Pathology of Inflammatory Bowel Disease Flashcards

1
Q

What is the definition of Inflammatory Bowel Disease (IBD)

A

Spectrum of chronic intestinal inflammation with episodic symptoms and exacerbation

spectrumL
CD - Indeterminate colitis - UC

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2
Q

Where is IBD most more common?

A

well-developed areas
urban areas
higher socioeconomic classes

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3
Q

What pathology is NOD2/CARD-15 associated with?

A

Crohn’s

gene product binds to bacterial peptidoglycans

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4
Q

What pathology is IL23R gene associated with?

A

IL-23 receptor

inc risk for both CD and US

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5
Q

What pathology is HNFA gene associated with? What other gene is it associated with?

A

reduce barrier function (tight junction defects)
Crohn’s
associated with MODY (maturity onset diabetes of the young)

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6
Q

What characteristic of the gut flora is associated with IBD?

A

anti-flagellin antibodies - Crohn’s

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7
Q

What are the mucosal immune responses in CD and UC?

A
  1. CD: TH1 cells that produce INF-gamma (chronic delayed type sensitivity rxn)
  2. US: excessive activation of TH2 cells
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8
Q

What are characteristics of Crohn’s Disease?

A
  1. Mouth to anus (skip lesions) - spares rectum
  2. cobblestoning, creeping fat
  3. Radiology: STRING SIGN
  4. NONCASEATING GRANULOMAS W MULTINUCLEATED GIANT CELLS (pathognomonic)
  5. Transmural inflammation
  6. Paneth cell metaplasia (left colon)
  7. mucosal aphthous ulcers (ulcers run parallel to length of bowel
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9
Q

What are histological features of Crohn’s?

A

Noncaseating Granulomas
Multinucleated Giant Cells
Paneth Cell metaplasia

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10
Q

What are characteristics of Ulcerative Colitis?

A
  1. Continuous lesions (starts at rectum, extends prox)
  2. Mucosa + submucosa (not full thickness)
  3. Friable + hemorrhagic
  4. Flattened mucosa = radiography = lead pipe
  5. chronic = inflammatory pseudopolyps
  6. crypt abscesses
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11
Q

What are pseudopolyps comprised of? what do they look like?

A
mononuclear inflammation
polypoid appearance (rug like)
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12
Q

How does smoking affect risk of UC and CD?

A

CD: increased risk
UC: decreased risk

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13
Q

What is the clinical presentation, extranintestinal features, and complications of Crohn’s?

A

clinical presentation: RLQ colicky pain, aphthous ulcers

Extraintestinal features: Erythema nodosum, iritis/uveitis, pyodermagrangrenosum, spondyloarthropathy, nephrolithiasis

Complications: Fistulas, calcium oxalate stones

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14
Q

What is the clinical presentation, extranintestinal features, and complications of Ulcerative Colitis?

A

presentation: Left sided pain, bloody/mucus diarrhea

Extraintestinal features: PSC, pyoderma grangrenosum, spondyloarthropathy

Complications: Epithelial dysplasia, adenocarcinoma, toxic megacolon

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15
Q

What are the two types of Microscopic colitis what are shared features of the two?

A
  1. Colagenous colitis
  2. Lymphocytic colitis

Idiopathic, chronic, watery diarrhea w/o blood or weight loss
radiographically: normal bowel

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16
Q

How are Collagenous colitis and lymphocytic colitis different?

A

Collagenous colitis: F>M, Dense subepithelial collagen layer; intraepithelial lymphs, mixed inflammation in Lamina Propria

Lymphocytic colitis: normal appearing basement membrane area, more dense thant collagenous colitis,
associated with celiac disease

17
Q

What is Dysplasia associated lesion or mass (DALM)? what are risk factors?

A
Long term complication of IBC
risk:
1. duration of ibd (>8-10 years)
2. extent of ibd (pancolitis > left sided disease)
3. Severity (more common = more risk)