Irritable bowel Disease Flashcards
Histological findings in Crohn’s?
Skip lesions Non-caseating granuloma formation Crypt branching in lamina propria Patchy chronic active colitis Deep knife-life fissures in mucosa Transmural inflammation Crypt abscess Cryptitis
Histological findings in UC?
Inflammatory cells and colitis Basal lymphoplasmicytic infiltrate Branching crypts Acute cruptitis Abcesses in crypts Fibrinopurulent exudate Broad based ulcers Superficial inflammation
Macroscopic findings UC?
Continuous diffuse inflammation starting rectum and moves proximally to ascending colon Superficial mucosal ulceration Pseudopolyps can be seen (no muscle) Rectal involvement almost always Contact bleeding colonscopy Loss vessel pattern
Macroscopic findings Crohn’s?
Strictures Fat wrapping blurred blood vessels Deep fissuring ulceration Cobblestoning Pseudopolyps may be seen (no muscle)
Complications crohn’s disease?
Malabsorption: HYPOproteinemia, B12 deficiency, anaemia
SHORT bowel syndrome
Gallstones
Anal disease
Why do patients with crohn’s get short bowel syndrome?
strictures
Resections - iatrogenic
Repeated recurrences
Why do patients with crohn’s get gallstones?
Bile malabsoprtion in terminal ileum due to inflammation
Excess of cholesterol leads to predisposition gallstones
Complications due to intractable crohn’s?
Bowel obstruction
Perforation
Malignancy
Amyloidosis
Extra-intestinal manifestations of UC?
EYES: Episcleritis, uvetitis
KIDNEY: Kidney stones, UTI, fistulae
SKIN: Erythema nodosum, pyoderma grangrenosum
LIVER: Steatosis
BILIARY TRACT: gall stones, schlerosing cholangitis
T/F
30% of primary sclerosing cholangitis patients have IBD
F
80% do
In terms of pathophysiology what do UC and crohn’s have in common?
- Persistent activation of T cells and macrophages
- Excess pro inflammatory cytokine production
- Absence in regulatory T cells
- Maybe alterable changing intestinal microflora!
Which T cells are overactive in UC?
TH1, TH2 and NK
Which T cells are overactive in Crohn’s?
TH1
In terms of pathophysiology what features are SPECIFIC to UC?
- Presence of autoantibodies (Anti neutrophil cytoplasm antibody)
- Neutrophilic inflammation
Main histologcical difference crohns and UC?
Crohns: deep fissures with transmural granulomas
UC: Superficial broad based ulcers, NO granulomas
Crohns: patchy mucosal involvement
UC: diffuse mucosal involvement
