Week 8 Inflammatory Bowel Disease

Question 1

Describe Crohn’s disease- where affected

Answer 1

Can affect any part of GI tract

• terminal ilium affected in most cases
• transmural- whole thickness
• skip lesions- diseased bit, normal, diseased bit

Question 1

describe ulcerative colitis- what affected

Answer 1

begins in rectum- can extend proximally to involve entire colin- caecum and terminal ilium rare

• continuous pattern- no stop lesions- complete area of disease
• mucosal inflammation

Question 2

what are some of the causes of IBDs?

Answer 2

genetic- 1st degree relative increased risk
gut organisms- altered interaction
immune response- trigger? - ABs, infections, smoking (>in crohns but decreases sympts for UC), diet

Question 3

What are inflammatory bowel diseases and give examples?

Answer 3

Group of conditions characterised by idiopathic Inflammation of the GI tract
2 common types:
- Crohn’s disease- affects 15-30yr olds and 60yr olds- 2 phase occurrence
- ulcerative colitis- Young adults up to late 30s
Less common:
- diversion colitis- after ileostomy- small bit of bowel left behind has no movement through it- inflammation
- pouchitis- after colectomy- artificial rectum created from Ilium- pouch becomes inflamed
- microscopic colitis- inflamed cells of mucosa- cannot see with naked eye

Question 4

what secondary conditions are often associated with inflammatory bowel diseases?

Answer 4

extra intestinal problems

• MSK pain (up to 50%)- arthritis
• skin (up to 30%) - erythema nodosum (skin inflammation in fatty later- tender lumps), pyoderma gangrenosum (causes necrotic tissue), psoriasis
• liver/biliary tree- primary sclerosing cholangitis (PSC) (inflammation and fibrosis of bile duct) - often linked to UC
• eye problems (up to 5%)- schleritis- red eye

Question 5

What variety of symptoms may present in crohns?

Answer 5

crohns:

• loose stools- non bloody
• right lower quadrant pain- tender mass
• some joint pain
• mild perianal inflammation/ulceration
• low grade fever
• mildly anaemic
• smokers

Question 6

What are some of the gross and microscopic changes caused by Crohns disease?

Answer 6

Crohns gross pathology:

• hyperaemia (excessive amount of blood)
• mucosal oedema- inflammatory process
• discrete superficial ulcers- deeper inflammation
• deeper ulcers
• transmural inflammation- thickening of bowel wall, narrowing of lumen
• cobblestone appearance- stones= unaffected area, grout= ulcerated area
• fistulae- bowel- bowel/bladder/vagina/skin

Microscopic pathologies:
granuloma formation- if epitheloid granulomas must be crohns

Question 6

What variety of symptoms may present in UC?

Answer 6

• bloody stools- in UC more as affects mucosa whereas Crohns is transmural and lots of smaller areas
• mucus in stools- epithelial cells
• weight loss
• mild lower abdo pain/ cramping- mid gut/hind gut areas
• painful red eye- scheritis
• no perianal disease
• normal temp

Question 7

What are some of the gross and microscopic changes caused by UC?

Answer 7

pathological changes:

• chronic inflammatory infiltrate of lamina propria
• crypt abscesses- full of infectious cells- crypt distortion
• decreased goblet cells
• pseudopolyps- projecting masses of scar tissue developed from granulation
• loss of haustra- bubble pouch appearance of colon wall lost- flat cylinder left

Question 8

What are the common methods used to investigate Crohns?

Answer 8

• bloods- anaemia, pernicious as low B12 in terminal ileum
• CT/MRI scans- bowel wall thickening, obstruction, extramural problems (outside walls)
• barium enema- Xray to determine changes in colon, dye injected into rectum - used less- stictures/fistulae- not good if someone unwell
• colonoscopy- see up to terminal ileum- need CT/MRI to see higher- can see strictures/obstruction

Question 9

What are the common methods used to investigate UC?

Answer 9

• bloods- anaemia, serum markers
• stool cultures- rule out infection
• plain abdo radiographs
• barium enema- mild cases only
• CT/MRI- dont need unless liver involved- can use endoscopy as not transmural
• colonoscopy- ulcerations continuous

Question 10

what radiological features are seen with UC?

Answer 10

UC- lead pipe colon - loss of haustra due to repeated inflammation and healing

Question 11

What are some of the diagnostic difficulties in separating inflammatory bowel diseases?

Answer 11

even after diagnostic evaluation - 10% have disorders that cannot be classified- intermediate colitis

Question 13

what are some of the distinguishing characteristics between Crohns and UC?

Answer 13

crohns UC
location- anywhere in GI - rectum and colon
rectal involvment- no - yes
gross bleeding- 25% - yes
perianal diasease- 75% - rare
fistula formation- yes - no
malnutrition- potential - no

Question 14

what are some of the pathological distinguishing features of crohns and UC?

Answer 14

crohns - UC
transmural inflam- yes - rare
granulomas- up to 75% - no
fibrosis- common - no
cryp abscesses- rare - yes

Question 15

what are some of the distinguishing endoscopic changes seen in Crohns and UC?

Answer 15

Crohns - UC
mucosal involvement skip lesions - continuous
aphthous ulcers (mouth) yes - rare
linear ulcers yes - rare
friable mucosa (touch it= bleeds) rare - yes
fistula yes - no
narrowing yes - rare

Question 16

What are some of the common treatment options available for inflammatory bowel disease?

Answer 16

medical:
-stepwise approach:
1. aminosalicylates- sulfasalazine for flares and remission
2. corticosteroids- prednisolone- flares only
3. immunomodulators- azathioprine- fistulas/remission
surgical:
-crohns- not curative, strictures/fistulas, as little bowel removed as possible
- UC- curable (colectomy), inflammation not settled, precancerous changes, toxic magacolon

lifestyle also