Inflammatory Bowel Disease

Question 1

Definition

Answer 1

– chronic lifelong disease with inflammation of the GI tract; acute flare-ups with remission
o Ulcerative Colitis – colon only, mucas and submucosa
 Associated with ex-smokers
 Glandular atrophy with crypt distortion; hypertrophy of Muscularis mucosa
o Crohn’s Disease – anywhere in GI tract; transmural inflammation

Question 2

Epidemiology

Answer 2

-1 million people worldwide with white people and jewish most common
o Often diagnosed between ages of 15-30 or 50-70

Question 3

Pathogenesis

Answer 3

– genetic predisposition, environmental triggers (bacteria/infection), mucosal immune system defect

Question 4

Colonoscopy Morphology

Answer 4

o Ulcerative colitis – rectum involved, ileum not involved, diffuse, superficial ulcers, pseudopolyps common; granular mucosa, primary sclerosing cholangitis (fibrotic disease of the bile duct)
o Crohn’s disease – ileum involved; rectum not involved; segmental disease, perianal disease, strictures/fistulas; deep linear ulcers

Question 5

Symptoms (GI, Specific to chrones, Systemic)

Answer 5

o GI – diarrhea, abdominal pain, mucus/pus/blood, tenesmus, urgency, incontinence, rectal pain
o Specific to Crohn’s – intra-abdominal abscess, perianal abscess, fistula
o Systemic – fever, weight loss, fatigue, pyoderma gangrenosum (ulcers on body from ulceritive colitis)

Question 6

Therapeutic Pyramid

Answer 6

aim to induce remission  sustain remission  improve quality of life
o Topical, oral antibiotics and steroid (5ASA) – mild cases
o Moderate – IV steroids and infliximab
o Severe – surgery

Question 7

Possible Diagnosis

Answer 7

o Ulcerative colitis
o Crohn’s colitis
o C. Difficile – bacterial infection causing diarrhea and inflammation of colon toxic megacolon; use of antibiotics can cause the infection because competing bacteria in gut get killed by antibiotics; can mask ulcerative colitis until it C. difficile is treated
o E.coli 0157:H7

Question 8

Side Effects of Steroids

Answer 8

sleep distrurbances, mood changes, fatigue, increase appetite, fluid retention, acne, heartburn, osteoporosis, headaches, avascular necrosis, myopathy (skin striae), cataracts

Question 9

Side Effects of Immunosuppressive Agents

Answer 9

(6MP, Azathioprine, Imuran, Purinethol) – pancreatitis, bone marrow toxicity, liver toxicity, lymphoma
 Useful to keep patient in remission but frequent lab work required to monitor

Question 10

Side Effects of Biologics/Anti-tumor necrosis factor

Answer 10

 infliximab IV infusion – used for induction, maintentance of CD and UC and fistulizing Crohn’s
 adalimuman (humira), Certolizumab (cimezia)
 reactivation of TB and hepatitis B, opportunistic infections, risk of lymphoma

Question 11

Symptoms Common to ulcerative colitis and crohn’s

Answer 11

diarrhea, abdominal pain, mucus/pus/blood in stool, tenesmus, urgency, incontinence, rectal pain, weight loss, fever, fatigue

Question 12

Ulcerative Colitis

Answer 12

affects ONLY colon
 Begins in rectum and extends proximally in CONTINUOUS fashion
 Quitting smoking can unmask ulcerative colitis (quitting does NOT CAUSE IT)
 Superficial inflammation
 Colonoscopy – reveals continuous inflammation, superficial ulcers, granular mucosa, pseuodopolyps
 Biopsy – grandular atrophy with crypt distortion
 Total colectomy is curative however extra-intestinal manifestations can still exist

Question 13

Crohn’s Disease

Answer 13

– can affect entire GI tract (rarely the rectum)
 Inflammation is transmural
 Complications include: stricture, fistula, abscess, perianal disease
 Colonoscopy – segmental inflammation, deep/linear ulcers, cobblestoning
 Biopsy – granulomas
- surgery can treat complications but NOT CURE