IBD Flashcards
what is IBD?
Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract.
what are the different types of IBD?
- crohn’s disease and ulcerative colitis
what is the definition of Chron’s Disease?
chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus
(most common in the terminal ileum and the colon)
who is more likely to get Crohn’s Disease?
- young patients
- more common in males
what is the presentation of Crohn’s Disease?
- abdominal pain
- small bowel obstruction
- diarrhoea
- bleeding PR
- anaemia
- weight loss
what are changes in histology?
granuloma formation, lamina propria plasma cells and lymphocytes, neutrophillic inflammation
what is the pathology of Crohn’s Disease?
- segmental disease
- ileal and/or colonic chronic active mucosal inflammation
- transmural inflammation
- deep knife-like fissuring ulcers
- granulomas, 50%, non-caseating
what are the malabsorption complications of Crohn’s Disease?
- malabsorption
- -iatrogenic (short bowel syndrome)
- -hypoproteinemia, vitamin deficiency
- -gallstones (interrupted enterohepatic ciruclation)
what are the fitula complications of Crohn’s Disease?
- vesicocolic
- enterocolic
- gastrocolic
- recto vaginal
- tuboovarian abscess
- bind loop syndrome
what are the anal disease complications of Crohn’s Disease?
- sinuses
- fissures
- skin tags
- abscesses
- perineum fall apart
what intractable disease complications are of Crohn’s Disease?
- failure to tolerate or respond to medial therapy
- continuous diarhoea or pian
- may require surgery
give examples of environmental triggers f Crohn’s Disease
- smoking
- NSAIDs
- infectious agents
- vasculitis
- sterile environment theory
describe the immune response involved in Crohn’s disease?
- persistent activation of T cells and macrophages
- excess proinflammatory cytokine production
what is the definition of ulcerative colitis?
- chronic inflammatory disorder confined to colon and rectum
- mucosal and submucosal inflammation
who is more likely to get ulcerative colitis?
- young patients
- males
where is ulcerative colitis?
colon and rectum
what is the clinical presentation of ulcerative colitis??
diarrhoea, mucus and blood PR
what are the changes in histology for ulcerative colitis
- massive influx of inflammatory cells
- basal lymphoplasmacytic infiltrate with irregular shaped branching crypts
- acute cryptitis
- absecesses
- excess fibrin
management of ulcerative colitis/
- does not respond to medical therapy
- subtotal colectomy
where is inflammation confined to in ulcerative colitis?
mucosa and submucosa
give a pathological summary of ulcerative colitis
- continuous, diffuse disease
- rectal involvement
- superficial ulceration and inflammation
- chronic active colitis
- cryptitis
- crypt abscess
- no granulomas
intractable disease complications of ulcerative colitis
- continuous diarrhoea
- flares may be due to intercurrent infection by enteric bacteria or CMV
- total colectomy
what are the toxic megacolon complications of ulcerative colitis?
- acute or acute on chronic fulinmant colitis
- colon swells up to massive size
- will rupture unless removed
- emergency colectomy
how can complications of ulcerative colitis lead to colorectal carcinoma?
- chronic inflammation leads to epithelial dysplasia and the carcinoma
- risk increased if
- pancolitis
- disease longer than 10 years
- requires surveillance
give a summary of complications of ulcerative colitis
- blood loss
- electrolyte disturbance
- anal fissures
- eyes: uveitis
- liver: primary sclerosing cholangitis
- joints: arthritis
skin, erythema ?
why do you get ulcerative colitis?
- genetic defects
- aberrant immune response
- environmental factors
describe the immune response of ulcerative colitis
- persistent activation of T-cells and macrophages
- autoantibodies present
- excess proinflammatory cytokine production
explain the pathogenesis of ID
the genetic predisposition + mucosal immune system + environmental triggers
what is the IBD gene?
NOD2/CARD15 (IBD-1)
what chromosome is the disease susceptibility gene located?
16q12
what does the gene encode?
a protein involved in bacterial recognition
describe the innate immunity involved in IBD
- tight junctions regulate epithelial permeability
- hydrophobic mucus protects the epithelial cell layer
- defensins (catatonic anti-microbial peptides) can be activated
- NOD2 contributes to normal mucosal defences