Non-Neoplastic Disease of the Colon (unfinished)(GIT) Flashcards
What are the two types of IBD>
Ulcerative colitis
Crohn’s disease
Describe epidemiology of IBD
Caucasian > African-American/Hispanics
Urban>Rural
Cold climate > Warm climate
What are the risk factors of developing UC or Crohn’s ?
Early life exposure to antibiotics
Smoking, diet, exercise
Family history
What is the aetiopathology of IBD?
Interaction of genetic dispostion, environment and microbiota resulting in a dysregulated immune response and development of chronic inflammatory damage.
What are the clinical features of UC and Crohn’s?
Common: Abdo pain, diarrhoea, weight loss
UC: Rectal bleeding
Crohn’s: Growth retardation, malabsorption
Differentiate the gross pathology of UC vs Crohn’s
Ulcerative colitis:
Thin walls
No fat wrapping
Continuous distal to proximal inflammatory pattern starting in rectum, STOPS at small bowel.
Shallow ulcers
Crohn’s:
Thick walls
Fat wrapping
Focal inflammation - skip lesions
Can affect anywhere from mouth to anus, with predisposition to distal small intestine and proximal colon.
Deep, fissuring, linear ulcers
Differentiate microscopic pathology of UC vs Crohn’s
UC:
Superficial inflammation
Superficial, shallow ulcers
Little fibrosis
No granulomas
Crohn’s
Transmural inflammation
Deep fissuring ulcers
Marked fibrosis
Granulomas present
What are the complications of UC and Crohn’s?
What are three Crohn’s specific complications?
Dysplasia, adenocarcinoma
Toxic megacolon (enlargement of bowel = can’t remove gas/faeces from body), perforation
Crohn’s specific:
Fistula, stenosis, abscesses
How do you manage UC and Crohn’s?
Surgical
Supportive
Surveillance to detect early neoplasia
What is microscopic colitis and its two subtypes?
Macroscopically normal colonic mucosa with microscopic inflammation. Looks norml on radiology/colonoscopy.
Two types:
Collagenous colitis
Lymphocytic colitis
What is the aetiopathogenesis of microscopic colitis and its clinical features?
It is an inflammatory disorder from inappropriate response to gut antigen, commonly NSAIDs
Clinical features:
Chronic diarrhoea
Normal radiology/colonoscopy
Weight loss, abdominal pain
What microscopic pathology differentiates collagenous colitis with lymphocytic colitis?
Thickening of colalgen distinguishes between the two.
What is the prognosis and treatment for microscopic colitis?
Prognosis is good - just remove the thing causing it (e.g. NSAIDs) and can add anti-inflamamtory therapy.
What is antibiotic associated diarrhoea?
Antibiotics can cause diarrhoea, particularly broad spectrum (CEPHALOSPORINS MOST COMMON).
Disturbance of colonic microflora can cause diarrhoea through several mechanisms:
Direct effect of the antibiotic
Overgrowth of pathogenic organisms
What is pseudomembranous colitis?
Formation of pseudomembranes, associated with Clostridium difficile.
