IBD (Nichols and Bessoff)

Question 1

IBD is characterized as a dysregulation of

Answer 1

the immune response to gastrointestinal luminal bacteria

Question 2

2 major forms of IBD

Answer 2

chron’s disease and ulcerative colitis

Question 3

smoking increase the risk for what form of IBD

Answer 3

chron’s disease

**DECREASED risk of ulcerative colitis

Question 4

appendectomy increase the risk for what form of IBD

Answer 4

chron’s disease

**DECREASED risk of ulcerative colitis

Question 5

high sanitation level in childhood has an increased risk for what form of IBD

Answer 5

chron’s disease

Question 6

location of chron’s disease vs ulcerative colitis

Answer 6

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

Question 7

microscoptic pathology of chron’s disease vs ulcerative colitis

Answer 7

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

Question 8

pts with what form of IBD are at a higher risk of CRC?

Answer 8

Ulcerative colitis > Chron’s disease

Question 9

gross appearence of chron’s disease vs ulcertive colitis

Answer 9

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

Question 10

imaging of chron’s disease vs ulcertive colitis

Answer 10

chron’s: string sing on barium swallow, fistulas

ulcerative colitis: lead pipe appearance, toxic megacolon on barium swallow, CT shows thickened mucosa

Question 11

more likely to present with blood diarrhea

Answer 11

ulcerative colitis

Question 12

what causes toxic megacolon in ulcerative colitis?

Answer 12

shutdown of neuromuscular function secondary to exposure of fecal material to muscularis mucosae and neural plexus

Question 13

what is ulcerative proctitis?

Answer 13

infalmmation confined to the rectum, milder form of ulcerative colitis

Question 14

what is proctosigmoiditis?

Answer 14

coninuous inflammation of the rectum to the sigmoid

*ulcerative colitis

Question 15

What is left sided colitis?

Answer 15

continuous Inflammation extends from the rectum up the left side through the sigmoid and descending colon
*stops at splenic fissure

Question 16

What is pancolitis?

Answer 16

inflammation affecting the entire colon

Question 17

What is fulimnant colitis?

Answer 17

affects entire colon and is life threatening –> pain, profuse diarrhea, dehydration and shock –> SIRS
*assc with extensive colonic injury

Question 18

how does chon’s disease typically present in the mouth?

Answer 18

apthoid ulcers

Question 19

what part of the stomach does chron’s disease typically present (if it is in the stomach at all)

Answer 19

distal antrum and duodenal buld

*presents as ulcers

Question 20

What are extra-intestinal manifestations of IBD

Answer 20

Erythema Nodosum (parallels IBD activity)
Pyroderma gangrenosum (not tied to flares)
Episcleritis (parallels flares), scleritis, uveitis
arthritis

Question 21

type of panniculitis (inflammation of subcutaneous tissue) with lymphocytes, macrophages and multinucleated giant cells, leading to fibroblastic repair response and fibrosis

Answer 21

Erythema Nodosum

Question 22

assc with utic acid and oxalate kidney stones

Answer 22

chron’s disease

Question 23

What is the most common age of onset for IBD

Answer 23

20-29 yo

Question 24

What is the most common chief complaint of IBD

Answer 24

bloody diarrhea

Question 25

What are the most common chief complaints seen in chron’s disease?

Answer 25

abdominal pain, non-blood diarrhea (right sided colon), weight loss

Question 26

effect of smoking on IBD

Answer 26

inc incidence of chron’s and decreased incidence of UC

Question 27

most common site of chron’s disease

Answer 27

ileum > ascending colon

Question 28

What is Bechet syndrome? How does it present?

Answer 28

small vessel vasculitis with recurrent oral aphthous ulcers, genital ulcers, and uveitis

Question 29

How does collagenous colitis present?

Answer 29

watery intermittent diarrhea with greater than 10 bowel movements per day

Question 30

which IBD is assc with fistulas?

Answer 30

Chron’s

Question 31

Incidence of tenesmus is more assc with chron’s or UC?

Answer 31

UC, rectum is inflamed and cannot control the urge to fefecate