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MD3002 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is the aetiology of inflammatory bowel disease ?

A 
• Multifactorial
• Genetic factors
• Autoimmune / Immune dysfunction 
• Environmental factors (e.g. diet, normal microflora)
- External 
- Internal
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2
Q

Identify the main types of inflammatory bowel disease.

A
  • Ulcerative Colitis
  • Crohn’s Disease
  • Indeterminate colitis
  • Pseudomembranous Colitis
  • Diverticulitis
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3
Q

Describe the epidemiology of UC.

A
  • Female > Male (due to auto-immune factors to the disease)
  • Adolescence and early adulthood – median age 30
  • Non-smokers (only)
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4
Q

ULCERATIVE COLITIS

  • Timeline
  • Pathogenesis
A

ULCERATIVE COLITIS
-Timeline: Usually relapsing/remitting course throughout life
-Pathogenesis:
• Characterised by inflammatory change in the colon (always affect rectum, and then a variable length of the colon)
• Raised inflammatory markers (WBCs, CRP increased)
• Inflammation is contiguous, circumferential (full circumference of colon), superficial (only affecting mucosa, not submucosa/muscle)

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5
Q

What is the word for UC of the entire colon ? What is the treatment for this ?

A

Pancolitis

Pancolectomy

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6
Q

What are the main symptoms of ulcerative colitis ? Explain why each one occurs.

A
  • Colicky type pain (inflamed colon squeezing)
  • Mucoid diarrhea, often bloody (blood from ulcers which ulcerate through mucosa and reveal blood vessels)
  • Fatigue (uses up energy, including nutrients and fluids)
  • Weight loss (most of what you eating is passing through v quickly + inflammatory process uses up nutrients)
  • Fever (due to inflammation)
  • Dehydration (bad diarrhea)
  • Tenesmus (“a feeling of constantly needing to pass stools, despite an empty colon”), because rectum inflamed so nerve endings also inflamed so feel need to go but nothing there
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7
Q

Identify possible complications of ulcerative colitis.

A

♦ Anaemia – iron-deficiency (blood in diarrhea)
♦ Dehydration (high urea and cretanine, because dehydrated)

UC can also predispose to colonic carcinoma:
• Chronic inflammatory change damages cells
• This leads to dysplasia – loss of growth control within cells, which increases colonic carcinoma risk

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8
Q

Describe the macroscopic appearance of UC.

A

Many ulcerations in between pseudopolyps (regenerative mucosa)

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9
Q

Describe the histological appearance of UC, comparing it with normal histology.

A
  • A lot more inflammatory cells (purple dots)
  • Crypts not reaching all the way to muscle layer (shortened crypts)
  • Inside crypts, abscesses (neutrophils present) with destruction of crypts
  • Inflammation affects mucosal layer (superficial submucosa barely affected if at all, deeper layers not affected at all, very superficial)
  • Loss of Goblet cells
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10
Q

Describe the epidemiology of Crohn’s disease.

A
  • Adolescence and early adulthood – median age 30
  • Female > Male
  • Smokers
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11
Q

Which of UC or Crohn’s is more prevalent ?

A

UC is more prevalent

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12
Q

CROHN’S DISEASE

  • Timeline
  • Pathogenesis
A

CROHN’S DISEASE
-Timeline: Usually relapsing/remitting course
-Pathogenesis:
• Characterised by inflammatory change anywhere in the GI tract (so raised inflammatory markers)
• Discreet, focal ulceration (‘Skip lesions’), separated by normal tissue

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13
Q

Which parts of the GI does Crohn’s usually affect ?

A

− Small intestine alone – 40%
− Small intestine and colon – 30%
− Colon alone – 30%

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14
Q

What is the initial presentation of Crohn’s disease ?

A

Initial presentation is sometimes Terminal ileitis, can also sometimes be appendicitis

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15
Q

Identify the main symptoms of Crohn’s disease.

A

Same as UC

Except, potentially not so much blood in diarrhea

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16
Q

Identify possible complications of Crohn’s disease.

A
  • Anaemia – Absorption/Blood Loss (e.g. due to poor B12 absorption in terminal ileum)
  • Dehydration
  • Fistulas (full thickness inflammation, and deep ulcers, so eventually may sometimes ulcerate from one part of bowel to another, to another organ, or to the outside out to the skin). This may result in an infection due to bowel bacteria getting to other places (e.g. to bladder)
17
Q

Describe the macroscopic features of Crohn’s disease.

A
  • Creeping fat (mesenteric fat wraps around bowel surface)
  • Thick / rubbery intestinal wall (due to edema, inflammation, fibrosis (due to recruitment of firbo and myofibroblasts due to heal involved muscle), hypertrophy of muscularis propria)
  • Strictures (string sign on barium enema)
  • Sharp demarcation of affected segments from uninvolved bowel (skip areas)
  • Mucosal ulcers coalesce into long, serpentine linear ulcers along bowel axis to acquire cobblestone appearance
  • Fissures in mucosal folds lead to fistulas or sinus tracts
18
Q

Describe the histological features of Crohn’s disease.

A
  • Superficial or deep ulceration with adjacent granulation tissue (thanks to fibroblasts and myofibroblasts) extending into deep submucosa or below
  • Goblet cells present
  • Collections of macrophages forming granulomas
19
Q

Which of UC or Crohn’s has worse Extraintestinal Manifestations ? Identify them.

A

Crohn’s

Extraintestinal Manifestations of Crohn’s:

  • Inflammatory arthropathies
  • Erythema nodosum (painful rash on legs due to inflammation of subcutaneous fat)
  • Pyoderma gangrenosum (skin becomes necrotic in patches)
  • Primary sclerosing cholangitis (more associated with UC, but can also be with Crohn’s )
  • Iritis/Uveitis
  • Aphthous stomatitis (mouth ulcers)
20
Q

Compare UC and Crohn’s in terms of the following symptoms:

  • Abdominal Pain
  • Diarrhoea
  • Weight Loss
  • Lethargy
  • Fever
  • Dehydration
  • Tenesmus
A

UC

  • Abdominal Pain: +
  • Diarrhoea: Mucoid, Bloody
  • Weight Loss: +
  • Lethargy: +
  • Fever: +
  • Dehydration: +
  • Tenesmus: +

Crohn’s

  • Abdominal Pain: ++ (after eating)
  • Diarrhoea: Watery
  • Weight Loss: +
  • Lethargy: +
  • Fever: +
  • Dehydration: +
  • Tenesmus: -/+
21
Q 
Compare UC and Crohn's in terms of the following: 
Involvement
Extent
Continuous?
Wall Involvement
Ulceration
Mesentery Involvement
Fissures/Fistulae
A 
UC
Involvement: Colon only 
Extent: Rectum →	Colon
Continuous? Yes
Wall Involvement: Mucosa
Ulceration: Broad based ulcers
Mesentery Involvement: No
Fissures/Fistulae: No
Crohn's
Involvement: Mouth →	Anus
Extent: Terminal ileum +/-
Continuous? No (skip lesions) 
Wall Involvement: Transmural 
Ulceration: Linear ulcers
Mesentery Involvement: Thickened/Fibrotic
Fissures/Fistulae: Yes
22
Q 
Compare UC and Crohn's in terms of the following: 
Crypts
Crypt Abscesses
Villi
Granulomas
Cells
A 
UC
Crypts: Shortened/Atrophic
Crypt Abscesses: ++
Villi: Not involved
Granulomas: No
Cells: Plasma/Neutrophils
Crohn's
Crypts: Shortened/Atrophic
Crypt Abscesses: +/-
Villi: Atrophic
Granulomas: Yes
Cells: Neutrophils/Lymphocytes
23
Q

Define Pseudomembranous Colitis.

A

Severe acute inflammation of the bowel mucosa, with the formation of pseudomembranous plaques. Often due to C. Diff following antibiotic therapy.

24
Q

What are the symptoms, and the histological appearance of pseudomembranous Colitis ?

A

Watery diarrhea

Classic volcano structure (pus that explodes out)

25
Q

Define diverticulosis, and diverticulitis.

A

Diverticulosis = Presence of a number of diverticula of the intestine. “Weakness of the muscles of the colon, leads to the formation of diverticula, small blind pouches that form in the lining and wall of the colon.”

Diverticulitis = inflammation of a diverticulum

26
Q

Where does diverticulosis usually occur ?

A

In the sigmoid colon

27
Q

Define ischemic colitis.

A

Atheroma in arteries supplying gut (so thrombus forming), trauma, or other causes leads to cutting off of supply to part of bowel, so necrotic debris forms.

MD3002 (95 decks)

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