Pathology of IBD Flashcards
types of idiopathic IBD
Crohn’s disease
ulcerative colitis
describe IBD
chronic diseases
unknown aetiology
what is Crohn’s disease
segmental, chronic, transmural inflammatory and ulcerating condition of GI tract
where does Crohn’s disease effect the GI tract
can affect anywhere
most common - ileum and colon
2/3 patients have small bowel involvement only
epidemiology of Crohn’s disease
young patients; 90% 10-40 50% 20-30 more common in males genetic defects - HLA-DR1 and HLA-DQw5
signs of Crohn’s disease
abdominal pain small bowel obstruction diarrhoea bleeding PR (rectal bleeding) anaemia weight loss
tests for Crohn’s disease
endoscopy
mucosal biopsy
microscopic changes in Crohn’s disease
chronic active colitis (increased chronic inflammatory cells in lamina proprietary)
granuloma formation - 50% non caseating
treatment for Crohn’s disease
steroids
bowel obstruction
surgery
pathology of Crohn’s disease
ill and/or colonic chronic active mucosal inflammation including;
cryptitis
crypt abscesses
deep fissuring ulcers
complications of Crohn’s disease
malabsorption fistulas anal disease intractable disease bowel obstruction perforation malignancy amyloidosis others - extra intestinal associated toxic megacolon - rare
malabsorption of Crohn’s disease
iatrogenic (short bowel syndrome) - repeated resections and recurrences
hypoproteinemia, Vitamin deficiency, anaemia
gallstones (interrupted entzroheptic circulation)
fistulas of Crohn’s disease
VesicoColic Enterocolic Gastrocolic Recto vaginal Tuboovarian abscess Blind loop syndrome
anal disease of Crohn’s disease
sinuses fissures skin tags abscesses perineum falls apart
intractable disease of Crohn’s disease
failure to tolerate or respond to medical therapy
continuous diarrhoea or pain
may require surgery - not curative
environmental triggers for Crohn’s disease
smoking
infectious agents - viral, mycobacterial
vasculitis
sterile environment theory
aberrant immune response of Crohn’s disease
persistent activation of T cells and macrophages - failure to switch off
excess pro inflammatory cytokine production
how can aberrant immune response of Crohn’s disease be altered
by changing intestinal microflora via probiotics
what is ulcerative colitis
continuous, diffuse chronic inflammatory disorder - mucosal and submucosal inflammation
where does ulcerative colitis effect in the GI tract
confined to colon and rectum;
always involves the rectum and continuous proximally for varying length
epidemiology of ulcerative colitis
young patients - peak in 30’s
can occur in elderly and children
more common in males
genetic defects - monozygotic twins, HLA-DR2 and NOD-2 gene
signs of ulcerative colitis
diarrhoea
mucus and blood PR
clinical presentation of ulcerative colitis
chronic course with exacerbation and remission
continuous low grade activity
single activity
acute fulminant colitis (toxic megacolon)
tests for ulcerative colitis
endoscopy
mucosal biopsy
microscopic changes of ulcerative colitis
massive influx of inflammatory cells;
basal lymphoplasmacytic infiltrate with irregular shaped branching crypts
severe ulceration (border based - superficial only!) with fibrinopurulent exudate, pseudo polyps seen
treatment for ulcerative colitis
steroids
subtotal colectomy
complications of ulcerative colitis
intractable disease toxic megacolon colorectal carcinoma blood loss electrolyte disturbance (hypokalaemia) anal fissures extra GI manifestations
intractable disease of ulcerative colitis
continuous diarhoea
flares due to intercurrent infection by enteric bacteria or CMV
requires total colectomy
toxic megacolon of ulcerative colitis
acute or acute on chronic fulminant colitis
colon swells up - will rupture unless removed
requires emergency colectomy
colorectal carcinoma of ulcerative colitis
chronic inflammation leads to epithelial dysplasia and then carcinoma
risk increased if pancolitis and/or disease has been there for longer than 10 years
requires surveillance
describe extra GI manifestations complications of ulcerative colitis - eyes
eyes - uveitis
describe extra GI manifestations complications of ulcerative colitis - liver
primary sclerosing cholangitis
describe extra GI manifestations complications of ulcerative colitis - joints
arthritis
ank spondylitis
describe extra GI manifestations complications of ulcerative colitis - skin
pyoderma gangrenosum
erythema nodusum
aberrant immune response of ulcerative colitis
persistent activation of T cells and macrophages
autoantibodies present e.g. ANCA
excess pro inflammatory cytokine production and bystander damage due to neutrophilic inflammation
how can aberrant immune response of ulcerative colitis be altered
changing intestinal microflora - probiotics
