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Gastrointestinal 2 > Pathology of IBD > Flashcards

Pathology of IBD Flashcards

1
Q

What is inflammatory bowel disease (IBD)?

A
  • chronic, relapsing inflammation of bowel possibly due to abnormal immune response to enteric flora; idiopathic.
  • classically presents in YOUNG WOMEN as recurrent bouts of bloody diarrhea and abdominal pain.
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2
Q

Where is IBD more prevalent?

A
  • in the WEST, particularly caucasians and eastern European Jews
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3
Q

Is IBD a diagnosis of exclusion?

A

YES bc many pts can have abdominal pain and bloody diarrhea.

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4
Q

How is IBD sub-classified?

A

ULCERATIVE COLITIS or CROHN’S DISEASE

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5
Q

What is the wall involvement of ULCERATIVE COLITIS?

A

mucosal and submucosal layers

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6
Q

What is the location of ULCERATIVE COLITIS?

A

always begins in the RECTUM and can extend proximally up to the cecum in a stepwise fashion; remainder of the GI tract is unaffected

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7
Q

What are the symptoms of ULCERATIVE COLITIS?

A
  • LLQ pain (rectum) with bloody diarrhea
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8
Q

*** What is the key histological inflammation marker of ULCERATIVE COLITIS?

A
  • crypt abscess with neutrophils

* can also see this in CROHN’S disease

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9
Q

What is the gross appearance of ULCERATIVE COLITIS?

A
  • pseudopolyps= bumps on the surface in response to healing from the ulcers; loss of haustra (‘lead pipe’ sign on imaging).
  • mucosal bridges= fusing of pseudopylops
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10
Q

What are the complications of ULCERATIVE COLITIS?

A
  • toxic megacolon and adenocarcinoma (risk is based on extent of colonic involvement and duration of disease; generally not a concern until greater than 10 years of disease).
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11
Q

What are the extraintestinal manifestation of ULCERATIVE COLITIS?

A
  • arthritis (ankylosing spondylitis, sacroiliitis), uveitis, pyoderma gangrenosum, primary sclerosing cholangitis, and p-ANCA.
  • similar to crohn’s but with higher incidence
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12
Q

What does smoking do to ULCERATIVE COLITIS?

A

actually protects against it.

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13
Q

What is the wall involvement of CROHN’S DISEASE?

A

full-thickness (transmural) inflammation with knife-like fissures

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14
Q

What is the location of CROHN’S DISEASE?

A

anywhere from the mouth to the anus with SKIP LESIONS

*terminal ileum and cecum are most common

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15
Q

What are the symptoms of CROHN’S DISEASE?

A
  • RLQ pain (ileum) with non-bloody diarrhea.
  • may present as abdominal mass
  • can mimic appendicitis or bowel perforation
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16
Q

*** What are the key histological markers of CROHN’S DISEASE?

A
  • Lymphoid aggregates with NON-CASEATING GRANULOMAS (may see crypt abscess with neutrophils as well).
  • paneth cell metaplasia
  • pseudopyloric metaplasia
  • marked fibrosis
17
Q

What is the gross appearance of CROHN’S DISEASE?

A
  • COBBLESTONE mucosa, CREEPING FAT, and strictures (STRING SIGN on barium swallow)
18
Q

What are the complications of CROHN’S DISEASE?

A

malabsorption with nutritional deficiency, calcium oxalate nephrolithiasis (kidney stones), fistula formation, and adenocarcinoma (but not as high as ulcerative colitis).

19
Q

What are the extraintestinal manifestations of CROHN’S DISEASE?

A

ankylosing spondylitis, sacroiliitis, migratory polyarthritis, uveitis, erythema nodosum, and gallstones.

20
Q

What does smoking do to CROHN’S DISEASE?

A

increases your risk for Crohn’s disease

21
Q

What is NOD2 (nucelotide oligomerization binding domain 2)?

A

susceptibility gene in CROHN’S DISEASE that encodes a protein that binds to intracellular bacterial peptidoglycans and activates NF-kB

22
Q

What are some other CROHN related genes?

A
  • ATG16L1 (augtophagy-related 16-like)= critical to host responses to intracellular bacteria.
  • IRGM (immunity-related GTPase M)= involved in autophagy and clearance of intracellular bacteria.
  • All indicate inappropriate immune reactions against luminal bacteria.
23
Q

What specific cell type is involved in IBD?

A

T cells (specifically Th1 and Th17) releasing TNF and interleukins.

24
Q

What are the similar features between ULCERATIVE COLITIS and CROHN’S?

A
  • crypt abscesses
  • crypt distortion
  • epithelial metaplasia

Gastrointestinal 2 (18 decks)

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