39. Inflammatory bowel diseases Flashcards Preview

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Flashcards in 39. Inflammatory bowel diseases Deck (36):
1

inflammation bowel disease types

1. Crohn disease
2. ulcertive colitis

2

Crohn disease vs Ulcerative colitis according to location in GI

Crohn disease ---> any potyion of GI tract usually terminal ileum and colom, and rectal spaing ( skip lesions)
Ulcerative colitis--> begins in rectum and can extend proximally up to the cecum ( continuous), remainder GI unaffected

3

Crohn disease vs Ulcerative colitis according to rectal involvement

Crohn disease ---> usually sparing
Ulcerative colitis ---> always

4

Crohn disease - gross morphology

transmural inflammation (--> fistula ) , Cobblestone mucosa creeping fat, bowel wall tickening - strictures, linear ulcers, fissures

5

Ulcerative colitis - gross morphology

mucosal and submucosal inflammation only , friable mucosal pseudopolyps with freely hanging mesentery, loss of haustra

6

Crohn disease vs ulcerative colitis according to imaging ( and mechanism

Crohn disease ---> string sign on barium swallow x-ray ( due to bowel wall thickening)
Ulcerative colitis --> lead pipe apperance ( due to loss of haustra

7

Crohn disease vs ulcerative colitis according to microscopic morphology

Crohn disease ---> noncaseating granulomas and lumphoid aggregates
Ulcerative colitis ---> crypt absecsses and ulcers, bleeding, no granulomas

8

Crohn disease vs ulcerative colitis according to intestinal manifestation

Crohn disease ---> diarrhea that may or may not be bloody
Ulcerative colitis ---> bloody diarrhea

9

Crohn disease - complications of GI

Malabsorption/malnutrition, colorectal cancer
( risk with pancolitis).
Fistulas (eg, enterovesical fistulae, which can
cause recurrent UTI and pneumaturia),
phlegmon/abscess, strictures (causing
obstruction), perianal disease.

10

Ulcerative colitis - complications of GI

Malabsorption/malnutrition, colorectal cancer
( risk with pancolitis).
Fulminant colitis, toxic megacolon, perforation

11

Crohn disease - extraintestinal manifestation

Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral
ulcerations (aphthous stomatitis), arthritis (peripheral, spondylitis).

Kidney stones (usually calcium oxalate),
gallstones.

12

Ulcerative colitis - extraintestinal manifestation

Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral
ulcerations (aphthous stomatitis), arthritis (peripheral, spondylitis).
1° sclerosing cholangitis. Associated with
p-ANCA.

13

IBD -eye?

episcleritis
uveitis

14

IBD- arthitis>

peripheral
spondilitis

15

IBD - rash

1. pyodema gangrenosum
2. erythema nodosum

16

IBD - smoking

protects against Ulcerative colitis
incrase risk for Crohn disease

17

• What is generally accepted as the etiology of Crohn disease?

Disordered immune responses to intestinal bacteria

18

• A man with ulcerative colitis asks if his condition was caused by a bacteria or virus. You explain that his disease a type of what process?

It is an autoimmune condition, possibly a disordered response to bacteria, but not directly caused by said bacteria

19

• A 20-year-old patient has recurrent diarrhea that is sometimes bloody, weight loss, oral ulcers, and perianal fistulas. Likely diagnosis?

Crohn disease

20

• What type of inflammatory bowel disease tends to show skip lesions (noncontiguous areas of mucosal involvement)?

Crohn disease

21

• A patient has a continuous segment of friable colonic mucosa that abruptly stops in the mid-transverse colon. First-line treatment is what?

Aminosalicylates (this is ulcerative colitis, which typically has colonic inflammation always involving the rectum)

22

• A man has transmural colonic inflammation with noncaseating granulomas and lymphoid aggregates. What cell type mediates this pathology?

Th1 cells (this is Crohn disease)

23

• No, as this is ulcerative colitis, which does not have granulomas; Th2 cells

.

24

• Is perianal disease mainly a complication of Crohn disease, ulcerative colitis, or both?

Crohn disease

25

• A young woman diagnosed with ulcerative colitis asks if she will have issues with malabsorption. How do you respond?

Malabsorption is unlikely with ulcerative colitis, since it is often limited to the colon (unlike Crohn disease)

26

• Is toxic megacolon mainly a complication of Crohn disease, ulcerative colitis, or both?

Ulcerative colitis

27

• A 26-year-old man with abdominal pain and mucous in the stool has transmural inflammation of the ileum. What complications may occur?

Migratory polyarthritis, erythema nodosum, pyoderma gangrenosum, ankylosing spondylitis, aphthous ulcers, uveitis (this is Crohn disease)

28

• A patient suffering from primary sclerosing cholangitis is likely to also carry a diagnosis of which inflammatory bowel disease?

Ulcerative colitis

29

• How does mucosal and submucosal inflammation with pseudopolyps and freely hanging mesentery in ulcerative colitis appear on imaging?

Lead-pipe appearance (the loss of haustra, giving the colon its segmented appearance, leads to this appearance)

30

• Describe the gross morphology typically found in Crohn disease.

Cobblestone mucosa, creeping fat, bowel wall thickening (string sign on X-ray), linear ulcers, fissures, fistulas, transmural inflammation

31

• Describe the gross morphology typically found in ulcerative colitis.

Mucosal and submucosal inflammation. friable mucosa with freely hanging mesentery (loss of haustra causes lead-pipe appearance on imaging)

32

• Name at least two complications of ulcerative colitis.

Malnutrition, primary sclerosing cholangitis, toxic megacolon, colorectal carcinoma (worse with right-sided colitis or pancolitis)

33

• Name at least two extraintestinal manifestations of ulcerative colitis.

Pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis, ankylosing spondylitis, aphthous ulcers, uveitis

34

• What mnemonic can help you to remember the basics of Crohn disease?

For Crohn, think of a fat granny and an old crone skipping down a cobblestone road away from the wreck (rectal bleeding)

35

• ULCCCERS = Ulcers, Large bowel, Continuous,

Colorectal carcinoma, Crypt abscesses, Extend proximally, Red diarrhea, Sclerosing cholangitis

36

• Rectum

• Crohn disease (strictures can lead to obstruction and require multiple resections of small bowel)
• Sulfasalazine, 6-mercaptopurine, infliximab, colectomy as last resort (this is ulcerative colitis)
• ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, or colectomy (diagnosis is ulcerative colitis)

..

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