Inflammatory Bowel Disease

Question 1

• Chronic, relapsing inflammation of the bowel
• Possibly due to abnormal immune response to tenteric flora
• Classically presents in young women (teens to 30’s)
• Presents with recurrent bouts of bloody diarrhea and abdominal pain
• Diagnosis of exclusion

Answer 1

Inflammatory Bowel Disease

Question 2

Involves mucosal and submucosal layers

Answer 2

Ulcerative Colitis

Question 3

• Begins in rectum, and ascends continuously proximally up to the cecum
• usually stays confined to rectosigmoid colon

Answer 3

Ulcerative Colitis

Question 4

• LLQ pain, with bloody diarrhea
• Formed versus loose stool
• Severe abdominal pain unusual

Answer 4

Ulcerative colitis

Question 5

Histology:

• Cryptitis/crypt abscesses with neutrophils
• Lamina propria expansion with acute and chronic inflammatory cells
• Crypt architectural distortion

Answer 5

Ulcerative colitis

Question 6

Gross appearance:

• pseudopolyps
• loss of haustra –> “Lead pipe” sign on imaging

Answer 6

Ulcerative colitis

Question 7

Complications: Toxic megacolon and carcinoma

Answer 7

Ulcerative colitis

Question 8

Associated with:

• primary sclerosing cholangitis
• p-ANCA positive

Answer 8

Ulcerative colitis

Question 9

Smoking is protective

Answer 9

Ulcerative colitis

Question 10

Full thickness inflammation with knife-like fissures

Answer 10

Crohn’s Disease

Question 11

• May involve any part of the GI tract from mouth to anus.
• Predominantly affects the terminal ileum; rectum is least common
• Skip lesions

Answer 11

Crohn’s Disease

Question 12

Lymphoid aggregates with granulomas (non-caseating)

Answer 12

Crohn’s Disease

Question 13

• Right lower quadrant pain (ileum) with non-bloody diarrhea
• Weight Loss
• Growth Retardation
• Fever of Unknown Origin

Answer 13

Crohn’s Disease

Question 14

Gross appearance:

• Cobblestone mucosa
• Creeping fat
• Strictures
• “String-sign” on imaging

Answer 14

Crohn’s Disease

Question 15

Complications:

• malabsorption with nutritional deficiency
• calcium oxalate nephrolithiasis
• fistula formation
• carcinoma
• perianal disease

Answer 15

Crohn’s Disease

Question 16

• Mutations of the NOD-2/ CARD 15 gene on chromosome 16 have been associated with Crohns disease in 30% of cases.
• CARD 15 is an intracellular protein expressed in monocytes and macrophages which has a high affinity for bacterial lipo-polysaccharides which lead to nuclear factor-KB activation

Answer 16

Crohn’s Disease

Question 17

Smoking increases risk and symptoms

Answer 17

Crohn’s Disease

Question 18

• a noninvasive method of diagnosing or assessing disease activity in suspected or known Crohn’s
• Complementary to SBFT, but potentially more sensitive

Answer 18

Enterography

Question 19

• Infectious colitis** (need to culture stools)
• Crohn’s colitis (Crohn’s diseaes of the colon)
• Diversiton colitis (colostomy/ileostomy)
• Radiation colitis
• Ischemic colitis
• C. difficile colitis
• Factitious colitis

Answer 19

Differential diagnosis for bloody diarrhea

Question 20

painful nodules on the shins

Answer 20

Erythema Nodosum

Question 21

• Ulcerations, but without pathogens; is a neutrophilic expansion
• Typically don’t biopsy, b/c will make the ulcer worse

Answer 21

Pyoderma Gangrenosum

Question 22

• Erythema Nodosum
• Pyoderma Gangrenosum
• Ankylosing spondylitis
• Sacroilitis
• Migratory polyarthritis
• Peripheral arthirtis
• Uveitis
• Episcleritis

Answer 22

Extraintestinal manifestions of IBD