IBD - pathology

Question 1

What makes up IBD?

Answer 1

Ulcerative Colitis + Crohn’s disease

Question 2

What is the effect of smoking on UC and Crohn’s?

Answer 2

Aggrevates Crohn’s

Protective against UC

Question 3

Are NSAID’s helpful in IBD?

Answer 3

no they aggrevate it

Question 4

What is the presentation of UC?

Answer 4

Diarrhoea + bleeding
Increased bowel frequency
Urgency
Tenesmus
Incontinence
Night rising – go to the toilet over night 
Lower abdo pain (esp. LIF)

Question 5

Describe the TrueLove and Whitt criteria for Severe UC?

Answer 5

Severe ulcerative colitis = 30% risk of colectomy
>6 bloody stools/24 hour
\+
1 or more of
  Fever (>37.8°C)
  Tachycardia (>90/min)
  Anaemia (Haemoglobin <10.5g/dl)
  Elevated ESR (>30mm/hr)

Question 6

What investigations are done for UC?

Answer 6

Bloods:
C-reactive protein (CRP)
Albumin (a negative acute phase reactant)

Plain AXR
Endoscopy
Histology

Question 7

What are the longterm complications of UC?

Answer 7

Increased risk of colorectal cancer

Extensive colitis (to beyond splenic flexure)

Question 8

Name some extra-intestinal manifestations of UC?

Answer 8

Skin
- pyoderma gangrnosum
- Erythema nodosum
Joints
- Axial, peripheral joints
Eyes
Deranged LFTs
Oxalate renal stones

Question 9

What is Primary sclerosing cholangitis?

Answer 9

Chronic inflammatory disease of biliary tree

Question 10

Describe the pathology of Crohn’s disease?

Answer 10

Can affect any region of GI tract from mouth to anus
Skip lesions
Transmural inflammation
CAN HAPPEN ANYWHERE IN THE GI TRACT

Question 11

What is Peri-anal disease?

Answer 11

Recurrent abscess formation
Pain
Can lead to fistula with persistent leakage
Damaged sphincters

Question 12

What are the symptoms of Crohn’s (depending on the site of it)?

Answer 12

Small intestine
-Abdominal cramps (peri-umbilical)
-Diarrhoea, weight loss
Colon
-Abdominal cramps (lower abdomen)
-Diarrhoea with blood
-Wt loss
Mouth
-Painful ulcers, swollen lips, angular chielitis
Anus
-peri-anal pain, abscess

Question 13

What investigations can be done for crohn’s disease?

Answer 13

Clinical exam
Evidence of wt loss, RIF mass, peri-anal signs

Bloods
CRP, albumin, platelets, B12 (t.ileum), ferritin

Stage disease extent

Question 14

What can happen to a Crohn’s patient who does not respond to drugs?

Answer 14

Not responding to drugs -> fibrosis in the bowel -> stricture in the bowel -> bowel obstruction -> surgery

Question 15

What are the complications of Crohn’s disease?

Answer 15

Malabsorbtion
Iatrogenic (short bowel syndrome) due to repeated resections and recurrences
Hypoproteinemia, Vitamin deficiency, Anaemia of all types
Gallstones
Fistulas
Anal disease
Bowel obstruction
Perforation – particularly in colon
Malignancy
Amyloidosis
Rarely Toxic megacolon - explodes

Question 16

What microbiology causes Crohn’s?

Answer 16

Persistent activation of T-cells and macrophages (failure to switch off)

Excess proinflammatory cytokine production

Maybe alterable by changing intestinal microflora…”Probiotics”

Question 17

Where is ulcerative collitis confined to?

Answer 17

colon and rectum

Question 18

What layers of the epithelium does UC affect?

Answer 18

Mucosal and submucosal inflammation

Question 19

What happens to the mucosa in UC?

Answer 19

inflammtory cells destroy the crypts

Question 20

Are there granulomas in Crohn’s or UC?

Answer 20

Crohn’s

Question 21

What is a rare complication of UC?

Answer 21

Toxic megacolon

Question 22

What is the general pathological outcome of Crohn’s?

Answer 22

Thickened bowel and stricture

Question 23

What is the general pathological outcome of UC?

Answer 23

Mucosal ulceration and thin wall