Inflammatory Bowel Disease B&B

Question 1

who is the classic patient to present with inflammatory bowel disease?

Answer 1

White woman, 15–40 years old, of Jewish descent

Question 2

which layers of the GI tract lining are affected in ulcerative colitis? which sections of the GI tract are involved?

Answer 2

mucosa + submucosa (NOT muscularis)

ALWAYS starts in rectum and works upwards, but NEVER involves small intestine (it’s called “colitis” for a reason!)

Question 3

which type of IBD always has rectal involvement?

Answer 3

ulcerative colitis: affects mucosa + submucosa

ALWAYS begins in rectum and works upwards (LLQ pain), NEVER involves small intestine (it’s called “colitis” for a reason!)

Question 4

what are the classic gross morphology features of ulcerative colitis? (2)

Answer 4

1. pseudopolyps due to healing of ulcers
2. lead pipe appearance due to loss of haustra (pouches)

Question 5

what will histological examination of ulcerative colitis show?

Answer 5

crypt abscesses due to PMN infiltration

Question 6

what are the extra-intestinal features of ulcerative colitis? (4)

Answer 6

1. pyoderma gangrenosum: deep, necrotic skin ulcer
2. primary sclerosing cholangitis: strictures in bile tree (very specific)

[also see in Crohn’s:]
3. ankylosing spondylitis: inflammation of spine causes back pain
4. uveitis - caused by many autoimmune disorders

Question 7

what is the feared complication of ulcerative colitis?

Answer 7

toxic megacolon - cessation of colonic contractions leads to intestinal dilation and rapid distention, which may cause deadly perforation

abdominal pain + distention + fever + diarrhea + shock

Question 8

which 2 factors modulate risk of adenocarcinoma developing from ulcerative colitis?

Answer 8

1. duration of disease (>10yrs)
2. extent of disease (begins in rectum, works up)

screening colonoscopy or colectomy recommended

Question 9

which antibody is found in patients with ulcerative colitis vs Crohn’s disease?

Answer 9

ulcerative colitis: p-ANCA - also seen in vasculitis syndromes

Crohn’s: anti-saccharomyces cerevisiae antibodies (ASCA) - something to do with yeast idk

Question 10

which layers of the GI tract lining are affected in Crohn’s Disease? which sections of the GI tract are involved?

Answer 10

transmural granulomatous inflammation affecting any portion of GI tract (mouth to anus)

however, often spares rectum (unlike UC!) and often “skips” lesions

Question 11

what malabsorptive complications are typical of Crohn’s Disease? (2)

Answer 11

commonly affects terminal ileum, causing malabsorption of:
1. vitamin B12 (absorbed in ileum)
2. bile salts —> gallstones, secretory diarrhea, steatorrhea (DAKE vitamin malabsorption)

Question 12

what is the hallmark of biopsy of Crohn’s Disease? what will gross morphology show (4)?

Answer 12

biopsy shows non-caseating granulomas, can be found in ANY portion of GI tract, causes transmural inflammation

gross morphology gives appearance of cobblestone mucosa, may also cause fistulas (due to transmural inflammation spreading), strictures, and creeping fat (fat wrapped around bowel)

Question 13

what are the extra-intestinal features of Crohn’s Disease? (5)

Answer 13

1. migratory polyarthritis - most common
2. erythema nodosum - red splotches due to inflammation of fat under skin
3. calcium oxalate kidney stones - fat malabsorption allows fat to bind Ca2+, increasing free oxalate

[also see in UC:]
4. anklyosing spondylitis
5. uveitis

Question 14

which type of T cells mediates ulcerative colitis vs Crohn’s Disease, and why does this make sense?

Answer 14

ulcerative colitis: Th2

Crohn’s: Th1 - this makes sense bc the pathology is characterized by granulomatous inflammation

Question 15

what is the relationship between smoking and ulcerative colitis vs Crohn’s Disease?

Answer 15

smoking improves (wth??) outcomes in ulcerative colitis

smoking worsens outcomes in Crohn’s and can cause flares

Question 16

why is sulfasalazine such a great drug for IBD caused by ulcerative colitis or Crohn’s*? which 2 side effects can occur?

Answer 16

sulfasalazine is broken down by colonic bacteria into 5-aminosalicyclic acid (5-ASA), which function the same as aspirin
[sulfASAlazine]

therefore, it isn’t active until it reaches the colon

great for UC or Crohn’s *with colonic involvement

note: is a sulfa drug, and can cause oligospermia in men (reversible)