Large Bowel Disorders/IBD Flashcards
What are examples of inflammatory bowel diseases?
Ulcerative Colitis Crohn's Disease Ischaemic colitis Radiation colitis Appendicitis
Microscopic colitis
Collagenous colitis
Lymphocytic colitis
What is the histological difference between Crohn’s and Ulcerative colitis?
Crohn’s has granulomas, UC does not
Goblet cells are depleted in Ulcerative colitis
Crypt abscesses more in UC than Crohn’s
What genetic mutations are associated with ulcerate colitis and Crohn’s disease? What other markers may be present?
NOD2 associated with Crohn’s
HLA associations in Ulcerative Colitis
pANCA (perinuclear antineutrophilic cytoplasmic antibody)
- positive in 75% of ulcerative colitis patients but only 11% of Crohn’s patients
How might ulcerative colitis present?
Bloody diarrhoea
Abdominal pain
Weight loss
What are the markers of a severe colitis attack?
Stool frequency >6 per day with blood Fever Tachycardia ESR (CRP) raised Anaemia Albumin Leukocytosis/Thrombocytosis
What is the prognosis of ulcerative colitis?
Mortality generally low (3%) but higher if severe attack (23%)
If pancolitis >10 years, 20-30x higher risk of developing cancer
Complications include
- haemorrhage
- perforation
- toxic dilatation
Where can Crohn’s affect? What are the ages of peak incidence?
Any level of GIT from mouth to anus - patchy, characterised by skip lesions
Peaks 20-30 years and 60-70 years
What are the symptoms of Crohn’s disease?
Diarrhoea Abdominal pain Weight loss Malaise, lethargy, anorexia, nausea/vomiting, low-grade fever Malabsorption - anaemia, vitamin deficiency
What are possible features of long-term Crohn’s disease?
Small intestine malabsorption Strictures Fistulas and abscesses Perforation Increased risk of cancer (5x)
What are the histological features of Crohn’s?
Cryptitis and crypt abscesses
Non-caseating granulomas
Deep ulceration
Transmural inflammation
What are the risk factors/causes for ischaemic enteritis?
Arterial thrombosis (atheroma, vasculitis, aneurysm, hypercoagulable)
Arterial embolism (vegetations, atheroembolism, cholesterol)
Non-occlusive ischaemia (cardiac failure, shock, dehydration, vasoconstriction)
What pathologies might be present in ischaemic enteritis?
Mucosal inflammation Ulceration Submucosal inflammation Fibrosis Stricture
Splenic flexure vulnerable
What is radiation colitis?
Abdominal irradiation can impair the normal proliferative activity of the small and large bowel epithelium
- usually rectum/pelvic radiotherapy
What are the symptoms/signs of radiation colitis?
Anorexia
Abdominal cramps
Diarrhoea
Malabsorption
Chronic mimics IBD
Bizarre cellular changes Ulceration Necrosis Haemorrhage Perforation
What are the inflammatory indicators for IBD in blood/stool?
High ESR and CRP High platelet count High WCC Low Hb Low albumin
Stool
- calprotectin
- 50-200 = equivocal
- 200+ = elevated
