inflammatory bowel disease Flashcards
mucosal ulceration in the colon
ulcerative colitis
transmural inflammation
chron’s
equal incidence between chron’s and ulcerative
yep
what type of cells are granulomas made off
histiocytes
IBD genetics:
- ATG16L1 and NOD2
- IRGM
- IL23-R
- autophagy related-process of segregation and disposal of damaged organelles within a cell is impaired leading to bacteria/antigens triggering immune response
- immunity relateed GTPase which increases risk for Chrons
- interleukin-23 receptor which leads to increased risk for chrons and certain populations with UC
ulcerative colitis:
- symptoms
- location
- serologic testing
- pseudopolyps
- histo
- acute complication
- natural course of disease
- increased risk as times goes on
- what do see endoscopally
- bloody diarrhea, nocturnal diarrhea
- always starts at the rectum and continues sequentially through the colon
- positive P-ANCA
- finger like projections of residual normal mucosa
- inflammation is confined to the mucosa with crypt abscess, gland distortion and dysplastic crypts with no goblet cells
- toxic megacolon
- intermittent
- colorectal cancer- colorectal adenocarcinoma
- erythmea, punctuate ulcerations
3 different types of chrons
- inflammatory
- obstructive
- fistulizing
string sign
chrons
cobblestone appearance
chrons, parts that is healing
chron’s skip lesions
chrons manifestation is through segmental involvement and not continuous
perineal disease
chrons
nearly 80% of patients with chrons require surgery
yep
- but recurrence is common within 6 year after surgery
- it is a chronic illness with flares and remissions
positive ASCA
chrons disease
osteoporosis in IBD
it happens!! incidence is about 20-30% and it can happen with or without corticosteroid use
complication of IBD specific to pediatric population
growth failure and delayed sexual development
surgery in IBD
- ulcerative colitis
- chrons
- panproctocolectomy due to failure of med therapy, dysplasia
- directed to specific complications
nutritional therapy in IBD
- best nutritional source
- parenteral
- enteral
- repleting vitamin deficiency
- food
- not a primary therapy for either
- primary therapy in chrons
- vit. D, calcium, vit. B12 especially in chrons
pro-inflammatory cytokines
TNFAlpha and IL-12
is rectal bleeding more common in UC or CD
UC
frequent small volume diarrhea with urgency
UC
abdominal pain localized to the right lower quadrant
CD
endoscopically, deep ulcers with skip lesions
CD
pathology shows cryptitis with crypt abcess and branching of crypts
both
pathology shows granulomas
CD
almost 90% chance of recurrence of disease after surgery
CD
chronic inflammatory disease of the colon where the etiology is unclear but us linked to several medications such as NSAIDs, PPIs, sertraline/SSRIs and ranitidine
microscopic colitis
diagnosis of microscopic colitis
colonoscopy with random biopsies from right and left side of the colon that will show lymphocytic colitis >10 or collagenous colitis with increased thick colonic subepithelial collagen band and increased intraepithelial lymphocytes
type of diarrhea with microscopic colitis (2)
- chronic, persisten, non-bloody watery diarrhea
2. nocturnal diarrhea, decal incontinence
treatment for microscopic colitis
- mild
- mild to severe
- low residue diet and pepto
- oral budesonide that works topically on the colon
*** eliminate offending medications
ischemic bowel disease occurs most commonly in the
colon
chronic ischemia can present with ulcers and strictures and thus resembles
chrons disease
ischemic bowel disease pathology
- acute
- organizing
- healed
- acute- hemorrhage in lamina propria, epithelial coagulative necrosis
- organizing- granulation tissue and fibrosis
- healed- atrophy, shortened crypts, branched glands
