Week 7: IBD, Crohn's Disease, and UC

Question 1

A 23-year-old woman presents with a history of intermittent cramping abdominal pain, low-grade intermittent fever, and fluctuating diarrhea, sometimes with steatorrhea. These symptoms have been present intermittently over the last 2 years but have gotten gradually worse over the last year. She lost 15 pounds in the last year.

Physical exam: Temperature is now normal but was up to 38.1 a few weeks ago. There is mild, diffuse abdominal tenderness. There is a vague fullness in the right lower quadrant. There is perianal tenderness and a discharge suggesting a fistula. Examination of the skin shows no lesions. There is mild arthralgias in both knees. Eye exam is normal - there is no uveitis.

Answer 1

Crohn’s Disease

Question 2

ID what you see on the GI barium series

Answer 2

Stricture on the distal ileum

Question 3

ID

Answer 3

Bear Claw or Rake Ulcers

Indication of Crohn’s Disease

Question 4

What are 5 histological features of Crohn’s Disease

Answer 4

• Transmural Lymphoid Aggregates
• Pyloric Gland Metaplasia
• Non-caseating Granulomas
• Cryptitis
• Crypt Abscess Formation

Question 5

ID

Answer 5

Transmural lymphoid aggregates

Strong indicator of Crohn’s Disease over Ulcerative Colitis (UC). UC is only Mucosal and Submucosal.

Question 6

ID

Answer 6

Pyloric Gland Metaplasia

the glands are more dark purple suggesting increased nuclear material

Question 7

ID

Answer 7

Non-Caseating Granuloma

Strong indicator of Crohn’s Disease over Ulcerative Colitis (UC). Absent in UC.

Question 8

ID

Answer 8

Cryptitis

Neutrophils (yellow arows)

Question 9

ID

Answer 9

Crypt Abscess Formation

Question 10

Is this Crohn’s Disease or Ulcerative Colitis (UC)?

Answer 10

Crohn’s Disease

We can see the lymphoid aggregates in the muscularis propria and the presence of Non-Caseating Granulomas

Question 11

ID

Answer 11

Crohn’s Disease

Question 12

ID

Answer 12

Ulcerative Colitis (UC)

Left-sided colitis

Question 13

ID

Answer 13

Skip Lesions

Indication of Crohn’s Disease

Question 14

A 19-year-old male presents with a one year history of intermittent, gradually worsening rectal bleeding, frequent stools (up to 10 per day), and mucus discharge from the rectum. Colonoscopy shows extensive disease with extensive ulcers and pseudopolyps, extending continuously from the anal verge to the hepatic flexure. There are more subtle changes in the ascending colon and cecum.

Answer 14

Ulcerative Colitis (UC)

Question 15

ID

Answer 15

Ulcerative Colitis (UC)

Pseudopolyp (yellow arrow) and normal mucosa (cyan arrow)

Question 16

ID

Answer 16

Ulcerative Colitis (UC)

Pseudopolyp (yellow arrow) and normal mucosa (cyan arrow)

Question 17

ID

Answer 17

Ulcerative Colitis (UC)

Crypt Abscesses (yellow arrow). Frequent and widespread in UC

Question 18

ID

Answer 18

Ulcerative Colitis (UC)

Absence of Non-Caseating Granuloma and see the submucosa is currently unaffected; See large area of inflammation in the mucosa layer

Question 19

What condition is closely linked to Ulcerative Colitis (UC)?

Answer 19

Primary Sclerosing Cholangitis (PSC)

Question 20

Is smoking a protective or risk factor for Ulcerative Colitis (UC)?

Answer 20

Protective

Question 21

Is smoking a protective or risk factor for Crohn’s Disease?

Answer 21

Risk Factor

Question 22

ID

Answer 22

Primary Sclerosing Cholangitis (PSC)

Periductal ‘onion-skin’ fibrosis

Question 23

ID

Answer 23

Primary Sclerosing Cholangitis (PSC)

Periductal ‘onion-skin’ fibrosis (red arrow)

Question 24

ID

Answer 24

Primary Sclerosing Cholangitis (PSC)

Periductal ‘onion-skin’ fibrosis (red arow) as well as eventually complete fibrosis obliteration of bile ducts ‘tombstone scars’ (cyan arrow)

Question 25

Inflammatory bowel disease may cause these changes, especially in patients with long standing or poorly controlled disease. What are they?

Answer 25

Dysplasia, leading to adenocarcinoma

Question 26

24 year-old primigravida gives birth at term to a male infant. Apgar scores are 9 and 10 at 1 and 5 minutes. There is no passage of meconium. Three days after birth, infant vomits all oral feedings. On physical examination , the infant is afebrile, but the abdomen is distended and tender, and bowel sounds are reduced. An abdominal US shows marked colonic dilation above a narrow segment in the distal sigmoid region. A biopsy specimen from the narrowed region show an absence of ganglion cells in the muscle wall and submucosa. The intraoperative organs are shown below. What is the diagnosis?

Answer 26

Hirschprung Disease

Question 27

**ID**

Answer 27

Hirschprung Disease ## Footnote loss of ganglion cells (yellow ellipses)

Question 28

ID the stucture and tissue

Answer 28

Auerbach's/Myenteric Plexus and nervous tissue