IBD (Nichols and Bessoff) Flashcards
IBD is characterized as a dysregulation of
the immune response to gastrointestinal luminal bacteria
2 major forms of IBD
chron’s disease and ulcerative colitis
smoking increase the risk for what form of IBD
chron’s disease
**DECREASED risk of ulcerative colitis
appendectomy increase the risk for what form of IBD
chron’s disease
**DECREASED risk of ulcerative colitis
high sanitation level in childhood has an increased risk for what form of IBD
chron’s disease
location of chron’s disease vs ulcerative colitis
chron’s disease involves skip lesion typically in colon and ileum but can occur anywhere in GI tract (mouth to anus) **rectal sparing
ulcerative colitis (almost) always involves rectum and is continuous as it extends proximally
microscoptic pathology of chron’s disease vs ulcerative colitis
chron’s: noncaseating granulomas (Th1 mediated) and lymphoid aggregates, fistulas/fissures
ulcerative colitis: crypt abscesses (no necrosis and in both…) and ulcers (Th2 mediated) –only involves mucosa and +/- submucosa
pts with what form of IBD are at a higher risk of CRC?
Ulcerative colitis > Chron’s disease
gross appearence of chron’s disease vs ulcertive colitis
chron’s: skipping transmural infalm with cobblestone musosa and bowel wall thickening, creeping fat
ulcerative colitis: pseudopolyps and infalm of mucosa and submucosa only (congestion), loss of haustra
imaging of chron’s disease vs ulcertive colitis
chron’s: string sing on barium swallow, fistulas
ulcerative colitis: lead pipe appearance, toxic megacolon on barium swallow, CT shows thickened mucosa
more likely to present with blood diarrhea
ulcerative colitis
what causes toxic megacolon in ulcerative colitis?
shutdown of neuromuscular function secondary to exposure of fecal material to muscularis mucosae and neural plexus
what is ulcerative proctitis?
infalmmation confined to the rectum, milder form of ulcerative colitis
what is proctosigmoiditis?
coninuous inflammation of the rectum to the sigmoid
*ulcerative colitis
What is left sided colitis?
continuous Inflammation extends from the rectum up the left side through the sigmoid and descending colon
*stops at splenic fissure
What is pancolitis?
inflammation affecting the entire colon
What is fulimnant colitis?
affects entire colon and is life threatening –> pain, profuse diarrhea, dehydration and shock –> SIRS
*assc with extensive colonic injury
how does chon’s disease typically present in the mouth?
apthoid ulcers
what part of the stomach does chron’s disease typically present (if it is in the stomach at all)
distal antrum and duodenal buld
*presents as ulcers
What are extra-intestinal manifestations of IBD
Erythema Nodosum (parallels IBD activity)
Pyroderma gangrenosum (not tied to flares)
Episcleritis (parallels flares), scleritis, uveitis
arthritis
type of panniculitis (inflammation of subcutaneous tissue) with lymphocytes, macrophages and multinucleated giant cells, leading to fibroblastic repair response and fibrosis
Erythema Nodosum
assc with utic acid and oxalate kidney stones
chron’s disease
What is the most common age of onset for IBD
20-29 yo
What is the most common chief complaint of IBD
bloody diarrhea
What are the most common chief complaints seen in chron’s disease?
abdominal pain, non-blood diarrhea (right sided colon), weight loss
effect of smoking on IBD
inc incidence of chron’s and decreased incidence of UC
most common site of chron’s disease
ileum > ascending colon
What is Bechet syndrome? How does it present?
small vessel vasculitis with recurrent oral aphthous ulcers, genital ulcers, and uveitis
How does collagenous colitis present?
watery intermittent diarrhea with greater than 10 bowel movements per day
which IBD is assc with fistulas?
Chron’s
Incidence of tenesmus is more assc with chron’s or UC?
UC, rectum is inflamed and cannot control the urge to fefecate
