Inflammatory Bowel Disease (IBD) Flashcards
Crohn’s and Ulcerative Colitis are the most common types of IBD.
What is IBD?
A group of conditions characterised by Idiopathic inflammation of the GI tract
What 2 conditions come under the term, Inflammatory Bowel Disease
Compare them in regards to;
- Part of GI affected
- Pattern of inflammation
- Part of area affected
- Presence of granulomas
- Likelihood of rectal bleeding
Crohn’s Disease:
- Can affect all of GI tract (Most cases-Ileum)
- Discontinuous patches of inflammation (Skip Lesions)
- Transmural (Full thickness of bowel wall affected)
- Sometimes Granulomas are present
- Rectal bleeding is less likely
Ulcerative Colitis (UC):
- Large bowel affected only, begins in Rectum
- Continuous
- Mucosa and Submucosa only
- No granulomas
- Rectal bleeding is more likely
What are 2 structural consequences of Crohn’s disease?
Why doesn’t Ulcerative Colitis lead to this?
Fistulas and Strictures, as Crohn’s is Transmural
UC- Not transmural
(Fistulas: Can be between Bowel and Skin/ Bladder/ Vagina)
What is Pancolitis? (AKA total/ universal colitis)
A form of UC that affects the entire large intestine (Begins at rectum)
What are 4 extra-intestinal regions affected by IBD?
- MSK (arthritis)
- Skin (Psoriasis, Erythema nodosum)
- Liver/ biliary tree (Primary Sclerosing Cholangitis)
- Eye problems
List 4 things that are thought to contribute to causing IBD
- Genetics
- Gut organisms
- Immune response
- Triggers (Diet, Smoking, Antibiotics, Infections)
How does smoking affects Crohn’s and Ulcerative Colitis?
- Makes Crohn’s worse
- Makes UC slightly better
How does Trasmural Inflammation in Crohn’s affect the bowel wall and lumen?
- Bowel wall thickens
- Lumen narrows
What are 4 methods of investigating Crohn’s?
- Blood tests (Anaemia)
- CT/ MRI (Obstruction, Bowel wall thickening)
- Barium enema (Allows visualisation of strictures, fistulae)
- Colonoscopy (Skip lesions, Cobblestone appearance, strictures, fistulae)
Under a microscope, Crohn’s will show a Granuloma
What are 4 pathological changes of Ulcerative Colitis under a microscope? (UC)
- Inflammatory infiltrate in Lamina Propria
- Reduced no. of goblet cells
- Crypt abscesses (Neutrophilic exudate in crypts, rare in Crohn’s)
- Crypt distortion (Irregular shaped glands with dysplasia, darker crowded nuclei)
What are 2 pathological changes of UC visible on a Colonoscopy?
- Pseudopolyps (Non-neoplastic, more common in UC, develop after repeated episodes)
- Loss of Haustra (folds within large bowel)
List 6 investigations for UC
- Blood tests (Anaemia, Serum markers of inflammation)
- Stool cultures (C Difficile, Faecal Calprotectin will be raised)
- Colonoscopy
- Plain abdominal radiographs
- Bacterial enema (mild cases only)
- CT/ MRI (Less useful for UC than Crohn’s)
What is Indeterminate colitis?
A set of symptoms that can’t be classified as either Crohn’s or Ulcerative Colitis
Describe the incidence of perianal disease/ inflammation in Crohn’s and UC
Crohn’s;
- Common (75% of cases)
UC;
- Rare
What is the “string sign of Kantour” in Crohn’s?
Strictures between areas of normal bowel, appears as a string of beads
