Inflammatory Bowel Disease (IBD)

Question 1

What is Inflammatory bowel disease?

Answer 1

Inflammation of the small and large intestine

Question 2

Are IBD conditions acute or chronic?

Answer 2

Chronic

Question 3

What are the 2 chronic conditions in IBD?

Answer 3

1. Crohn Disease

2. Ulcerative Colitis

Question 4

Etiology of IBD

Answer 4

• Genetic susceptibility
• Complex trait etiology-> always have environmental triggers (In most cases, bacteria is the trigger)
• Loss of immune tolerance for normal gut flora

Question 5

Is IBD classic autoimmunity?

Answer 5

NO, because the immune system is not targeting the intestinal wall but is targeting the bacteria that is attached to the wall. This triggers inflammation and by default causes damage.

Question 6

Type of inflammation in crohn disease.

Answer 6

Granulomatous

Question 7

Type of inflammation in UC

Answer 7

Ulcerative and exudative

Question 8

Level of involvement in crohn disease

Answer 8

primarily submucosal

Question 9

Level of involvement in UC

Answer 9

primarily mucosal

Question 10

Extent of involvement in crohn disease

Answer 10

skip lesions

Question 11

Extent of involvement in UC

Answer 11

continuous lesions

Question 12

Areas of involvement in crohn disease

Answer 12

Primarily ileum, secondarily colon

Question 13

Area of involvement in UC

Answer 13

primarily rectum & left colon

Question 14

Is diarrhea common in crohn disease and UC?

Answer 14

yes

Question 15

Is rectal bleeding common in crohn disease and UC?

Answer 15

crohn disease = no

UC = yes

Question 16

Are fistulas common in crohn disease and UC?

Answer 16

crohn disease = yes

UC = no

Question 17

Are strictures common in crohn disease and UC?

Answer 17

crohn disease = yes

UC = no

Question 18

Are perianal abscesses common in crohn disease and UC?

Answer 18

crohn disease = yes

UC = no

Question 19

Is the development of cancer common in crohn disease and UC?

Answer 19

crohn disease = no

UC = yes

Question 20

Granulomatous?

Answer 20

Bumps of scar tissue

Question 21

What is the appearance of granulomatous tissue in a scope?

Answer 21

Cobblestone like appearance

Question 22

What are the statistics of the areas affected in Crohn disease?

Answer 22

~40% of cases affect the small intestine, ~30 of cases affect the large intestine, ~30% of cases affect both the small and large intestine

Question 23

Does crohn disease slowly or quickly progress and is it aggressive or non-aggressive?

Answer 23

It slowly progresses and is non-aggressive

Question 24

Manifestations of Crohn disease

Answer 24

• Intermittent diarrhea
• Colicky pain (spasmodic) in the abdomen
• Weight loss
• fluid-electrolyte imbalance d/t diarrhea

Question 25

Why does weight loss occur in Crohn disease?

Answer 25

The ileums major function is absorption and with damage to the intestinal wall this function is impaired so nutrients are not absorbed as much

Question 26

Complications of crohn disease?

Answer 26

- Fistulas - Abscesses - Strictures - Bowel obstruction

Question 27

Fistula?

Answer 27

An abnormal connection b/w two body parts

Question 28

Abscess?

Answer 28

Swollen area of the body, containing accumulation of pus

Question 29

Where is the abscess in Crohn disease?

Answer 29

Perianal area

Question 30

Stricture?

Answer 30

Constriction of a tube [aka the intestine, may result in obstruction]

Question 31

What are 3 reasons weight loss occurs in IBD?

Answer 31

- decrease absorption SA in SI (only in Crohns) - fluid loss d/t diarrhea - malnutrition

Question 32

What kind of spread occurs from the rectum in US?

Answer 32

proximal spread

Question 33

Crypt abscesses?

Answer 33

Crypts of Leiberkuhn

Question 34

Crypts of leiberkuhn?

Answer 34

Tubular glands of the intestinal mucosa, attached to the villi of the intestines AKA intestinal crypt or intestinal gland

Question 35

What do the crypts secrete?

Answer 35

They normally secrete digestive enzymes and regenerate new tissue when damaged.

Question 36

Where can accumulation of pus in UC occur and what occurs when this happens?

Answer 36

In the crypts. This prevents the regrowth of new tissue (which is thought to lead to colorectal CA)

Question 37

What type of ulcers occur in UC?

Answer 37

bleeding ulcers aka lacerations

Question 38

Lacerations

Answer 38

A cut in the tissue, open sore

Question 39

What kind of tissue do you see in a pt with UC?

Answer 39

thickened and inflamed tissue

Question 40

Polyps?

Answer 40

invagination of granulation tissue into the lumen (the opposite of an out pouching such as diverticula)

Question 41

What kind of "sores/ulcers" do you see in UC?

Answer 41

pseudepolyps

Question 42

Pseudopolyps?

Answer 42

Pseudopolyps assume the appearance of a polyp, but contain inflammatory tissue so there is a substantial amount of exudate produced

Question 43

What can result due to the pseudopolyps in UC?

Answer 43

Can result in edema & fluid in the lumen which can cause congestion

Question 44

Manifestations of UC?

Answer 44

intermittent, bloody diarrhea d/t bleeding ulcers | abdominal cramping

Question 45

How do you diagnose UC?

Answer 45

scoping [colonoscopy/sigmoidoscopy] | - exclude GI infections by using lab tests

Question 46

What are treatment options for a pt with IBD?

Answer 46

- Anti-inflammatories (eg. Sulfasalazine -> used for chronic inflammation) - Steroids - Immunoregulatory drug (Methotrexate) - Antibiotics to control an overgrowth of normal flora (low dose bc you do not want to wipe out the normal flora) - Surgery may be required - Lifestyle modifications (decrease ingestion of offending foods)

Question 47

In which cases would surgery be required in IBD?

Answer 47

- fistulas cause a bowel obstruction - drain a bleeding ulcer - bowel ressection