Pathology of IBD

Question 1

types of idiopathic IBD

Answer 1

Crohn’s disease

ulcerative colitis

Question 2

describe IBD

Answer 2

chronic diseases

unknown aetiology

Question 3

what is Crohn’s disease

Answer 3

segmental, chronic, transmural inflammatory and ulcerating condition of GI tract

Question 4

where does Crohn’s disease effect the GI tract

Answer 4

can affect anywhere
most common - ileum and colon
2/3 patients have small bowel involvement only

Question 5

epidemiology of Crohn’s disease

Answer 5

young patients;
90% 10-40
50% 20-30
more common in males 
genetic defects - HLA-DR1 and HLA-DQw5

Question 6

signs of Crohn’s disease

Answer 6

abdominal pain
small bowel obstruction 
diarrhoea
bleeding PR (rectal bleeding)
anaemia 
weight loss

Question 7

tests for Crohn’s disease

Answer 7

endoscopy

mucosal biopsy

Question 8

microscopic changes in Crohn’s disease

Answer 8

chronic active colitis (increased chronic inflammatory cells in lamina proprietary)
granuloma formation - 50% non caseating

Question 9

treatment for Crohn’s disease

Answer 9

steroids
bowel obstruction
surgery

Question 10

pathology of Crohn’s disease

Answer 10

ill and/or colonic chronic active mucosal inflammation including;
cryptitis
crypt abscesses
deep fissuring ulcers

Question 11

complications of Crohn’s disease

Answer 11

malabsorption 
fistulas 
anal disease 
intractable disease 
bowel obstruction 
perforation 
malignancy
amyloidosis 
others - extra intestinal associated 
toxic megacolon - rare

Question 12

malabsorption of Crohn’s disease

Answer 12

iatrogenic (short bowel syndrome) - repeated resections and recurrences
hypoproteinemia, Vitamin deficiency, anaemia
gallstones (interrupted entzroheptic circulation)

Question 13

fistulas of Crohn’s disease

Answer 13

VesicoColic
Enterocolic
Gastrocolic
Recto vaginal
Tuboovarian abscess
Blind loop syndrome

Question 14

anal disease of Crohn’s disease

Answer 14

sinuses
fissures
skin tags
abscesses 
perineum falls apart

Question 15

intractable disease of Crohn’s disease

Answer 15

failure to tolerate or respond to medical therapy
continuous diarrhoea or pain
may require surgery - not curative

Question 16

environmental triggers for Crohn’s disease

Answer 16

smoking
infectious agents - viral, mycobacterial
vasculitis
sterile environment theory

Question 17

aberrant immune response of Crohn’s disease

Answer 17

persistent activation of T cells and macrophages - failure to switch off
excess pro inflammatory cytokine production

Question 18

how can aberrant immune response of Crohn’s disease be altered

Answer 18

by changing intestinal microflora via probiotics

Question 19

what is ulcerative colitis

Answer 19

continuous, diffuse chronic inflammatory disorder - mucosal and submucosal inflammation

Question 20

where does ulcerative colitis effect in the GI tract

Answer 20

confined to colon and rectum;

always involves the rectum and continuous proximally for varying length

Question 21

epidemiology of ulcerative colitis

Answer 21

young patients - peak in 30’s
can occur in elderly and children
more common in males
genetic defects - monozygotic twins, HLA-DR2 and NOD-2 gene

Question 22

signs of ulcerative colitis

Answer 22

diarrhoea

mucus and blood PR

Question 23

clinical presentation of ulcerative colitis

Answer 23

chronic course with exacerbation and remission
continuous low grade activity
single activity
acute fulminant colitis (toxic megacolon)

Question 24

tests for ulcerative colitis

Answer 24

endoscopy

mucosal biopsy

Question 25

microscopic changes of ulcerative colitis

Answer 25

massive influx of inflammatory cells;
basal lymphoplasmacytic infiltrate with irregular shaped branching crypts
severe ulceration (border based - superficial only!) with fibrinopurulent exudate, pseudo polyps seen

Question 26

treatment for ulcerative colitis

Answer 26

steroids

subtotal colectomy

Question 27

complications of ulcerative colitis

Answer 27

intractable disease
toxic megacolon
colorectal carcinoma 
blood loss
electrolyte disturbance (hypokalaemia)
anal fissures
extra GI manifestations

Question 28

intractable disease of ulcerative colitis

Answer 28

continuous diarhoea
flares due to intercurrent infection by enteric bacteria or CMV
requires total colectomy

Question 29

toxic megacolon of ulcerative colitis

Answer 29

acute or acute on chronic fulminant colitis
colon swells up - will rupture unless removed
requires emergency colectomy

Question 30

colorectal carcinoma of ulcerative colitis

Answer 30

chronic inflammation leads to epithelial dysplasia and then carcinoma
risk increased if pancolitis and/or disease has been there for longer than 10 years
requires surveillance

Question 31

describe extra GI manifestations complications of ulcerative colitis - eyes

Answer 31

eyes - uveitis

Question 32

describe extra GI manifestations complications of ulcerative colitis - liver

Answer 32

primary sclerosing cholangitis

Question 33

describe extra GI manifestations complications of ulcerative colitis - joints

Answer 33

arthritis

ank spondylitis

Question 34

describe extra GI manifestations complications of ulcerative colitis - skin

Answer 34

pyoderma gangrenosum

erythema nodusum

Question 35

aberrant immune response of ulcerative colitis

Answer 35

persistent activation of T cells and macrophages
autoantibodies present e.g. ANCA
excess pro inflammatory cytokine production and bystander damage due to neutrophilic inflammation

Question 36

how can aberrant immune response of ulcerative colitis be altered

Answer 36

changing intestinal microflora - probiotics