inflammatory bowel disease Flashcards
what are the two chronic conditions of inflammatory bowel disease
- crohns disease
- ulceratvie colitis
what is the etiology of inflammatory bowel disease
- genetic susceptibility -not pinpointed to one specific gene
- environmental trigger (COMPLEX TRAIT)
- loss of immune tolerance for NORMAL gut flora (just gut flora immune defenses in gut targeting them)
what kind of lesions are there in crohns disease
skip lesions
what are the lesions like in ulcerative colitits
continuous (lesion) involvement of colon, beginning with rectum
what type of inflm does crohns disease have
granulomatous
what type of inflm does ulcerative colitis have
ulcerative & exudative
what level of bowel is invovled in crohns disease
primarily submucosal
what level of bowel is invovled in ulcerative colitis
primarily mucosal
extent of involvement in crohns disease
skip lesions
extent of involvement in ulcerative colitis
continuous
areas of involvement crohns disease
primarily ileum, secondarily colon
areas of involvement ulcerative colitis
primarily rectum and left colon
diarrhea common characteristic of crohns disease
yes
diarrhea common characterstic of ulcerative colitis
yes
does rectal bleeding happen with crohns or ulcerative colitis
crohns- rare
ulcerative colitis-common
do fistulas happen with crohns or ulcerative colitis
crohns- common
ulcerative colitis- rare
do strictures happen with crohns or ulcerative colitis
crohns- common
ulcerative colitis- rare
are peri anal abscesses crohns or ulcerative colitis
crohns- common
ulcerative colitis- rare
development of cancer with crohns or ulcerative colitis
crohns-uncommon
ulcerative colitis- relatively common
Chrons disease
- granulomatus inflm skip lesions: -cobblestone appearance
- primarily affects submucosa of terminal ileum
- other layers & areas may be affected: 40% LI, 30% SI, 30% both small and large intestine
- slow non aggressive progression
Mnfts of crohns disease
- intermittent diarrhea
- abdominal colic (wavey pattern of pain, cramping, spasmotic)
- WT loss
- fluid & electrolyte imbalance
Complications: -fistulas (structural complications, tube may obstruct contents in bowel) -abscesses -bowel obstruction (structural changes can cause bowel obstruction & other reasons)
why would a person loose weight if they had crohns disease?
parts of the small intestine are inflamed, inflammation damages & scar tissue, then cannot absorb nutrients through small intestine, nutritional deficiency d/t lack of absorption (decrease in absorptive surface causes nutritional deficiency)
what are the Crypts of Liebuerkuhn
are glandular structures that open into spaces between the villi (the cells of these glands are called paneth cells that secrete intestinal juice as the gradually migrate along the side of the crypt & the villus they are eventually shed into the lumen of the intestine)
in ulcerative colitis a characteristic of the diseases is the lesions that form in the crypts of liebuerkuhn
Ulcerative colitis
- primarily affects mucosa of colon & rectum
- proximal spread form rectum (begins in rectum progress proximaly to sigmoid colon to terminal descending colon
- continuous lesions with:
- crypt abscess
- bleeding ulcers
- inflamed & thickening of layer
- pseudopolyps (areas of granulation tissue & inflammatory cells, like polyps pouches into intestinal wall)
- edema & congestion
Mnfts of ulcerative colitis
- relapsing bloody diarrhea (when it relapses it is persistent)
- abdominal cramping
Diagnosing Inflammatory bowel disease
- history, physical exam
- sigmoidoscopy, colonoscopy, biopsy
- exclude GI infection
Treatment of Inflammatory bowel disease is based on
-based on severity
Treatment of Inflammatory bowel disease is?
- anti-inflm (eg. SULFASALAZONE)
- steriods (if non-responsive to sulfasalazone, do not use steriods as first line because have many side effects dont want to use steriods longterm or in high doses)
- immunomodulator (eg. METHOTREXATE)
- Abx for overgrowth (only if there is overgrowth of normal flora)
- Sx? if fistulas want to remove, -if bleeding ulcers need to drain ulcers -If area of the gut is too far gone non-responsive resect the gut (bowel resuction)
- lifestyle modifications -diet, offending foods same as IBS
