Inflammation of the GI tract Flashcards

Question

What is Ulcerative Colitis?

Answer 1

- Chronic relapsing and remitting condition typically presenting with recurrent episodes of rectal bleeding - Mild and infrequent vs severe - Highest incidence 15-25 years, smaller peak at 60-70 years, no gender difference - Inflammation confined to mucosa unless severe - Typically involves rectum +/- left colon (variable length) - Involvement of whole colon (pancolitis) continuous distribution but generally limited to colon and rectum

Answer 2

- Congested - Erythematous - Ulceration - Granular appearance - Flat (loss of normal mucosal folds in large bowel) - Sharp demarcation of diseased segments and normal mucosa

Answer 3

-Infiltration of colonic crypts by neutrophils -Formation of crypt abscesses -Inflammatory polyps -Some pseudo polyps= islands of residual mucosa appear polyp as surrounded by areas of extensive ulceration =Broad and flat bottomed, extend into submucosa, undermine adjacent mucosa, rupture of crypt abscesses

Answer 4

- Limited to rectum only (proctitis) - Rectum and variable length of colon in continuity - Rectum and variable length of colon in continuity and discontinuous involvement of caecum and appendix (caecal patch lesion) - Entire colon and rectum (pan-proctocolitis)

Answer 5

-Irregular, shortened and branched crypts and increased inflammatory cells in mucosa

Answer 6

- "Regional enteritis" - Chronic, multifocal, relapsing condition that can affect any part of the GI tract (mouth to perianal skin) - Peak incidence 20-30 years with smaller peak 60-70 years, no gender difference - Variety of presentations depending on part of GI tract involved- abdominal pain, diarrhoea, weight loss, strictures and obstruction, fistulae - Transmural (all layers) inflammation often patchy and discontinuous (skip lesions)

Answer 7

- Small intestine (30-35%) - Colon (25-30%) - Small intestine and colon (30-40%) - Anus/ perianal region (50%) - Stomach and duodenum (5%, more common in children) - Oesophagus (2%, more common in children)

Answer 8

``` -Granulomas =aggregates of activating macrophages =70% cases =Fewer in right colon than left =Commoner in children =Tend to be larger in adults =Fewer after 2 years of illness =Particularly helpful in diagnosis when present deeper within wall/ within draining lymph nodes =Mucosal granulomas least specific as can occur in UC but usually associated with damaged crypts in lamina propria ```

Answer 9

- Aphthous ulcers - Not broad based and flat like UC - Small superficial ulcers overlying patches of mucosa-associated lymphoid tissue - In rectum, ulceration extends into anal canal, involves perianal skin - Ulceration typically along border of colon to which the mesocolon is attached - More severe= crisscrossing linear ulceration= cobblestone mucosa - Fissuring ulceration= deep and knife-like, can extend through to muscularis propria, can give rise to fistula

Answer 10

- As involves full thickness= fibrosis - Narrowed lumen, stricture formation - Lymphoid aggregates

Answer 11

*All from Crohn's -Subacute intestinal obstruction =Fistulae =Malabsorption (small bowel involvement) *with UC as well =Toxic dilation (distended large bowel loops as damage to nerve supply) =Perforation =Haemorrhage =Amyloidosis =Neoplasia

Answer 12

- Risk increased in both UC and CD (highest in UC) - Risk increases with time since diagnosis (mean duration 17-21 years) - Risk increases with severity and extent of disease - Most commonly colorectal adenocarcinomas but also increased risk of small bowel carcinomas and other malignancies (bile duct carcinomas, leukaemias) - Affects about 5% of patients with CD and 11% of UC

Answer 13

Arthritis and ankylosing spondylitis - UC + - CD +++

Answer 14

``` -Primary sclerosing cholangitis =UC +++ =CD + -Bile duct carcinoma =UC +++ =CD + ```

Answer 15

``` -Erythema nodosum =UC +++ =CD +++ -Pyoderma gangrenosum =UC +++ =CD + ```

Answer 16

``` -Oral ulceration =UC + =CD +++ -Eye lesions =UC +++ =CD +++ -Amyloid (rare) =UC + =CD +++ ```

Answer 17

- UC= Cryptitis, crypt abscesses, mucin depletion, crypt architectural distortion and crypt loss in chronic UC, paneth cell metaplasia - CD= patchy inflammation, lymphoid aggregates, cryptitis and mucin cell depletion less prominent, pyloric metaplasia in small intestine, cobblestone pattern from linear ulcers running in different direction

Answer 18

- Infective colitis mimics CD= bacterial and parasitic, sextually trasnmitted chlamydia and syphilis cause inflammation in rectum that resembles UC - Ischaemic colitis= most common in region of splenic flexure and descending colon - Diverticular disease= most common in sigmoid colon, can result in fistulas to bladder - Drug induced colitis (NSAIDs, ileocolic inflammation where CD usually presents) - Radiation colitis- proctitis - Neoplasia= CD= mass lesions, fistulae and strictures

Answer 19

- Characterised by outpouching of bowel mucosa through weak points in the wall - Consequence of high intra-lumenal pressure in chronic constipation - Outpouchings can rupture= abscesses= fistulae

Answer 20

- CD - Ischaemic colitis - Diverticular disease - Diaphragm disease (NSAIDs)= thin membrane like strictures due to repeated episodes of ulceration and healing - Neoplasia

Answer 21

-Older patients -Usually presents as chronic watery diarrhoea over several months -Normal appearance of colonic and rectal mucosa at endoscopy -Increase in chronic inflammatory cells in lamina propria -Two patterns =Collagenous colitis (thick band of thick collagen within superficial lamina propria, mucosal fragility- detached from collagen band) =Lymphocytic colitis (numerous intraepithelial lymphocytes, CD3 immunohistochemistry)

Answer 22

- Cause often not identified - Lymphocytic colitis can be associated with coeliac disease - Drugs implicated in both forms, lansoprazole (PPI for acid suppression, collagenous) and NSAIDs

Answer 23

Steroids (budesonide)

Inflammation of the GI tract Flashcards

(47 cards)