Inflammatory Bowel Disease - Pathoma

Question 1

What is the proposed cause of IBD?

Answer 1

Probably due to abnormal immune response to enteric flora

Question 2

What is the classic presentation of IBD?

Answer 2

• Young women (teens to 30s) with recurrent bouts of blood diarrhea and abdominal pain
• More prevalent in the West
  
  • particularly Caucasians, and Eastern European Jews

Question 3

What is the extent of the wall involvement in Ulcerative Colitis?

Answer 3

mucosal and submucosal ulcers

Question 4

What areas of the GI tract are predominantly affected by Ulcerative Colitis (location)?

Answer 4

• Begins in rectum
  
  • can end extend proximally up to the cecum
  • remainder of the GI tract is unaffected
• CONTINUOUS INVOLVEMENT

Question 5

What symptoms are specific to Ulcerative Colitis?

Answer 5

Left lower quadrant pain (rectum)

with bloody diarrhea

Question 6

What is the histologic hallmark of the inflammation seen in Ulcerative Colitis?

Answer 6

Crypt abscesses with neutrophils

Question 7

What does the gross appearance of Ulcerative Colitis look like?

Answer 7

• Pseudopolyps
  
  • (response to healing of the ulceration)
• Loss of haustra
• “Lead pipe” sign on imaging

Question 8

What are the potential complications of Ulcerative Colitis? What are the risks of complications based on?

Answer 8

• Toxic megacolon and Carcinoma
  
  • risk is based on extent of colonic involvement and duration of disease
  • generally not a concern until >10 years of disease

Question 9

What are three pathological associations of Ulcerative Colitis?

Answer 9

1. Primary sclerosing cholangitis
2. p-ANCA positivity
3. Smoking (protective against UC)

Question 10

What is the extent of the wall involvement in Crohn’s Disease?

Answer 10

Full-thickness inflammation with knife-like fissures

Question 11

What areas of the GI tract are predominately involved in Crohn’s Disease?

Answer 11

• Anywhere from mouth to anus
  
  • with skip lesions
• Terminal ileum is the most common site
• Rectum is least common site

Question 12

What symptoms are specific to Crohn’s Disease?

Answer 12

• Right lower quadrant pain (ileum)
• Non-bloody diarrhea

Question 13

What is the histologic hallmark of the inflammation seen in Crohn’s Disease?

Answer 13

Lymphoid aggregates with granulomas

Question 14

What is the gross appearance of Crohn’s Disease?

Answer 14

Cobblestone mucosa

creeping fat

strictures

(“string sign” on imaging)

Question 15

What are the potential complications of Crohn’s Disease?

Answer 15

• Malabsorption with nutritional deficiency
• Calcium oxalate nephrolithiasis
• Fistula formation
• Carcinoma
  
  • if colonic disease is present

Question 16

What are the 6 pathological in Crohn’s Disease?

Answer 16

1. Ankylosing spondylitis
2. Sacroiliitis
3. Migratory polyarthritis
4. Erythema nodosum
5. Uveitis
6. Smoking → increases risk for Crohn’s Disease