The pathology of IBD Flashcards
What is the definition of Crohns disease?
Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus
Where is crohns disease most common?
Terminal ileum and colon
Who is most likely to get crohns diseases?
Young patients (20-30) More common in males
What is the presentation of crohns diseases?
Abdo pain small bowel obstruction diarrhoea Bleeding PR Anaemia Weight loss
What is the usual clinical course of crohns?
Chronic
Exacerbations and remission
Unpredictable response to therapy
What might you see histologically with crohns disease?
Granuloma formation
increased chronic inflammatory cells in lamina propria
Increased goblet cells
How far does the inflammation in crohns go?
Transmural
Give a brief summary of crohns disease?
Transmural inflammation
Patchy
Deep knife like fissuring ulcers
granulomas - non ceasating
What might be some complications of crohns disease?
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
Can you cure crohns disease?
No you can preform surgery but its not curative
Failure to tolerate or respond to medical therapy, continuous diarrhoea or pain
What might be some environmental triggers of crohns disease?
Smoking
Infectious agents
Vasculitis could explain segmental distribution
Sterile environment theory
Describe the aberrant immune response in Crohns disease?
Persistent activation of T-cells and macrophages (failure to switch off)
Excess pro inflammatory cytokine production
What is ulcerative colitis?
Chronic inflammatory disorder confined to colon and rectum
Mucosal and submucosal inflammation
Unknown aetiology
Who can get UC?
Young patents
Can present in the elderly
More common in males
Where does UC affect?
Disease is confined to coon and rectum
Nearly always involved rectum
What are the symptoms of UC?
Diarrhoea
Mucus
Blood
What is the clinical course of UC?
Chronic course with exacerbation and remission
Continuous low grade activity
A single attack
Acute fulminant colitis (Toxic megacolon)
Where is inflammation confined to in UC?
Mucosa and submucosa (except in toxic megacolon)
Are there any granulomas in UC?
No granulomas
What might flare ups in UC be due to?
Intercurrent infection by enteric bacteria or CMV
What can be done for patents with UC?
Colectomy
What is a complication of UC?
Toxic megacolon
acute or acute on chronic fulminant colitis
colon swells up to massive size
Will rupture unless removed
Emergency colectomy
What else is a complication of UC?
Colorectal carcinoma
Chronic inflammation leads to epithelial dysplasia and then carcinoma
Risk increased if
- Pancolitis - Disease longer than 10 years
• Requires surveillance
What might be present in UC when investigating?
p-ANCA
