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GI > Pathology of IBD > Flashcards

Pathology of IBD Flashcards

1
Q

What is the definition of Crohn’s disease?

A
  • Chronic inflammatory and ulcerating condition

- can affect anywhere from the mouth to the anus

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2
Q

What is the most COMMON site for Crohn’s disease to appear?

A
  • terminal ileum and colon
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3
Q

What age are most patients when they are diagnosed with Crohn’s disease?

A
  • Usually Young patients (90% are 10-40 years old)

- Can occur in children

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4
Q

Is Crohn’s disease is more common in males or females?

A

Males

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5
Q

Where can Crohn’s disease present along the GI Tract?

A
  • 2/3 of patients have small bowel involvement only
  • 1/6 have colonic/ anal disease only
  • 1/6 have both
  • Variable involvement of stomach, oesophagus and mouth
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6
Q

How do patients present with Crohn’s disease? What symptoms do they have?

A
  • Abdominal pain
  • Small bowel obstruction
  • Diarrhoea
  • Bleeding PR
  • Anaemia
  • Weight loss
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7
Q

Describe the clinical course/ progression of Crohn’s disease.

A
  • Chronic
  • Patients have exacerbations and remissions
  • Unpredictable response to therapy
  • There is a subgroup of patients who go into lasting remission with 3 years of diagnosis
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8
Q

Describe a typical who would present with Crohn’s Disease?

A 
~ 22 years
Male
Abdominal pain
Bloody diarrhoea for 3 months
Tender abdomen
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9
Q

How would you investigate a patient with suspected Crohn’s Disease?

A
  • ENDOSCOPY

- MUCOSAL BIOPSY

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10
Q

Describe the pattern of Crohn’s disease seen on endoscopy (colonoscopy)

A
  • Patchy/segmental disease

- skip areas (lesions) anywhere in GI tract

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11
Q

Describe how Crohn’s disease histology differs from that of the normal colonic mucosa

A
  • Chronic active colitis
    => inflammatory cells in the lamina propria
    => crypt branching (cryptitis and abscesses)
  • granuloma formation!!
    (non-caseating)
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12
Q

What are the potential complications of Crohn’s disease?

A
  • Patient doesnt respond to medical therapy (steroids)
  • Bowel obstruction
  • Surgery
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13
Q

What may lead to patients having surgery for Crohn’s disease?

A
  • Stricturing of terminal ileum

- Deep fissuring ulceration destroys mucosa => cant absorb/ secrete

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14
Q

Fissuring of the mucosa causes what appearance macroscopically?

A

“Cobblestoning”

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15
Q

Describe how a fissure looks on histology?

A

Like a knife cutting through the slice of mucosa

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16
Q

What does transmural inflammation in Crohn’s disease mean?

A

The inflammation is consistent through all layers of the bowel wall

17
Q

What complications can result from Crohn’s disease?

A
  • Malabsorption
  • Fistulas
  • Anal disease (Sinuses, Fissures, Skin tags, abscess)
  • Bowel obstruction
  • Perforation
  • Malignancy
  • Amyloidosis
18
Q

Crohn’s disease is thought to be liked to which histocompatibility complex (HLA) groups?

A

HLA-DR1
HLA-DQw5

=> may have a genetic component

19
Q

What environmental triggers can exacerbate Crohn’s disease?

A
  • Smoking increases risk
  • Infectious agents (viral, mycobacterial) cause similar pathology
  • Vasculitis could explain the segmental distribution
  • Sterile enviroment theory
20
Q

Describe the abnormal immune response seen in Crohn’s disease?

A
  • Persistent activation of T-cells and macrophages (failure to switch off)

=> Excess proinflammatory cytokine production

21
Q

What is the definition of Ulcerative Colitis?

A
  • Chronic inflammatory disorder
  • confined to colon and rectum
  • Mucosal and submucosal inflammation ONLY (not transmural)
  • Unknown aetiology
22
Q

Who usually gets ulcerative colitis?

A
  • Young patients
  • Peak incidence in the third decade
  • Can present in the elderly/ children too
  • More common in males
23
Q

How does Ulcerative Colitis usually present?

A

Diarrhoea, mucus and blood PR

24
Q

Describe the clinical course of Ulcerative Colitis

A
  • Chronic course
  • Exacerbation and remission
  • Continuous low grade activity
  • Single attack = Acute fulminant colitis (Toxic megacolon)
25
Q

Describe a typical patient with Ulcerative Colitis

A

32 years
Female
Bloody diarrhoea and mucus
Goes to toilet 25 times a day

26
Q

How is Ulcerative Colitis investigated?

A
  • ENDOSCOPY

- MUCOSAL BIOPSY

27
Q

Describe how the colonic mucosa in Ulcerative Colitis differs from normal colonic mucosa.

A

Diffuse chronic active colitis:
=> massive influx of inflammatory cells
=> Basal lymphoplasmacytic infiltrate

Cryptitis:

  • Irregular shaped branching crypts
  • crypt abscesses form

Severe ulceration:
- fibrinopurulent exudate

NO GRANULOMAS

28
Q

If a patient has Chronic Inactive UC, how does this appear on histology?

A
  • Low grade chronic inflammation
  • crypt distortion
  • low grade diarrhoea
29
Q

If a patient fails to respond to medical therapy in UC, what treatment are they offered?

A

Sub-total Colectomy

30
Q

Describe how the ulcers appear in UC?

A
  • Superficial on mucosa
  • broader based
  • pseudopolyps are seen
31
Q

What is the only occasion in UC where inflammation is not contained to the mucosa and submucosa?

A

Toxic Megacolon

32
Q

What are the main complications of UC?

A
  • intractable disease (i.e. not curable) => total colectomy required
  • Toxic megacolon
  • Colorectal carcinoma
  • Blood loss
  • Electrolyte disturbance (hypokalemia)
  • Anal fissures (not common)

Extra GI manifestations:

  • Eyes: Uveitis
  • Liver: PSC
  • Joints: Arthritis, Ank Spondylitis
  • Skin: Pyoderma gangrenosum, erythema nodusum
33
Q

What happens in Toxic Megacolon and how is this treated?

A

=> Colon swells up to massive size
=> Will rupture unless removed
=> Emergency colectomy

34
Q

What increases a patients risk of developing colonic carcinoma if they have UC?

A

Risk increased if:

  • Pancolitis
  • Disease longer than 10 years
35
Q

What genetic links does UC have?

A
  • Association with HLA-DR2

- Familial cases associated with NOD-2 gene

36
Q

Describe the abnormal immune response taking place in UC

A
  • Persistent activation of T-cells and macrophages
  • Autoantibodies eg ANCA present
  • Excess proinflammatory cytokine production
  • neutrophillic inflammation causing damage
37
Q

Are there any environmental triggers for UC?

A
  • They are Unknown

- Smoking is not associated with UC

38
Q

Describe the difference in ulcer appearance between Crohn’s and UC

A

Crohn’s = Deep fissuring ulcers

UC = horizontal, undermining ulcers

39
Q

Describe the main difference between Crohn’s and UC

A

LOCATION
Crohns = Anywhere in GI tract + Skip lesions
UC = Colon and rectum, Rarely skips

WALL
Crohn’s = THICK bowel, stricture, Transmural inflammation
UC = Mucosal ulceration, THIN wall, Superficial inflammation

GRANULOMAS
Crohn’s = YES
UC = NO

FISTULAE
Crohn’s = YES
UC = NO

CANCER RISK
Crohn’s = LOW
UC = HIGH

EXTRA GI SYMPTOMS
Crohn’s = NO
UC = YES

GI (33 decks)

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