Pathoma Appendix & IBD

Question 1

acute appendicitis

Answer 1

*acute inflammation of appendix
*most common cause of acute abdomen
*related to OBSTRUCTION of the appendix by lymphoid hyperplasia (children) or a fecalith (adults)

Question 2

acute appendicitis - clinical features

Answer 2

*periumbilical pain, fever, and nausea
**pain eventually localizes to RLQ (McBurney’s point)
*rupture results in peritonitis that presents with guarding and rebound tenderness
*periappendiceal abscess is a common complication

Question 3

basic principles of inflammatory bowel disease (IBD)

Answer 3

*chronic, relapsing inflammation of the bowel
*possibly due to abnormal immune response to enteric flora
*classically presents in young women (teens to 30s) as recurrent bouts of bloody diarrhea and abdominal pain
*most prevalent in the West, esp Caucasians & Eastern European Jews
*diagnosis of exclusion (sx mimic other causes of bowel inflammation)
*subclassified as (1) ulcerative colitis or (2) Crohn disease

Question 4

ulcerative colitis

Answer 4

note - UC is one of 2 types of IBD
*wall involvement: mucosal & submucosal ulcers
*location: BEGINS IN RECTUM & can extend proximally up to cecum (involvement is continuous; anywhere in colon but remainder of GI tract is unaffected)
*symptoms: LLQ pain (rectum) with bloody diarrhea
*inflammation: CRYPT ABSCESS with neutrophils
*gross appearance: pseudopolyps; loss of haustra (“lead pipe” sign on imaging)
*complications: toxic megacolon & carcinoma
*associations: primary sclerosing cholangitis and p-ANCA positivity
*smoking: protects against UC

Question 5

Crohn Disease

Answer 5

note - Crohn disease is one of 2 types of IBD
*wall involvement: full-thickness inflammation with knife-like fissures
*location: anywhere from mouth to anus with skip lesions
*symptoms: RLQ pain with non-bloody diarrhea
*inflammation: lymphoid aggregates with GRANULOMAS
*gross appearance: cobblestone mucosa, creeping fat, and strictures (“string-sign” on imaging)
*complications: malabsorption with nutritional deficiency, calcium oxalate nephrolithiasis, fistula formation, and carcinoma (if colonic disease is present)
*associations: ankylosing spondylitis, sacroiliitis, migratory polyarthritis, erythema nodosum, and uveitis
*smoking: increases risk for Crohn disease

Question 6

2 factors that determine the risk of developing carcinoma with ulcerative colitis

Answer 6

1. extent of colonic involvement
2. duration of disease (generally not a concern until > 10 years of disease)

Question 7

IBD: ulcerative colitis vs. Crohn disease

Answer 7

ulcerative colitis:
-mucosal & submucosal ulcers
-LLQ pain
-begins in rectum; continuous
-crypt abscesses

Crohn disease:
-full thickness inflammation
-RLQ pain
-anywhere from mouth to anus; skip lesions
-lymphoid aggregates with granulomas

Question 8

histologic hallmark of ulcerative colitis

Answer 8

crypt abscesses with neutrophils

Question 9

histologic hallmark of Crohn disease

Answer 9

lymphoid aggregates with granulomas

Question 10

which type of IBD presents with LLQ pain

Answer 10

ulcerative colitis

Question 11

which type of IBD presents with RLQ pain

Answer 11

Crohn disease