Inflammatory Bowel Disease Flashcards
What are the types of inflammatory bowel disease?
Ulcerative colitis and crohn’s disease
What are the 6 main characteristics features of ulcerative colitis?
-diffuse inflammation limited to the colonic mucosa. - Disease can be confined to the rectum (proctitis), - extend more proximal into the sigmoid and descending colon (left sided colitis), or involve the entire colon (pancolitis). - The inflammation will almost always involve the rectum, - Inflammation will be continuous to its proximal most extent (i.e. there are no skip lesions), - Does not involve the upper gastrointestinal tract or small bowel.
What are the main features of crohn’s disease?
- characterized by transmural inflammation - can affect any part of the gastrointestinal tract - locations of involvement such as the terminal ileum, colon and perianal area are much more common than other areas. - If Crohn’s disease is confined to the colon without small bowel or perianal involvement it can be difficult to distinguish from ulcerative colitis → In this case the term indeterminate colitis is often employed.
What are the features of microscopic and collagenous colitis?
- Collagenous colitis and microscopic colitis (also called lymphocytic colitis) are colitides characterized by: = watery, non-bloody diarrhea with inflammation present on the microscopic level but normal appearing mucosa when viewed endoscopically. = Commonly occur in woman age 50 and older.
drugs used to treat UC?
- sulfasalazine - 5-ASA molecule 2. 6-MP - purine synthesis inhibitor 3. Infliximab - anti TNFalpha 3. Colectomy NB: Mesalamine does not work for Crohn’s But first line for UC Immunomodulators –> 6MP, azathioprine and MTX
treatment of colorectal cancer
- excision of the tumor and involved lymph nodes 2. adjunct chemotherapy 5-FU
What is the difference in the gross morphology of UC and Crohn’s?
- In Crohn disease = “cobblestone” mucosa, strictures and creeping fat - In ulcerative colitis, there is pseudopolyps
What are the differences in barium imaging between Crohn’s and UC?
Crohn’s –> string pipe = narrowing of the lumen UC –> lead pipe appearance = loss of haustra
Biologic agents
-Infliximab, Certolizumab and Adalimumab –> injection or IV. Work well. Work against TNF alpha. Keep people from having abscesses, flares and surgeries. - Vedolizumab –> helps with homing. Only interacts with the alpha4B7 which is only in the gut unlike natalizumab which also works in the brain. - Natalizumab –> blocks interaction between integrin/addressin pairs – > problem causes PML (progressive multifocal leukoencephalopathy)
Differences in extraintestinal manifestations seen in UC vs. Crohn’s?
Crohn disease is associated with migratory polyarthritis and nephrolithiasis - Ulcerative colitis is associated with primary sclerosing cholangitis (p-ANCA positive) - Both subtypes are associated (to varying degrees) with the following disorders: Pyoderma gangrenosum; Erythema nodosum; Ankylosing spondylitis; Uveitis; Aphthous ulcers
Compare effectiveness of biologics and immunomodulators.
-Biologics are better than immunomodulators -Also better in combinaton
Risks of biologics?
Serious infection –> clear association of biologic agents with TB
What is the difference between Crohn’s and UC in the location of the GI affected?
- Crohn disease begins anywhere from mouth to anus with “skip lesions”; the rectum is very rarely involved. - Ulcerative colitis begins in the rectum and can extend up to the cecum, with continuous involvement (and sparing of the remainder of the GI tract)
What is the difference in the pattern of inflammation seen in UC and Crohn’s?
- Crohn’s = transmural inflammation, Th1-mediated process; lymphoid aggregates with noncaseating granulomas. - UC = mucosal inflammation (superficial submucosa may also be affected), Th2-mediated process; crypt abscesses with neutrophils, but no granulomas.
Risk = probability X consequence
perceived risk is more important
Three ways of presentation of colorectal cancer? (second leading cause of cancer-related deaths in the US)
- Asymptomatic discovered through screening - Suspicious symptoms and signs - Emergency admission for intestinal obstruction, peritonitis, or acute GI bleed
How do notable signs and symptoms of colorectal cancer differ based on location along the GI tract?
- Proximal (right-sided) tumors commonly appear as fungating exophytic masses. More commonly produce occult bleeding leading to iron deficiency anemia. - Distal (left-sided) tumors commonly appear annular (sometimes called a “napkin-ring” or “apple core” appearance). - Distal tumors also more commonly produce obstructive symptoms (constipation, decreased stool caliber, bowel obstruction). - Rectal cancer symptoms may include tenesmus (constantly feeling the need to pass stools despite an empty colon), rectal pain, and diminished caliber of stools.
What are the two common most important risk factors from IBD?
- Malnutrition due to inflammation which destroys the mucosal cell wall and decreases the intestine’s ability to digest and absorb nutrients. - Adenocarcinoma due to higher turnover of epithelial cells, which increases the risk of cancer. Seen in all chronic inflammatory conditions.
How often do immunomodulators cause lymphoma? How often do they cause pancreatitis?
0.04% (4 in 10 000) 3% Absolute risks better than relative risk 5-ASA works well for UC not Crohn’c Combination therapy is most effective for both
What can we learn about lymphoma from the transplant literature?
Mostly caused by reactivation of IBD
How would a tubular adenoma look on histology?
How would a tubular adenoma look on histology?
How would a colorectal cancer look grossly?
Appearance of the intestinal wall in UC
Appearance of the intestinal wall in Crohn’s
