Inflammatroy Bowel Disease Flashcards
idiopathic inflammatory intestinal disease resulting from an inappropriate immune activation to host intestinal micro flora
Inflammatory bowel disease
define IBD
it is an idiopathic inflammatory intestinal disease resulting from an inappropriate immune activation to host intestinal micro flora
types of IBD
Crohn’s Disease (CD)
Ulcerative Colitis (UC)
Others (Indeterminate colitis)
between UC and CD, which has a higher incidence?
incidence of UC is 3 times higher than that of CD
Autosomal recessive missense mutations of the interleukin (IL)-10 receptor gene cuses what?
cause severe disease through loss of function and, therefore, failure of IL-10 to down-regulate inflammation.
Highest rates of IBD are seen among ____ population
Jewish
1st peak of IBD
15-40
2nd peak of IBD
55-65
CD is associated with _____ gene polymorphisms and E. coli outer membrane and flagellin
NOD2/CARD15
interaction between ____ and ____ is critical to the pathogenesis of Crohn’s
T cells and APC
genetic etiology of UC
IL-23R gene polymorphisms have been identified, most notably the Arg381Gln polymorphism
pathogenesis of IBD
continuous antigenic stimulation by commensal enteric bacteria, fungi or viruses
autoantibody that has received significant attention in UC patients
pANCA
Extends into the deeper layers of the intestinal wall and may affect the mouth, esophagus stomach and small intestines
CD
Transmural inflammation and skip lesions
CD
ulceration and inflammation of the inner lining of the colon and rectum
UC
form of characteristic ulcers or open sores
UC
Symmetrical, continuous
UC
DR2-related genes
UC
DR5DQ1 alleles
CD
pathologic hallmark of CD
Focal intestinal inflammation
what is an aphthae
superficial ulcer in the mucosa
Cobblestone appearance
CD
35-50% CD is located in
both ileum and colon
35% CD is located in
SI
late features of CD
Large ulcers, sinus tracts, and stricture, adhesion of bowel loops
macroscopic features of CD
skip lesions narrowing of lumen linear mucosal ulceration creeping fat fat wrapping
creeping of mesenteric fat onto the serosal surface of the bowel
fat wrapping
fat wrapping is seen in
CD
Granuloma
CD
CD compared to TB Ileitis
TB has no central and caseating necrosis
key cytokine in the formation of granulomas
TNF
if a granuloma is not seen what is a reliable sign of CD
presence of lymphoid aggregates in the submucosa and external to the muscularis propria
UC affects
only the colon
No skip pattern in
YC
total involvement of the colon
pancolitis
pancolitis is seen in
UC
involves only the rectum
proctitis
involves the rectum and sigmoid colon (the lower segment of the colon before the rectum)
Proctosigmoiditis
involves only the left side of the colon
Distal colitis
universal colitis; involves the entire colon
pancolitis
extension of UC into the terminal ileum
backwash ileus/ileitis
Inflammation in UC characteristically is confined to the
mucosa
pseudopolyps results from
coalescence of primary ulcerations in the area and later regeneration
epithelial regeneration intestinal mucosa with recurrent attacks results in the formation of
pseudopolyps
neutrophylic infiltration of colonic crypts leads to
cryptitis and crypt abscesses
Cryptitis – is associated with discharge of
mucus and goblet cells
Presence of plasma cells is another characteristic of
UC
major manifestatoin of IBD
recurrent ab pain and diarrhea
Grossly bloody stools, occasionally with tenesmus is typical in
UC
perianal lesions is a char of
CD
toxic megacolon is present in
UC
Fistulas are manifestations of the transmural nature of
CD
string sign is a feature of
CD
markedly narrowed bowel segment amid widely-spaced bowel loops
String sign
glucagon is used as an
antispasmodic
external manifestations of IBD
clubbing
Arthritic manifestations
Metabolic bone disease
Granulomatous vasculaitis, periostitis and amyloidosis
gold standard for imaging studies in IBD
endoscopic evaluation
The presence of marked colonic dilatation suggests
fulminant colitis or toxic megacolon
string sign is due to
spasm
comb sign is pathognomonic of
CD
segmental dilatation of the vasa recta involving an intestinal loop
Comb sign
The earliest endoscopic sign of UC is
mucosal erythema and edema
what imaging modality would you do if you want to find obscure sources of GI blood loss
Tablet enteroscopy
complications of CD
Perforation • Abscess formation • Stricture and small bowel obstruction • Nutritional deficiency • Cancer: small bowel adenocarcinoma
complications of UC
toxic megacolon
colon adenocarcinoma
perforation
massive hemorrhage
Mainstay of therapy for mild to moderate UC and CD
5 ASA agents
pro drug of 5 ASA
Balsalazine
the use of this demonstrated a prophylactic effect on endoscopic and clinical recurrence at one year
metronidazole
Utilized to initiate remissions particularly in persons who are not responding well to 5-ASA
glucocorticoids
Purine analogs that interfere with nucleic acid metabolism
Azathioprine and 6-Mercaptopurine
surgery is performed in UC or CD?
UC
idiopathic inflammation that may develop in patients who undergo IPAA
pouchitis
ASCA positive in
CD
Bleeding is more common in
UC
inflammation in mucosa and submucosa only
UC
Transmural inflammation
CD
factors affecting disease relapse and remission
Use of NSAIDS and antibiotics • Bacterial and viral infection • Smoking • Psychosocial stress • Both the severity and the extent of disease are important prognostic factors after the first attack of UC
