Inflammatory Bowel Disease/Carcinoid, Gastrointestinal Stromal Tumor and Lymphoma Flashcards
Inflammatory Bowel Disease
- group of chronic inflammatory conditions of colon and small intestine
- chronic relapsing immune activation and inflammation within the GI tract
- dysregulation of the immune response to GI luminal bacteria
2 major forms of IBD
1) Crohn Disease
2) Ulcerative Colitis
Environmental Risk Factors for IBD
- cigarette smoking (dec. UC, inc. CD)
- appendectomy (dec. UC, inc. CD)
- high-sanitation level in childhood (inc. CD)
- high-intake refined carbs (inc. CD)
“Hygiene Hypothesis”
- -incidence of immune-mediated diseases rising in developed countries (related to modern hygiene or lack of exposure)
- Conflicting data in IBD (protective: exposure to pets), or maybe risk factor
Ulcerative Colitis
- chronic inflammatory disorder of the GI tract affecting the large bowel, relapsing
- begins in rectum and extends proximally continuously,no skin lesions
- rarely pericolonic abscess
- indolent, relapsing disease
- no skip lesions
Ulcerative Colitis: Endoscopically
-hyperemia, edema, granularity with friability, easy bleeding, broad based ulceration, pseudopolyps, tunnels with mucosal bridges, rarely perforation
Ulcerative Colitis: Toxic Megacolon
-shutdown of neuromuscular function secondary to exposure of fecal material to muscularis mucosae and neural plexus
Ulcerative Colitis: Gross Pathology
-edematous, congested and hemorrhagic mucosa with superficial ulceration and loss of normal folding pattern
Ulcerative Colitis: Microscopic Pathology
- edematous congested mucosa with more blue than normal = inflammatory cell nuclei, and with superficial ulceration
- cyrpt “abscesses”
Ulcerative Proctitis
- inflammation is confined to the rectum
- rectal bleeding may be the only sign
- rectal pain, feeling of urgency or an inability to move the bowels in spite of the urge to do so (tenesmus)
- this form of ulcerative colitis tends to be mildest
Proctosigmoiditis
- involves rectum/sigmoid
- bloody diarrhea, abdominal cramps and pain and tenesmus are common
- continuous
Left-sided colitis
- inflammation extends from rectum up the left side through the sigmoid and descending colon
- bloody diarrhea, abdominal cramping and pain on left side, and unintended weight loss
- continuous
Pancolitis
- entire colon
- bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue and significant weight loss
Fulminant Colitis
- uncommon, life-threatening
- entire colon
- severe pain, profuse diarrhea, dehydration and shock, SIRS
- extensive and deep colonic injury
Barium Contrast Studies
- superb instrument to observe fine mucosal detail
- dependent on skill of radiologist
- requires appropriate use of barium, air insufflation, palpation, positioning, compression and use of spot films
Ulcerative Colitis: CT
- increasing use in diagnosis
- most sensitive for evaluation of free air (toxic megacolon with perforation)
- See liver, mesenteric inflammation & lymphadenopathy
- CT dosen’t show mucosal detail well (may miss subtle changes early in disease that can be seen with air contrast BE and endoscopy
Crohn’s Disease
- chronic
- involves any location of GI tract
- propensity for distal small bowel & proximal colon
- can involve mouth to anus: apthoid ulcers in mouth, esophageal ulcers, gastric disease, small bowel
Main location for Crohn’s?
illeum small intestine alone (30%) small intestine + colon (40%) colon alone (40%)