inflammatory bowel disease: UC + Chron's Disease

Question 1

TRANSMURAL inflammation EVERYWHERE
ANYWHERE: mouth to anus (small intestine + large intestine, most common location: TERMINAL ILEUM)
SKIP LESIONS
SPARING OF RECTUM: 50%

Answer 1

Chron’s disease

Question 2

imbalance between intestinal flora → inflammation

Answer 2

Chron’s disease

Question 3

treatment of Chron’s disease

Answer 3

probiotics: maintain healthy bacterial flora

Question 4

diagnosis of Chron’s disease

Answer 4

transmural inflammation→narrowed lumen (barium swallow - “string sign”)

Question 5

complications of Chron’s disease

Answer 5

stricturing
diarrhea
malabsorption (inflammation prevents absorprtion by enterocytes)
weight loss
fissures
fistulas
↑ risk colon cancer
systemic symptoms:
arthritis (IBD - HLA B27 seronegative spondyloarthropathies)
immunologic problems
erythema nadosum

Question 6

types of fistulas in Chron’s disease

Answer 6

enterocolonic: small intestine and colon
enterovesicular: small intestine and bladder
enterovaginal
enterocutaneous

Question 7

IBD associated with erythema nadosum: red, painful subq nodules on shins

Answer 7

Chron’s disease

Question 8

histology of Chron’s disease

Answer 8

non-caseating granulomas (= chronic inflammation)

Question 9

treatments for chron’s disease

Answer 9

mild disease: 5-ASA agents (mesealamine, sulfasalazine)
azathioprine or mercaptopurine > methotrexate
anti-TNF agent (infliximab, adalimumab): if have IBD + arthritis
steroids +/- antibiotics for acute exacerbation

Question 10

MUCOSA + SUBMUCOSA inflammation in COLON only
starts in distal colon → proximal
CONTINOUS lesions
ALWAYS affects rectum

Answer 10

ulcerative colitis

Question 11

autoimmune IBD

Answer 11

ulcerative colitis

Question 12

diagnosis of ulcerative colitis

Answer 12

barrium enema: haustra are obliterated “lead pipe”

Question 13

histology of ulcerative colitis

Answer 13

crypt abscesses
ulceration
bleeding

Question 14

complikcation

Answer 14

bloody diarrhea (rectum involved)
malnutrition
↑ risk of colon cancer (more than IBD)
1° sclerosing cholangitis (scarring, inflammation of biliary tract)
pyoderma gangrenosum
sacroilitis or uveitis (HLA-B27 association)

Question 15

IBD associated with pyoderma gangrenosum

Answer 15

ulcerative colitis

Question 16

treatment of ulcerative colitis

Answer 16

salicylates (5-ASA agent): sulfasalazine (bound to salicylate when in colon it breaks apart so will only work in colon)
 6-mercaptopurine
infliximab: anti-TNFalpha
TNF-alpha inhibitors
colectomy (cure)

Question 17

IBD associated with primary sclerosing cholangitis

Answer 17

ulcerative colitis

Question 18

IBD associated with ankylosing spondylitis

Answer 18

ulcerative colitis and

chron’s disease (type of arthritis - HLA-B27)