Inflammatory Bowel

Question 1

Types of IBD

Answer 1

ulcerative colitis

crohn’s disease

Question 2

other differentials for IBD

Answer 2

indeterminate colitis

pseudomembranous colitis (reaction to antibiotics. overgrowth of clostridium and toxins cause ulceration and loss of surface)

diverticulitis (blips of mucosa punched out of gaps in muscle)

Question 3

Features of Ulcerative Colitis

Answer 3

relapsing/remitting course
inflammatory change in the WHOLE colon
superficial ACUTE inflammation (no fibrosis as get rid of damage in ulcer)

Question 4

Clinical signs of UC AND crohn’s

Answer 4

anaemia
raised inflammatory markers
dehydration

Question 5

Classic features of UC pathology

Answer 5

crypt abscesses (with neutrophils in)
ulceration on top
oedema
ALL damage is more superficial than muscularis mucosa. remainder of wall spared from inflammation.

Question 6

Risk in Ulcerative Colitis

Answer 6

Colonic carcinoma
the regeneration of gut epithelium, provides increased risk of mutation, risk of dysplasia.
Increased risk of colonic carcinoma.

Question 7

Major differences between UC and Crohn’s

Answer 7

1. not JUST the colon - anywhere on the GIT! often terminal ileum
2. inflammation not restricted to mucosa - goes all the way through wall = FIBROSIS.
3. LYMPHOCYTES not neutrophils.
4. GRANULOMAS
5. skip lesions
6. FISTULA can develop if lymphoid infiltrates out on cirrhosa and ulcers join up

Question 8

Symptoms of Crohn’s

Answer 8

tiredness
fever
dry
diarrhoea

Question 9

How do fistulas develop

Answer 9

if two loops of SI are affected and stick together, stick to bladder, can go through into bladder

Question 10

If have macrocytic anaemia - what are you thinking?

Answer 10

Crohn’s!

Question 11

Differences between UC and Crohn’s

Answer 11

Involvement (colon/mouth to anus)
Extent (rectum to colon/terminal ileum +-)
Continuous? (yes/skip lesions)
Wall Involvement (mucosa/transmural)
Ulceration (broad-based ulcers/linear ulcers
Mesentery involvement (no/thickened)
Fissures/fistulae (No/Yes)
Crypts (shortened atrophic in both)
Crypt abscesses (Yes/No)
Granulomas (No/Yes)
Cells (plasma and neutrophils/neutrophils and lymphocytes)

Question 12

What is meant by ‘Pseudomembranous’ Colitis C.diff

Answer 12

explosion of necrotic/mucousy stuff all over the place, covers colonic surface with necrotic
= pseudomembrane

Question 13

problems associated with the pseudomembrane in ‘Pseudomembranous’ Colitis

Answer 13

gap in mucosa integrity - risk of infection

problems with absorption = diarrhoea

Question 14

who does ‘Pseudomembranous’ Colitis usually affect

Answer 14

older vulnerable people post antibiotic

Question 15

Treating ‘Pseudomembranous’ Colitis

Answer 15

need to get the normal bugs back to suppress the clostridium!
high grade antibiotics
or

Question 16

Diverticulitis

Answer 16

increased pressure in the gut can result in diverticulosus. if constipated, faeces can fill diverticulum. If thin wall, trauma/ischaemia causes gap in epithelium. Body exposed to lump of faeces causes acute inflammatory reaction focussed at the diverticulum.