wk 5 3 - Pathology of IBD

Question 1

define crohns disease, where is it most likely to occur

Answer 1

chronic inflammation and ulceration that can occur anywhere in GI tract

most common - terminal ileum and colon

Question 2

t/f 2/3 of patients with crohns only have small bowel involvement

Answer 2

true

1/6 have colonic/anal only
1/6 have both
variable involvement of stomach ..

Question 3

signs of crohns

Answer 3

ab pain 
small bowel obstruction 
diarrhoea
bleeding PR 
anaemia 
weight loss

Question 4

likely to be seen histologically in a crohns patient

Answer 4

granuloma formation
incr chronic inflam cells in lamina propria/transmural/cryptitis
deep fissures

Question 5

which disease does this describe

segmental areas of disease with intervening normal areas

Answer 5

crohns (skip lesions)

Question 6

likely complications of crohns 10

Answer 6

malabsorbtion (hypoproteinemia, Vit defiency ,Anaemia)
Short bowel syndrome (resections + recurrences)
Gall stones
Fistulas
Anal diseases
Intractable disease (failure to respond to therapy - cont. diarrhoea/pain)
obstruction
perforation
malignancy
amyloidosis

Question 7

define ulcerative colitis

Answer 7

chronic inflammation of colon and rectum (mucosal and submucosal)

Question 8

t/f crohns is the commonest cause of diarrhoea with pus and mucus in temperate climates

Answer 8

false

ulcerative colitis

Question 9

likely histology of ulcerative colitis

Answer 9

massive influx of inflam cells
irregular shaped crypts
acute cryptitis, crypt abscesses
ulceration and fibrinopurulent exudate

Question 10

ulcerative colitis is a superficial inflammation only,, in what circumstances does this not apply

Answer 10

toxic megacolon

Question 11

t/f granulomas may be present in ulcerative colitisv

Answer 11

false

Question 12

define toxic megacolon

Answer 12

acute/acute on chronic fulminant colitis
colon swells up to massive size, will rupture
emergency colectomy reqd

Question 13

complications of ulcerative colitis

Answer 13

colorectal carcinoma (inflam - epithelial dysplasia - carcinoma) (risk incr if longer than 10years/pancolitis)
blood loss
hypokalaemia (electrolyte disturbance)
anal fissures

Question 14

extra GI manifestations of ulcerative colitis 7

Answer 14

uveitis (eyes) 
primary sclerosing cholangitis (liver) 
arhritis, ankylosing spondylitis (spine inflam) 
pyoderma gangrenosum (skin) 
erythema nodusum (skin)

Question 15

which antibodies are present in ulcerative colitis

Answer 15

ANCA

Question 16

outline differences of ulcerative and crohns disease, histologically, areas affected

Answer 16

histologically - crohns has fissures,transmural inflam, focal/patchy mucosal involvement, granulomas

ulcerative has superificial involvement mainly (except deep ulcers), diffuse mucosal inflam, horizontal undrmining ulcers

areas - ulcerative is diffuse, continuous, of colon and rectum
crohns is patchy and segmental anywhere in GI

Question 17

which disease crohns or ulcerative has a higher risk of cancer

Answer 17

ulcerative