Inflammatory Bowel Disease

Question 1

Two areas primarily affected by IBD’s

Answer 1

• Colon

- Small Intestine

Question 2

Two Major forms of IBD

Answer 2

• Crohn’s Disease

- Ulcerative Colitis `

Question 3

Correlation between smoking and Ulcerative Colitis

Answer 3

-Smoking drastically DECREASES the development of Ulcerative colitis.

Question 4

Important Risk Factors for Crohn’s Disease

Answer 4

• Smoking (Most important)
• High Sanitation level in Childhood
• High intake of refined carbohydrates
• Previous Appendectomy

Question 5

“Hygiene Hypothesis”

Answer 5

• Incidence of immune-mediated diseases is rising in developed countries.
• There are conflicting data, so not quite set in stone.

Question 6

Areas of Ulcerative Colitis-mediated damage

Answer 6

• Begins in the rectum, then progresses proximally and continuously; NO SKIP SPOTS, inflammation and ulceration are seen in a continuous fashion
• Inflammatory damage is confined to either the mucosa or submucosa

Question 7

Endoscopic observations of Ulcerative Colitis

Answer 7

• Hyperemia, redness
• Edema
• Broad-based ulceration
• Pseudopolyps (also seen in Crohn’s Disease)
• Atrophy (in prolonged cases)

Question 8

Onset of Ulcerative Colitis

Answer 8

• Indolent

- Often relapses, then recurs

Question 9

Gross Pathology of Ulcerative Colitis

Answer 9

• Congested, hemorrhagic, and edematous mucosa
• Superficial ulceration
• Loss of normal folding pattern
• Pseudopolyps

Question 10

Microscopic Pathology of Ulcerative colitis

Answer 10

• Congested, edematous mucosa which is laden with the inflammatory cell nuclei
• Superficial ulceration
• Crypt abcesses which contain neutrophils
• Lymphocytes, Plasma Cells, Eosinophils, and Macrophages (BUT NO GRANULOMA FORMATION!)

Question 11

Ulcerative Proctitis

Answer 11

• Mildest form of Ulcerative Colitis
• Inflammatory damage is confined to the RECTUM
• RECTAL BLEEDING may be the only sign of actual disease

Question 12

S/S of Ulcerative Proctitis

Answer 12

• Rectal pain
• Feeling of Urgency
• Inability to move the bowels, despite the urge to do so (Tenesmus)

Question 13

Proctosigmoiditis

Answer 13

• Form of Ulcerative Colitis
• Continuous inflammatory damage in the RECTUM AND SIGMOID
• S/S:
  
  • BLOODY DIARRHEA
  • Abdominal Cramps, pain
  • Tenesmus

Question 14

Left-Sided Colitis

Answer 14

• Form of Ulcerative Colitis
• Continuous inflammatory damage IN THE RECTUM, SIGMOID, AND DESCENDING COLON
• S/S:
  
  • Bloody diarrhea
  • Abdominal cramps, PAIN ON THE LEFT SIDE
  • unintended weight loss

Question 15

Pancolitis

Answer 15

• Form of Ulcerative Colitis
• Inflammatory damage which affects the RECTUM AND ALL OF THE COLON
• S/S:
  
  • Bouts of bloody diarrhea which CAN BE SEVERE
  • Abdominal Cramps, Pain
  • SIGNIFICANT weight loss

Question 16

Fulminant Colitis

Answer 16

• Form of Ulcerative Colitis
• UNCOMMON, BUT LIFE THREATENING!
• Affects the ENTIRE COLON AND RECTUM
• Inflammatory damage is DEEP and EXTENSIVE
• S/S:
  
  • Severe pain in the abdominal region
  • Profuse diarrhea
  • Dehydration, resulting in shock
  • SIRS

Question 17

Barium Contrast studies

Answer 17

• Allows for the visualization of fine mucosal detail
• Early stages of IBD can be seen
• Critical in the Dx of IBD

Question 18

CT Studies in IBD

Answer 18

• Most sensitive for evaluation of free air in colon
• Allows for the visualization of other abdominal organs, as well as mesenteric lymph nodes
• DOES NOT demonstrate mucosal details well; may not show subtle changes in early stages of IBD

Question 19

Areas of Involvement in Crohn’s Disease

Answer 19

• ANY location from the mouth to the anus
• Tend to affect the distal ileum and proximal colon the most
• SKIP LESIONS are common

Question 20

Common Findings in Crohn’s Disease

Answer 20

• Aphthous Ulcers in mouth
• Esophageal Ulcers
• Gastric disease/trauma
• Small bowel

Question 21

Epidemiology of Crohn’s Disease

Answer 21

• Females are slightly more affected than males.
• Can arise anytime from adolescence to middle adulthood
• MOST CASES occur in the age range of 20-30

Question 22

Classical Findings in Crohn’s Disease

Answer 22

• Aphthous Ulcers
• Skip lesions
• Deep ulcerations
• Stricture Formation
• Fistula formation
• Disease which may be limited to the right colon

Question 23

Pathological Features of Crohn’s Disease

Answer 23

• Transmural involvement
• NONCASEATING GRANULOMA
• Fissuring with fistula
• Skip Lesions

Question 24

Gross Pathology of Crohn’s Disease

Answer 24

• COBBLESTONE MUCOSA
• Transmural disease
• Skip lesions, with alternating areas of affected bowel
• “Creeping fat” on serosa

Question 25

Microscopic Pathology of Crohn’s Disease

Answer 25

• Edema

- Neutrophils, Eosinophils, Plasma Cells, Lymphocytes, Macrophages with GRANULOMA FORMATION

Question 26

Endoscopy of Crohn’s Disease

Answer 26

• Ulcerations

- Pseudopolyps

Question 27

Radiology of Crohn’s Disease

Answer 27

• Mucosal Hyperenhancement
• Mesenteric Hypervascularity
• Visual Evidence of Fistula formation

Question 28

Extra-intestinal Manifestations of Crohn’s Disease

Answer 28

• Enterocutaneous Fistulae
• Aphthous Ulcers
• Erythema Nodosum
• Pyoderma Gangrenosum
• Scleritis, Episcleritis, Uveitis
• Gallstones (USUALLY DUE TO TERMINAL ILEUM RESECTION!)
• UA and Oxaloacetate stones
• Hypercoagulable state

Question 29

Risk Factors for Colorectal Cancer

Answer 29

• Extensive, Chronic IBD
• Young age at the onset of IBD
• Family history of colorectal cancer
• History of Sclerosing Cholangitis
• Presence of backwash ileitis (UC variant)