years
- The more colon involved the greater risk
- Right sided colitis or pancolits are risk factors
- Screening colonoscopies are recommended
- multiple biopsies are taken
Churns Disease. High Yield features
- Granulomas inflammation!
- Transmural (entire wall is effected)
- Mouth to anus, any portion of GI tract can be effected
CHrons Disease Most common Location
- Terminal Ileum most common location
- Malabsorption, b12 deficiency, and malabsorption of bile salts
- Bc you can’t reabsorb bile salts, pt with churns are at increased risk of gallstones and can lead to secretary diarrhea, malabsorption of fats so steatthorea develops, may have NON bloody diarrhea due to malabsorption
- RLQ pain bc terminal ileum radiates to RLQ
Other features of Chrons
- CHrons spares the rectum
- Has “Skip Sections”
Hallmark of Biopsy
-GRANULOMAS
Gross Morphology Hallmark of CHrons Disease
Cobblestone mucosa formed by transmural inflammation
Characteristic Feature Of Chrons
- Fistulas (perianal, abdominal, bladder (enter visceral fistula))
- Loop of small bowel affected by churns, we have transmural inflation can spread outside wall of intestine to whatever structure is nearby, if the bladder happens to be near by then the infection spreads to the bladder and they bridge.
Other Gross Morphology of Chrons
Creeping Fat
-transural inflammation heals and the condense fibrous tissue pulls fat around bowel wall, so the intestine of chrons disease pt will have fat wrapped entirely around the bowel
Strictures
-healing lumen leads to fibrous tissue which causes NARROWING of intestinal lumen
-Radiology finding: “String Sign” pt drinks barium we fill their intestines and take X-ray, the barium will fill normal parts of intestines, when the barium reached intestine like the ileum the barium will narrow down to a string
