IBD up to Peptic Ulcer Disease Flashcards
What constitutes IBD?
2 conditions:
Ulcerative colitis
Crohn disease (aka Crohn’s)
Etiology of IBD?
- complex trait
- Genetic susceptibility → is not specific genetic defect (not monogenic problem);
- Environ trigger → suggested to be bacterial infection
- IR against normal gut flora
Is IBD autoimmunity?
Ahmed says no…b/c is NOT autoimmunity b/c are not self-cells and do not have MHC and HLA genetic defect listed here
Textbook p 892 specifically says it is autoimmunity and that HLA is involved…
For fuck’s sakes.
How does targetting normal gut flora in IBD result in lesions?
Here normal tolerance that body has for normal flora is lost…problem here is that these flora have attachments to the lining of the gut (because can’t be free floating or would be swept through with fecal matter) so when bacteria are targeted, so are some of the cells
How is the distribution of lesions different in Crohn’s and Ulcerative Colitis?
- In Crohn’s disease, lesions are “skipped”
- Ulcerative colitis: has one, continuous lesion that affects only large intestine and rectum
(See figure 37-6)
Describe Crohn’s disease in terms of:
1) Area of intestines affected
2) Layer of intestine affected
3) Nature of lesions
4) Rate of progression
- Primarily affects terminal ileum – others can be affected
- Primarily affects submucosa – but all layers can be affected
- Granulomatous skip lesions - cobble stone appearance
- Slow, non-aggressive progression
Manifestations of Crohn’s disease
1) Diarrhea
2) Intermittent abdominal pain
3) Weight loss
Why does diarrhea result form crohn’s?
Intermittent pain?
peristalsis affected b/c lining affected, exudate formation
pain with peristalsis and passage of food…if not ingesting food and peristalsis is not ocurring, will not feel pain
Why does weight loss result in crohn’s disease?
Most lesions are in small intestine, which is where we absorb our nutrients…these areas are inflamed and damaged, decreasing absorptive surface → nutritional deficiency AND diarrhea means food moving too quickly to be absorbed properly
Ulcerative colitis
1) What areas affected? Layer of intestine?
2) How does progression occur?
3) are lesions skipped?
1) Primarily involves mucosa of colon and rectum
2) Spread is proximal from rectum → almost always begins in anus and rectum and progresses over time to spread upwards
3) Continuous lesions
Describe the changes that occur with the lesions and gut in ulcerative colitis
o Tissue thickens and becomes inflamed
o Bleeding ulcers
o Edema and congestion within lumen of gut → this occurs in area that is affected, edema develops from exudate formation in these areas
Manifestations of ulcerative colitis?
- Bloody diarrhea (resulting in anemia)
- Abdominal cramping
- Weight loss (d/t diarrhea…may not be as significant as with Crohn’s disease)
Why is weight loss in Crohn’s disease tyically more sig?
Crohn’s affects small intestine more…where absorption occurs
UC: just about loss of absorptive time r/t diarrhea
Dx of Crohn’s and UC?
- Hx, px
- differential diagnosis: Exclude GI infection – serology, stool samples. etc
- Sigmoidoscopy, colonoscopy, biopsy → taken to lab, lab will exclude other problems; looking for polyps, tumours
Tx of Crohn’s and UC?
- Chronic so need to manage both progression of disease and symptoms
- Based on severity (may only need lifestyle and diet mods)
- If moderate to severe:
1) Anti inflm eg: sufasalazine (+ Abx)
2) Prednisone if non-responsive
3) Immunomodulator for prevention of progression = Methotrexate
4) Sx (if need to fix ulcers or do resection)
