Inflammatory Bowel Disease Flashcards
- 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
Inflammatory Bowel Disease
Involves mucosal and submucosal layers
Ulcerative Colitis
- Begins in rectum, and ascends continuously proximally up to the cecum
- usually stays confined to rectosigmoid colon
Ulcerative Colitis
- LLQ pain, with bloody diarrhea
- Formed versus loose stool
- Severe abdominal pain unusual
Ulcerative colitis
Histology:
- Cryptitis/crypt abscesses with neutrophils
- Lamina propria expansion with acute and chronic inflammatory cells
- Crypt architectural distortion
Ulcerative colitis
Gross appearance:
- pseudopolyps
- loss of haustra –> “Lead pipe” sign on imaging
Ulcerative colitis
Complications: Toxic megacolon and carcinoma
Ulcerative colitis
Associated with:
- primary sclerosing cholangitis
- p-ANCA positive
Ulcerative colitis
Smoking is protective
Ulcerative colitis
Full thickness inflammation with knife-like fissures
Crohn’s Disease
- May involve any part of the GI tract from mouth to anus.
- Predominantly affects the terminal ileum; rectum is least common
- Skip lesions
Crohn’s Disease
Lymphoid aggregates with granulomas (non-caseating)
Crohn’s Disease
- Right lower quadrant pain (ileum) with non-bloody diarrhea
- Weight Loss
- Growth Retardation
- Fever of Unknown Origin
Crohn’s Disease
Gross appearance:
- Cobblestone mucosa
- Creeping fat
- Strictures
- “String-sign” on imaging
Crohn’s Disease
Complications:
- malabsorption with nutritional deficiency
- calcium oxalate nephrolithiasis
- fistula formation
- carcinoma
- perianal disease
Crohn’s Disease
- 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
Crohn’s Disease
Smoking increases risk and symptoms
Crohn’s Disease
- a noninvasive method of diagnosing or assessing disease activity in suspected or known Crohn’s
- Complementary to SBFT, but potentially more sensitive
Enterography
- 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
Differential diagnosis for bloody diarrhea
painful nodules on the shins
Erythema Nodosum
- Ulcerations, but without pathogens; is a neutrophilic expansion
- Typically don’t biopsy, b/c will make the ulcer worse
Pyoderma Gangrenosum
- Erythema Nodosum
- Pyoderma Gangrenosum
- Ankylosing spondylitis
- Sacroilitis
- Migratory polyarthritis
- Peripheral arthirtis
- Uveitis
- Episcleritis
Extraintestinal manifestions of IBD
