inflammatory bowel disease Flashcards
what is the course associated with IBD ?
relapsing remitting
what is the most common population associated with IBD ?
white jewish female in her 30s
what are the typical studies that should be sent when considering IBD ?
stool cultures
testing for E coli
other stool studies
what are the pathologic features associated with UC ?
autoimmune inflammation of the mucosa - not full thickness
1- presents with ulcers
2- pseudopolyps
3- crypt abscess
always starts in the rectum - works its way up
never involves the small intestine
what is the presentation of UC ?
bloody diarrhea
left lower quadrant pain
what is the gross morphology appearance of UC ?
loss of hausterations ( lead pipe appearance)
what type of infiltration is associated with crypt abscess in UC ?
PMN infiltration of the crypts
what are the extra intestinal features associated with UC ?
pyoderma gangernosum
PSC
ankylosing spondylitis
Uveitis
what is a feared complication of UC ?
toxic megacolon
what is the cause of toxic megacolon ?
cessation of colonic contractions
inhibiton of smooth muscle contraction due to increased levels of nitric oxide
this can cause perforation
what is the presentation of toxic megacolon ?
UC - ba3dein geh b bowel distention and shock
what is the risk of developing adenocarcinoma after UC based on?
duration of the disease
extent of the disease
involvement of the right side of the colon is associated with more disease
what are the risk factors of developing adenovcarnoma after UC ?
right sided colitis
pancolitis
what s the serology associated with the diagnosis of UC ?
p-ANCA
ASCA
what are the pathologic features associated with crohns disease ?
granulomatous inflammation
entire wall is affected - transmural
has skip lesions
often spares the rectum
any potion of the GI tract can be affected
what is the classic location of crohns and what are the associated clinical features ?
associated with the terminal ileum
so prsents with malabsorption
vitamin b12 def
non bloody diarrhea
what is the hallmark of crohns disease on biopsy ?
non caseating granuloma
what is the gross morphology finding in Crohns disease ?
cobblestone mucosa
development of fistulas
creeping fat
strictures
what type of fistulas are seen in crohns disease ?
enterovesical ( bladder)
peri anal
abdominal
what is seen with strictures in crohns disease ?
string sign
what is the gross morphology associated with crohn’s disease ?
fistulas
creeping fat
strictures
when is adenocarcinoma a risk ?
only when there is colon involvement
what are the extra intestinal features of crohns disease ?
migratory polyrthiritis - large joint affection
erythema nodosum
kidney stones - calcium oxalate stones ( due to fat malabsorption)
ankylosing spondylitis
uveitis
what is the immunology associated with IBD ?
UC - th2 mediated response ( no granukoma)
CD - Th1 response due to the presence of granuloma
what is the effect of smoking on IBD ?
smoking improves the UC
worsens CD
what are the side effects of sulfasalzine ?
GI upset
sulfonamide hypersenitivity
oligospermia in men
where is 5 ASA absorbed ?
in the jejunum
which of the cytokines are anti inflammatory in association with IBD ?
IL-10 TGF-b
what does the description ulcer with necrotic debris in association with IBD refer to ?
pyoderma gangernoum in association with UC
