Lec 29

Question 1

What happens to crypts in IBD?

Answer 1

have distortion of crypts; neutrophils within crypt epithelium

can form crypt abscess

Question 2

Which IBD disease associated with creeping fat?

Answer 2

crohns

Question 3

Which IBD disease associated with penetrating fissures and peritonitis?

Answer 3

crohns

Question 4

What is major complication of toxic megacolon?

Answer 4

perforation

Question 5

Is patient with crohns colitis or ulcerative colitis at more risk for colon cancer?

Answer 5

same risk

Question 6

What do you see histologically in pseudomembranous colitis?

Answer 6

surface necrosis with dilated crypts; volcano-like acute inflammatory exudate

dilated glands filled with mucous

Question 7

What is morphology of clostridium difficile?

Answer 7

gram positive spore forming rod
endemic in health care settings

toxins A and B –> necrosis of colonic epithelial cells

Question 8

What are 3 treatments for CDiff colitis?

Answer 8

metronidazole
vancomycin
fecal transplant

Question 9

What is string sign in barium xray?

Answer 9

sign of stenosis in crohns

Question 10

What do you see on endoscopy with colonic ischemia?

Answer 10

• dusky red discoloration with ulceration

Question 11

What are features of colon that make it at risk for ischemia?

Answer 11

• low blood flow relative to tissue mass
• poor collateral flow
• sensitivity to vasoconstrictors
• watershed regions

Question 12

What are the two watershed areas of colon?

Answer 12

splenic flexure = SMA + IMA

sigmoid colon = IMA + hypogastric artery

Question 13

Can superficial ischemia of colon heal completely? What about injury deep to mucosa?

Answer 13

superficial can heal; deep may cause stricture when it heals

Question 14

Who is at risk for colonic ischemia?

Answer 14

elderly
pts in shock
oral contraceptives; vasoconstrictive drugs

Question 15

What are complications of diverticular disease?

Answer 15

painless bleeding from small artery at base of diverticulum

inflammation –> diverticulitis

Question 16

What are signs of diverticulitis?

Answer 16

fever, LLQ tender, rope-like mass

can get abscess, fistula, perforation

Question 17

What do you see on endoscopy with collagenous colitis?

Answer 17

nothing

Question 18

What are symptoms of mild colonic ischemia?

Answer 18

ab cramps
rectal bleeding
diarrhea

Question 19

What do you see histologically with colonic ischemia?

Answer 19

eosinophilic staining, near absence of goblet cells, shrunken crypts
coagulative necrosis
few inflammatory cells

Question 20

Where are most diverticula located?

Answer 20

sigmoid colon

Question 21

What is triad of signs seen in collagenous and lymphocytic colitis

Answer 21

• long standing watery non-bloody diarrhea
• mucosa looks normal grossly
• chronic mucosal inflammation by histology

Question 22

What do you see histologically in collagenous colitits?

Answer 22

abnormal band of collagen beneath surface epithelium

may have intraepithelium lymphocytes

Question 23

Who gets collagenous colitits?

Answer 23

mostly women; middle aged or older

Question 24

What do you see histologically in lymphocytic colitis?

Answer 24

intraepithelial lymphocytes

no collagen band

Question 25

Who gets lymphocytic colitits?

Answer 25

equally affects men/women