inflammatory bowel disease

Question 1

inflammation ….. infection

Answer 1

IS NOT

Question 2

What are the two major forms of IBD

Answer 2

1. Crohn’s disease
2. Ulcerative colitis

Question 3

epidemiology of IBD

Answer 3

o Peak between the ages of 15-30 and second peak between the ages of 60-80.
oMore frequent in“rich” countries/places such as north America, Scandinavia, andEurope.

Question 4

Where does UC begin

Answer 4

Colon and rectum

Question 5

Where does CD begin

Answer 5

Any part of the GI tract

Question 6

describe the development of UC

Answer 6

Continuous pattern of inflammation

Question 7

describe the development of CD

Answer 7

Skips lesions

Question 8

describe the onset of UC

Answer 8

Acute (sudden/rapid) onset

Question 9

describe the onset of CD

Answer 9

Gradual onset

Question 10

What happens within patients with UC

Answer 10

»Ulcers, ulcerations, (pseudo)polyps, bulges in mucosa
»Normal architecture damaged
»Microbiome affected.
» BLOOD IN STOOL
»Can cause colon cancer

Question 11

What happens within patients with CD

Answer 11

» Entire intestinal wall affected.
» Granulomas (inflammations)
» Thicker wall, smaller lumen
» Cobble stones
» Perforations – stool leaks into abdominal cavity

Question 12

What are the symptoms of UC

Answer 12

» Rectal bleeding
» Having to go to the toilet very often
» Loose stools
» Abdominal pain on the lower left side
»Tenesmus: urge to defecate
» Blood in stool

Question 13

WHat are the symptoms of CD

Answer 13

» Chronic and nocturnal diarhhea OR constipated
» Pain in lower right abdomen
» Weight loss
» Mild fever
» Increases in severity with age = progressive disease
» absecces and fistulae

Question 14

What are the extra intestinal symptoms of UC

Answer 14

»Joint pain
»Canker sore(aften) in mouth
»Spinal deformation due to inflammation
»Slow healing wounds
»Erythema nodosum
»Eye bleeding

Question 15

WHat are the extra-intestinal symptoms of CD

Answer 15

» Inflammated joints
» Same as ulcerative colitis
» Kidney problems
» Galstones
» Liver problems

Question 16

Crohn’s disease clinical features

Answer 16

(1) Inflammation -> small intestine (abdominal pain, diarrhea, and fever) & large intestine (diarrhea, blood loss, weight loss and fever)
(2) Stricturing -> Bowel obstructions due to wall thickening
(3) Penetration -> abscesses and fistulae (abnormal passages get formed)

Question 17

describe the pathogenesis of IBD

Answer 17

1. Genetic susceptibility: some kind of genetic predisposition – variants that cause an exaggerated inflammatory response.
2. Immune response: the overreactive immune response – people with IBD react worse to inflammations.
3. Environmental triggers: we see that IBD is more common inn wealthy countries so environmental factors do play a role HOWEVER we’re not really sure which ones.
4. Microbiome (more recently added): the collection of all bacteria that live inside our intestines – people with IBD have distinctively different microbiomes than their family members without IBD.

Question 18

Risk factors that can cause IBD

Answer 18

» Diet
» Infection – if people with a genetic predisposition get certain infections, their body will react with an exaggerated inflammatory
response = the start of IBD
o Crohn’s – mycobacterium paratuberculosis
o Ulcerative colitis - after episodes of infective diarrhea
» Appendectomy (ONLY UC)
» Stress – stress triggers a relapse of IBD (NOT THE CAUSE BUT CAN TRIGGER RELAPSE)

Question 19

What actually happens within the body during the overreactive immune response? (IBD)

Answer 19

= it’s an abnormal reaction of the T-cells that cause an exaggerated inflammatory response
o (Causative agents+luminal factors+modifying factors)–cause an inflammation.

But HOW?
o Lymphatic T-cells get sent to the affected zone.
o These T-cells cause the exaggerated inflammatory response.
o If the response is not transmural then it’s UC, if it is then it’s Crohn’s disease.

Question 20

Explain the diagnosis of IBD

Answer 20

1. Blood tests – check for c-reactive protein which gets released in blood during an inflammatory reaction
2. Stool studies
3. Colonoscopy (=most frequently done) and endoscopy
   a. Ileo-colonoscopy with biopsies (sometimes with small intestine as well)
   b. Upper endoscopy with biopsies
   (Capsule endoscopy - capsule with camera = still in development)

Question 21

Explain the treatment of IBD

Answer 21

= the main goal of the treatment is to minimize the intestinal inflammation + improve general health + repair/heal the mucosa

Pharmacological management
o Anti-inflammatory agents: 5-amino salicylic acid (5-ASA)
o Steroids, cortisone they suppress the immune system HOWEVER can only be given for acertain number of days.
o Anti-tumor necrosis factor(anti-TNF) agents–TNF is a protein in your body that causes inflammation (everything that can be given ends with …mab)
o Probiotics – they strengthen the microbiome daily.

Question 22

Is UC transmural or not

Answer 22

no, NOT transmural

Question 23

Is CD transmural or not

Answer 23

yes, transmural

Question 24

Tenesmus

Answer 24

urge to defecate

Question 25

abscesses

Answer 25

localized collections of pus that result from an infection

Question 26

fistulae

Answer 26

abnormal connections or tunnels that form between two organs or between an organ and the outside of the body - the transmural inflammation can lead to the formation of fistulae

Question 27

Erythema nodosum

Answer 27

red spots on legs

Question 28

explain the role of appendectomy in UC

Answer 28

people that get an appendectomy are less likely to develop UC, and people who developed UC after appendectomy were less likely to develop recurrent disease. = less severe course