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Pathology & Clinical IBD Flashcards

1
Q

what 2 diseases cause inflammatory bowel disease (IBD)?

A
  • Crohn’s disease

- ulcerative colitis

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2
Q

True or False.

IBD is chronic.

A

True

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3
Q

what is Crohn’s disease?

A

= chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

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4
Q

where is Crohn’s disease most common?

A

= terminal ileum and colon

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5
Q

who does Crohn’s disease affect?

A

= young patients

- more common in males

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6
Q

where can you get Crohn’s disease?

A

= some have only small bowel involvement
= some have colonic/anal disease only
= some have both
- viable involvement of stomach, oesophagus and mouth

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7
Q

what are 7 symptoms of Crohn’s?

A
  • abdominal pain
  • small bowel obstruction
  • diarrhoea
  • bleeding PR
  • anaemia
  • weight loss
  • tender abdomen
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8
Q

describe the clinical course of Crohn’s disease?

A
  • chronic
  • exacerbations & remission
  • un-predictable response to therapy

(some patients go into lasting remission within 3 years of diagnosis)

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9
Q

what 2 tests should be done in patients with suspected Crohn’s disease?

A
  • endoscopy

- mucosal biopsy

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10
Q

what would an endoscopy show in Crohn’s disease?

A

= patchy, segmented disease with skip areas (lesions) anywhere in GI tract

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11
Q

what is a histological feature of Crohn’s disease?

A

= chronic active colitis with (non-caseating) granuloma formation

= increased chronic transmural inflammatory cells in the lamina propria and crypt branching with granulomas

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12
Q

describe Crohn;s disease in an unlucky patient?

A

= doesn’t respond to medical therapy (steroids)
= bowel obstruction
= require surgery

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13
Q

describe the typical late stage appearance of Crohn;s disease?

A

= stricturing of terminal ileum with thickening of bowel wall & fat wrapping

= deep fissuring ulceration destroying mucosa

= deep fissuring producing cobble-stoning of mucosa

= pseudo polyps may be seen (not common)

= deep fissures (knife like in appearance)

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14
Q

what is a key feature seen in Crohn’s disease?

A

= transmural inflammation

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15
Q

what are 9 complications of Crohn’s disease?

A

1) malabsorption
2) Fistulas
3) Anal disease
4) Intractable disease
5) Bowel obstruction
6) perforationn
7) malignancy
8) amyloidosis
9) others (extra-intestinalassociation)
- rarely toxic megacolon

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16
Q

describe the causes and effects of malabsorption as a consequence of Crohn’s disease?

A

Causes
= iatrogenic (short bowel syndrome) due to repeated resections and recurrences

Effects
= hypoproteinemia, vit defieicny, anaemia
= gallstones

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17
Q

describe fistulas, as a complications to Crohn’s disease?

A 
= vesicocolic
= enterocolic
= gastrocolic
= recto vaginal 
= tuboovarian abscess
= blind loop syndrome
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18
Q

describe 5 anal diseases that can occur as a complication of Crohn’s disease?

A
  • sinuses
  • fissures
  • skin tags
  • abscesses
  • perineum falls apart
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19
Q

describe intractable disease as a complication of Crohn’s disease?

A
  • failure to tolerate or respond to medical therapy
  • continuous diarrhoea or paint
  • may require surgery
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20
Q

what genes are Crohn’s associated with?

A

= HLA-DR1 and HLA-DQw5

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21
Q

what are 5 environmental triggers of Crohn’s disease?

A
  • smoking increases risk
  • infectious agents (viral, mycobacterial) causes similar pathology
  • vasculitis (could explain segmental distribution)
  • sterile environment therapy
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22
Q

Describe the aberrant immune response in Crohn’s disease?

A

= persistent activation of T cells and macrophages
= excess pro-inflammatory cytokine production
= maybe alterable by change intestinal microflora “probiotics”

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23
Q

what is ulcerative colitis?

A

= chronic inflammatory disorder confined to colon and rectum

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24
Q

where does inflammation occur in ulcerative colitis?

A

= mucosal and sub-mucosal inflammation

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25
Q

describe who can present with ulcerative colitis?

A
  • young people
    + can occur in any age
  • more common in males
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26
Q

where about does ulcerative colitis occur?

A

= confined to colon & rectum
- nearly always involves the rectum

= continuous & confluent extending proximally for varying lengths.

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27
Q

True or false.

Ulcerative colitis is continuous and confluent not segmented.

A

True

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28
Q

what are 3 features of ulcerative colitis and describe the clinical course of it?

A
  • diarrhoea
  • mucus
  • blood PR

= chronic course with exacerbations & remission
= continuous low grade activity

29
Q

what is acute fulminant colitis (toxic megacolonn)?

A

subgroup of patients with severe ulcerative colitis who have more than 10 stools per day, continuous bleeding, abdominal pain, distension, and acute, severe toxic symptoms including fever and anorexia

30
Q

describe the appearance of ulcerative colitis in the mucosa?

A

= diffuse mucosal chronic active colitis & massive influx of inflammatory cells

= basal lympho-plasmacytic infiltrate with irregular shaped branching crypts

= acute cryptitis

= crypt abscesses

= severe ulceration with fibrino-purulent exudate
(ulcers are broader based, pseudo polyps are seen)
= superficial mucosal ulceration

31
Q

describe the chronic state of ulcerative colitis?

A

= chronic inactive disease

  • low grade chronic inflammation
  • crypt distortion
  • low grade diarrhoea
32
Q

what happens in an unlucky patient with ulcerative colitis?

A

= fails to response to therapy (steroids)

- subtotal colectomy

33
Q

describe the inflammations even in ulcerative colitis?

A

= superficial inflammation only
- inflammation confined to mucosa and sub-mucosa
(except in toxic mega-colon)

34
Q

what are 7 complications of ulcerative colitis?

A

1) intractable disease
2) toxic mega-colon
3) colorectal carcinoma
4) blood loss
5) electrolyte disturbance
6) anal fissures
7) extra GI manifestations
- eyes( uveitis)
- liver (primary sclerosing cholangitis)
- joints (arthritis, and spondylitis)
- skin (pyoderma ganrenosum, erythema nodusum)

35
Q

describe intractable disease as a complication of ulcerative colitis?

describe toxic mega-colon as a complication of ulcerative colitis?

describe colorectal carcinoma as a complication of ulcerative colitis?

A

Intractable disease
= continuous diarrhoea
- flares may be due to inter-current infection by enteric bacteria or CMV
= total colectomy

Mega-colon
= acute or chronic fulminant colitis 
= colon swells up to massive size
= will rupture unless removed
= emergent colectomy

Colorectal carcinoma;
= chronic inflammation leading to epithelial dysplasia and then carcinoma
- risk increased if pan colitis and disease longer than 10 years

36
Q

what genes are associated with ulcerative colitis?

A

= HLA-DR2

- familial associated with NOD-2 gene

37
Q

describe the aberrant immune response in ulcerative colitis?

A
  • Persistent activation of T-cells and macrophages
  • Autoantibodies eg ANCA present
  • Excess proinflammatory cytokine production and bystander damage due to neutrophillic inflammation
  • Maybe alterable by changing intestinal microflora…”Probiotics”
38
Q

what are 2 environmental triggers in ulcerative colitis?

A

= unknown

= smoking is not associated with UC

39
Q

describe the many different types of colitis?

A
  • Ulcerative Colitis
  • Crohn’s Colitis
  • Collagenous Colitis
  • Lymphocytic Colitis
  • Radiation Colitis
  • Diversion Colitis
  • Drug inducedIschaemic Colitis
  • Antibiotic induced Colitis
  • Infective Colitis
  • Indeterminate Colitis
  • Necrotizing enterocolitis
  • Others
40
Q

LECTURE 2 - clinical of IBD

A

LECTURE 2 - clinical of IBD

41
Q

when does inflammatory bowel disease occur?

A

when gut immune system becomes dysregulated

42
Q

what does the gut need in order to maintain a healthy gut?

A

= trafficking immune cells

Immune tolerante;

  • foreign proteins
  • hosts bacteria
43
Q

what is the similarities and differences between crohn’s and ulcerative colitis?

A

Share

  • epidemiology
  • some shared clinical and therapeutic characteristics

Differ;
- Clinical presentations;
Crohn’s = abdominal pain & peri-anal disease
Ulcerative colitis = diarrhoea + bleeding
= pathology will differ

44
Q

what are the 3 key features of pathogenesis of IBD?

A

1) genetic predisposition
2) mucosal immune system
3) environmental triggers

45
Q

what chromosome is disease susceptibility gene located on?

A

= chromosome 16q12

46
Q

in caucasian patients with Crohn’s disease, what mutated genes would they have?

A

= NOD2

47
Q

what are 2 important genes in IBD?

A
  • NOD2

- CARD15

48
Q

what inflammatory cells are associated with Crohn’s disease?

A
  • Th1 mediated
49
Q

what inflammatory cells re ulcerative colitis associated with?

A

= mixed Th1/Th2 mediated disuse/NKTC

50
Q

what environmental factor aggravates Crohn’s disease but protects against ulcerate colitis?

A

= smoking

51
Q

what drugs have an affect on IBD?

A

= NSAIDS

52
Q

what is ulcerative colitis?

A

= inflammation of colon of unknown cause

  • relapsing course
  • always affects rectum and extends proximally
53
Q

what are 3 types of ulcerative colitis?

A
  • proctitis
  • left sided colitis
  • pancolitis
54
Q

what are symptoms of ulcerative colitis?

A
  • diarrhoea + bleeding
  • increased bowel frequency
  • urgency
  • tenesmus
  • incontinence
  • night rising
  • lower abdominal pain (esp left iliac fossa)
  • proctitis can cause connstipation
55
Q

what are 6 important factors to gain in a history of ulcerate colitis?

A
  • recent travel
  • antibiotics
  • NSAIDS
  • family history
  • smoking
  • skin, eyes, joints
56
Q

what criteria allows you to determine severity of ulcerative colitis?

A

truelove and Witt criteria

> 6 bloody stools/24hours 
\+ 
1 or more of; 
- fever (>37.8)
- tachycardia > 90
- anaemia (Hb < 10.5g/dI)
- elevated ESR (>30mm/hr)
57
Q

what 4 investigations could be done for ulcerative colitis?

A
  • bloods
    = C reactive proteins (CRP)
    = albumin (a negative acute phase reactant)
  • plan abdominal X-ray
  • endoscopy
  • histology
58
Q

what sorts of things are you looking for in a plain abdominal x-ray of ulcerative colitis?

A
  • stool distribution
    = absent in inflamed colon
  • mucosal oedema/thumb printing
  • toxic megacolonn
    = transverse > 5.5cm
    = caecum > 9cm
59
Q

what sorts of things are you looking for in an endoscopy of ulcerative colitis?

A
  • confluence inflammation extending proximally from anal margin to transition zone
  • loss of vessel pattern
  • granular mucosa
  • contact bleeding
60
Q

what are longterm complications of ulcerative colitis?

A

= increased risk of colorectal cancer

Determined by;

  • severity of inflammation
  • duration of disease
  • disease extent
61
Q

what is extensive colitis?

A

= colitis beyond splenic flexure

- at risk and require surveillance after 10 years of disease

62
Q

what are some extra-intestinal manifestations of ulcerative colitis?

A
  • skin
  • joints, axial, peripheral joints
  • eyes
  • deranged LFTs
  • oxalate renal stones
63
Q

what is primary sclerosing cholangitis (PSC)?

A

= chronic inflammatory disease of biliary tract
= causing stenosis

  • mostly asymptomatic or itch or riggers
  • cholestatic LFTs
64
Q

describe the distribution of Crohn’s disease?

A

= can affect any region from mouth to anus

  • skip lesions
  • transmural inflammation
65
Q

describe peri-anal disease?

A

= recurrent abscess formation

  • pain
  • can lead to fistula with persistent leakage
  • damage sphincters
66
Q

what are the symptoms of Crohn’s?

A

Small intestine

  • abdominal cramps
  • diarrhoea, weight loss

Colon

  • abdominal cramps
  • diarrhoea with blood
  • weight loss

Mouth

  • painful ulcers
  • swollen lips
  • angular chielitis

Anus

  • peri-anal pain
  • abscess
67
Q

what investigations should you do with someone with Crohn’s?

A
  • clinical exam
    = evidence of weight loss, RIF mass, peri-anal signs
  • bloods
    = CRP, albumin, platelets, B12 (t. ileum), ferritin
  • stage disease extent
68
Q

describe the histological feature that would be seen with someone with Crohn;s?

A

= patchy disease with granulomas in some cases

69
Q

what are 3 tests that could bee used to asses small bowel?

A

= barium follow through
= small bowel MRI
= technetium-labelled white cells can

GI (43 decks)

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