The pathology of IBD

Question 1

What is the definition of Crohns disease?

Answer 1

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

Question 2

Where is crohns disease most common?

Answer 2

Terminal ileum and colon

Question 3

Who is most likely to get crohns diseases?

Answer 3

Young patients  (20-30)
More common in males

Question 4

What is the presentation of crohns diseases?

Answer 4

Abdo pain 
small bowel obstruction 
diarrhoea 
Bleeding PR
Anaemia
Weight loss

Question 5

What is the usual clinical course of crohns?

Answer 5

Chronic
Exacerbations and remission
Unpredictable response to therapy

Question 6

What might you see histologically with crohns disease?

Answer 6

Granuloma formation
increased chronic inflammatory cells in lamina propria
Increased goblet cells

Question 7

How far does the inflammation in crohns go?

Answer 7

Transmural

Question 8

Give a brief summary of crohns disease?

Answer 8

Transmural inflammation
Patchy
Deep knife like fissuring ulcers
granulomas - non ceasating

Question 9

What might be some complications of crohns disease?

Answer 9

Malabsorption

Gallstones (interrupted enterohepatic circulation - secondary to reduced bile and acid reabsorption)

Iatrogenic (short bowel syndrome) due to repeated resections and recurrences

Hypoproteinemia, Vitamin deficiency, Anaemia of all types

Fistulas

Anal disease

Bowel obstruction
Perforation
Amyloidosis

Question 10

Can you cure crohns disease?

Answer 10

No you can preform surgery but its not curative

Failure to tolerate or respond to medical therapy, continuous diarrhoea or pain

Question 11

What might be some environmental triggers of crohns disease?

Answer 11

Smoking
Infectious agents
Vasculitis could explain segmental distribution
Sterile environment theory

Question 12

Describe the aberrant immune response in Crohns disease?

Answer 12

Persistent activation of T-cells and macrophages (failure to switch off)
Excess pro inflammatory cytokine production

Question 13

What is ulcerative colitis?

Answer 13

Chronic inflammatory disorder confined to colon and rectum

Mucosal and submucosal inflammation

Unknown aetiology

Question 14

Who can get UC?

Answer 14

Young patents
Can present in the elderly
More common in males

Question 15

Where does UC affect?

Answer 15

Disease is confined to coon and rectum

Nearly always involved rectum

Question 16

What are the symptoms of UC?

Answer 16

Diarrhoea
Mucus
Blood

Question 17

What is the clinical course of UC?

Answer 17

Chronic course with exacerbation and remission

Continuous low grade activity

A single attack

Acute fulminant colitis (Toxic megacolon)

Question 18

Where is inflammation confined to in UC?

Answer 18

Mucosa and submucosa (except in toxic megacolon)

Question 19

Are there any granulomas in UC?

Answer 19

No granulomas

Question 20

What might flare ups in UC be due to?

Answer 20

Intercurrent infection by enteric bacteria or CMV

Question 21

What can be done for patents with UC?

Answer 21

Colectomy

Question 22

What is a complication of UC?

Answer 22

Toxic megacolon

acute or acute on chronic fulminant colitis
colon swells up to massive size
Will rupture unless removed
Emergency colectomy

Question 23

What else is a complication of UC?

Answer 23

Colorectal carcinoma

Chronic inflammation leads to epithelial dysplasia and then carcinoma

Risk increased if

- Pancolitis
- Disease longer than 10 years

• Requires surveillance

Question 24

What might be present in UC when investigating?

Answer 24

p-ANCA