Inflammatory bowel diseases (Crohns Disease and Ulcerative Colitis)

Question 1

What is Crohns Disease?

Answer 1

Granulomatous Inflammation that occurs anywhere in the GI tract (from mouth to anus).

Discontinuous spread of disease.

Question 2

What are the causes of Crohns Disease?

Answer 2

Food intolerance
Persistent viral infection/immune system activity
Mycobacterium (paratuberculosis) infection

Question 3

Describe granulomatous inflammation and its role in Crohns disease.

Answer 3

A collection of multinucleate cells - which are not easily phagocytosed - form together.
The immune system continuously tries to phagocytose these cells which results in irritation and damage to the bowel.

Question 4

Who’s is commonly affected by Crohns disease?

Answer 4

Young individuals

Question 5

What areas of the GI tract are commonly affected by Crohn’s disease?

Answer 5

The terminal ileum, the ileocaecal junction, the mouth and the rectum.

Question 6

What does Crohns of the terminal ileum and ileocaecal junction cause?

Answer 6

Malabsorption of Vitamin B12.

Question 7

What is the physical presentation of Crohns in the bowel?

Answer 7

Inflammation
Oedema - from the granulomas blocking the lymphatic system.
Narrowing of the lumen
Cobblestoning
Thickening of the bowel wall
Abscesses that extend outside of the bowel wall

Question 8

Describe how fistulas occur in Crohn’s disease.

Answer 8

Since the bowel loops are closely packed together - inflammation in one area spreads to a loop nearby and creates a fistula between the 2 loops.

Question 9

What are the symptoms of Crohns disease?

Answer 9

Depends which are of the GI tract is affected.

Colon:
Abdominal pain
Diarrhoea
Bleeding

Small Bowel:
Pain from the narrowing/obstruction
Malabsorption

Mouth:
Oral granulomas - no discomfort
Gingivitis

Question 10

What is the medical treatment for Crohns disease?

Answer 10

Medical:
Immunosuppressants:
Systemic steroids e.g. prednisolone 
- useful since Crohns extends throughout the whole bowel wall. 
Non-steroidal immunosuppressants

Anti-inflammatory drugs

Anti TNF drugs - prevents inflammation

Question 11

What is the surgical treatment for Crohn’s disease?

Answer 11

Remove obstructed part of the bowel
Drain abscesses
Close the fistula

Usually fitted with a stoma bag.

Question 12

What causes Ulcerative colitis?

Answer 12

Immune system

Genetics

Question 13

What areas of the GI tract are affected by Ulcerative colitis?

Answer 13

Rectum and colon

Starts at the rectum and moves up into the colon.
Continuous spread of disease.

Question 14

What are the symptoms of ulcerative colitis?

Answer 14

Abdominal pain
Bleeding
Diarrhoea

Question 15

What are the complications of ulcerative colitis?

Answer 15

Carcinoma can develop

The longer the disease is active the higher the risk

Question 16

What is the medical treatment for Ulcerative colitis?

Answer 16

Immunosuppressants:
Topical steroids - rectally administered
Non-steroidal immunosuppressants

Anti-inflammatory drugs

Anti TNF drugs

Question 17

What is the surgical treatment for Ulcerative colitis?

Answer 17

Colectomy - cures UC

Question 18

What areas are affected by ulcerative colitis in proctitis?

Answer 18

The rectum only

Question 19

What areas are affected by ulcerative colitis in proctosigmoiditis?

Answer 19

The rectum and the sigmoid colon

Question 20

What areas are affected by ulcerative colitis in distal colitis?

Answer 20

The left side of the colon (descending end)

Question 21

What areas are affected by ulcerative colitis in Pancolitis?

Answer 21

The entire colon

Question 22

What areas are affected by ulcerative colitis in backwash ileitis?

Answer 22

The distal ileum/terminal

Question 23

Compare the features of Crohns to Ulcerative colitis.

Answer 23

Crohns:
Discontinous
Affects anywhere in the GI tract mouth to anus
Extends throughout the entire bowel wall
Non-vascular

Ulcerative Colitis:
Continuous  
Affects the rectum and the colon. 
Superficial - only affects the surface layer of the bowel. 
Vascular

Question 24

Compare the microscopic features of Crohns to Ulcerative colitis.

Answer 24

Crohns:
Transmural - extends throughout the whole bowel wall
Oedematous
Granulomatous

Ulcerative Colitis:
Vascular
Mucosal abscesses
Mucosal