Maladies inflammatoires intestinales Flashcards
What are the two main intestinal inflammatory diseases? (IBD)
- Ulcerative colitis
- Crohn’s disease
What is the most common form of intestinal disease?
MII —> 50-250 cases/100 000
Men = women
More prevalent in occidental countries of the Northern Hemisphere
What are the two “pics d’incidence” for MIIs?
15-30 and 50-80
Are MIIs genetic?
10-25% of the cases are linked to familial history
Twins: heterozygotes —> 6% chance, homozygotes —> 58%
Parent with MII = child 3-20x more likely to have it and if both parents —> 20-30%
Are there any genes associated with MIIs?
NOD2 —> predisposition to ileal crohn’s disease
20% of chron’s patients have this mutation
leads to a “defaut de sensing” des bactéries intraluminales
MIIs are polygenic illnesses… > 100 genetic anomalies associated to Chrons and > 40 to UC
What are the auto-immune factors associated with MIIs?
Associated to other auto-immune diseases such as Ankylosing Spondylitis, arthritis, and uveitis
Are there any environmental factors associated to MIIs?
They’re more common in northern counties
No relation to diet or toxic exposure BUT
Tabacco:
- decreases risk of UC
- doubles risk of Crohns and is associated with worse evolution
Are there any infectious factors associated to MIIs?
Nothing shown yet.. but one of the theories is a disequilibrium of the intestinal microbiota
What is “la théorie uniciste”?
A way to combine different risk factors to see their influence on development and progression of the disease
What would happen if a genetically predisposed pt was exposed to environmental/infectious risk factors?
Leads to an inflammatory cascade with lymphocytes and neutrophils —> production of cytokines, IL, TNF —> can set of MII
What is ulcerative colitis?
Inflammation de la muqueuse colique —> starts at rectum and the spreads to the rest of the colon
DOES NOT impact the small intestine
Clinical manifestations of UC:
Bloody diarrhea sometimes with mucus, nocturnal diarrhea, incontinence
Anorectal sx of UC: (4)
Ténesme: cramping rectal pain
Rectorragies: bleeding in the rectum
Urgences fécales
Spasmes
What is the initial presentation of UC? (3 kinds)
1/3 —> proctitis
- Rectum only
- Sx: fausses envies d’aller à la selle, mucus
1/3 —> colite gauche
- Rectum —> left colon
1/3 —> colite étendue ou pancolite
- Passes angle splénique (étendue) or all the way to the caecum (pancolite)
What are some complications of UC? (4)
- Hémorragie colique (rare)
- Colite fulminante
- Mégacolon toxique
- Cancer
What is colite fulminante?
Severe symptoms/atteinte de l’état général:
- fever, tachycardia, anemia, leucocytosis, hypotension, dehydration, electrolytic imbalance
Requires hospitalization
What is mégacolon toxique?
EMERGENCY
Distension of colon with severe colitis and systematic sx
- extension of severe inflammation: muqueuse —> sous-muqueuse —> musculeuse —> loss of contractility
- Dilatation colique radiologique
Increased risk of peritonitis and intestinal perforation (50% mortality rate)
- Can be an indication that surgery is necessary —> total colectomy (removing the entire colon)
How is cancer associated with UC?
Increased risk if colite étendue vs if colite gauche, the longer you have the illness (accrus après 10 ans), if associated with other diseases, stronger the inflammatory rxn
Colonoscopy with biopsies every 2-3 years in higher risk pts