inflammatory bowel disease

Question 1

what are the two chronic conditions of inflammatory bowel disease

Answer 1

• crohns disease

- ulceratvie colitis

Question 2

what is the etiology of inflammatory bowel disease

Answer 2

• genetic susceptibility -not pinpointed to one specific gene
• environmental trigger (COMPLEX TRAIT)
• loss of immune tolerance for NORMAL gut flora (just gut flora immune defenses in gut targeting them)

Question 3

what kind of lesions are there in crohns disease

Answer 3

skip lesions

Question 4

what are the lesions like in ulcerative colitits

Answer 4

continuous (lesion) involvement of colon, beginning with rectum

Question 5

what type of inflm does crohns disease have

Answer 5

granulomatous

Question 6

what type of inflm does ulcerative colitis have

Answer 6

ulcerative & exudative

Question 7

what level of bowel is invovled in crohns disease

Answer 7

primarily submucosal

Question 8

what level of bowel is invovled in ulcerative colitis

Answer 8

primarily mucosal

Question 9

extent of involvement in crohns disease

Answer 9

skip lesions

Question 10

extent of involvement in ulcerative colitis

Answer 10

continuous

Question 11

areas of involvement crohns disease

Answer 11

primarily ileum, secondarily colon

Question 12

areas of involvement ulcerative colitis

Answer 12

primarily rectum and left colon

Question 13

diarrhea common characteristic of crohns disease

Answer 13

yes

Question 14

diarrhea common characterstic of ulcerative colitis

Answer 14

yes

Question 15

does rectal bleeding happen with crohns or ulcerative colitis

Answer 15

crohns- rare

ulcerative colitis-common

Question 16

do fistulas happen with crohns or ulcerative colitis

Answer 16

crohns- common

ulcerative colitis- rare

Question 17

do strictures happen with crohns or ulcerative colitis

Answer 17

crohns- common

ulcerative colitis- rare

Question 18

are peri anal abscesses crohns or ulcerative colitis

Answer 18

crohns- common

ulcerative colitis- rare

Question 19

development of cancer with crohns or ulcerative colitis

Answer 19

crohns-uncommon

ulcerative colitis- relatively common

Question 20

Chrons disease

Answer 20

• granulomatus inflm skip lesions: -cobblestone appearance
• primarily affects submucosa of terminal ileum
• other layers & areas may be affected: 40% LI, 30% SI, 30% both small and large intestine
• slow non aggressive progression

Question 21

Mnfts of crohns disease

Answer 21

• intermittent diarrhea
• abdominal colic (wavey pattern of pain, cramping, spasmotic)
• WT loss
• fluid & electrolyte imbalance

Complications: -fistulas (structural complications, tube may obstruct contents in bowel) -abscesses -bowel obstruction (structural changes can cause bowel obstruction & other reasons)

Question 22

why would a person loose weight if they had crohns disease?

Answer 22

parts of the small intestine are inflamed, inflammation damages & scar tissue, then cannot absorb nutrients through small intestine, nutritional deficiency d/t lack of absorption (decrease in absorptive surface causes nutritional deficiency)

Question 23

what are the Crypts of Liebuerkuhn

Answer 23

are glandular structures that open into spaces between the villi (the cells of these glands are called paneth cells that secrete intestinal juice as the gradually migrate along the side of the crypt & the villus they are eventually shed into the lumen of the intestine)
in ulcerative colitis a characteristic of the diseases is the lesions that form in the crypts of liebuerkuhn

Question 24

Ulcerative colitis

Answer 24

• primarily affects mucosa of colon & rectum
• proximal spread form rectum (begins in rectum progress proximaly to sigmoid colon to terminal descending colon
• continuous lesions with:
  - crypt abscess
  - bleeding ulcers
  - inflamed & thickening of layer
  - pseudopolyps (areas of granulation tissue & inflammatory cells, like polyps pouches into intestinal wall)
  - edema & congestion

Question 25

Mnfts of ulcerative colitis

Answer 25

• relapsing bloody diarrhea (when it relapses it is persistent)
• abdominal cramping

Question 26

Diagnosing Inflammatory bowel disease

Answer 26

• history, physical exam
• sigmoidoscopy, colonoscopy, biopsy
• exclude GI infection

Question 27

Treatment of Inflammatory bowel disease is based on

Answer 27

-based on severity

Question 28

Treatment of Inflammatory bowel disease is?

Answer 28

• anti-inflm (eg. SULFASALAZONE)
• steriods (if non-responsive to sulfasalazone, do not use steriods as first line because have many side effects dont want to use steriods longterm or in high doses)
• immunomodulator (eg. METHOTREXATE)
• Abx for overgrowth (only if there is overgrowth of normal flora)
• Sx? if fistulas want to remove, -if bleeding ulcers need to drain ulcers -If area of the gut is too far gone non-responsive resect the gut (bowel resuction)
• lifestyle modifications -diet, offending foods same as IBS