IBD Of The Colon Flashcards
What is the most characteristic feature of crohn disease?
“Skip-like” inflammatory lesions involving all layers of the gut wall that can be found anywhere in the alimentary tract, but usually is found in the terminal ileum
Bowel symptoms between CD and UC
CD: (usually diagnosed in 20s)
- intermittent abdominal pain and cramping
- watery diarrhea that infrequently has blood in it (although it can)
UC: (usually diagnosed in 30s)
- abdominal pain only when defecating
- almost always bloody diarrhea
- urge incontinence and tenesmus
- increased stool frequency
Systemic symptoms of CD and UC
CD:
- weight loss
- fever
- bloating
- postprandial nausea
UC: (way less common than CD)
- weight loss
- fever
Extra manifestations of UC and CD
CD:
- canker sores (aphthous ulcers)**
- esophageal ulcers and dysphagia
- waxy skin tags on anus**
- anal diseases
- osteopenia
- arthropathies
- erythema nodosum/gangrenosum (more common)**
UC:
- osteopenia
- arthropathies
- erythema nodosum/gangrenosum (less common)**
- primary sclerosing cholangitis**
- opthalamologic manifestations**
What is “indetermittent colits”?
IBD that cant be distinguished between UC or CD
- these cases are exceptionally difficult to determine proper treatment
**also need to know before doing colon resection since UC will be “cured” but CD will not be sure in this
What is the histology findings in CD
Non-caseating granulomas
- live cells inside
Crypt atrophy
Transmural ulcers (“bear claw ulcers”)
“Skip areas”
Granulation tissue with monocyte infiltrates
Fistula/abscesses and strictures of all layers (may or may not be found)
Aphthous ulcers in bowel walls
What is the histology findings in UC
Ulcers that only affect mucosa layer
Mild crypt branching and abscesses
“Cryptitis” (crypts grow into the goblet cells)
Pa colonic inflammation
Mucosal damage with normal serosa
Gross pathology of CD
Bowel will show strictures and ulcers (narrowing lumen)
- will also show “creeping fat” where the mesentery moves to engulf the bowel stricture sections
Thick inflamed transmural bowel
- NEVER effects the rectum and usually not the. Sigmoid colon
Also may show pseudopolyps
Ashkenazi jews and IBD
Have the highest documented rates of all subsections of populations.
- also has the highest amongst all Jewish cultures
Gross pathology of UC
Shows “pancolitis”
- the entire colon can be involved in the inflammatory process
- also is usually chronic
Can show pseudopolyps and hemorrhages
There will be NO creeping fat
Can show “lead pipe” appearance also
- colon loses haustra
Blood testing in CD/UC
Both need the following 4 tests
1) CBC
- look for microcytic/microcytic anemia
(Macrocytic is more common in CD patients especially if they have had terminal ileal resection)
- elevated WBC
2) liver function tests
- AST/ALT levels (will especially be high in primary sclerosing cholangitis)
- bilirubin, albumin, transferrin levels
3) inflammatory markers
- CRP (more commonly elevated in CD)
- ESR (more commonly elevated in UC)
4) serum antibodies
- p-ANCA (more commonly elevated in UC)
- ASCA (more commonly elevated in CD)
Imaging for diagnosis of CD/YC
CTR enterography with oral contest
MRI enterography
- very useful in pregnancy and children**
Small bowel follow-through (SBFT)
MRI/CT of the abdomen
- MRI is better across the board
Plain film radiography of abdomen
- useful for accessing toxic or perforated colon**
Colonoscopy w/ biopsy
- gold standard for diagnosis for IBD
Capsule endoscopy
- be very careful if structures are suspected (need to use dissolvable potency pill in this case)
Smoking and IBD
Smoking increases the odds of getting IBD
- is the #1 environmental risk factor
HOWEVER, it is actually protective against UC, but increases risk of CD
Genetic risk factors for IBD
#1 risk factor is a family member has IBD (especially siblings) - Chance and risk is increased 17x in this case
IBD risk of monozygotic twin = 50%
2 affected family members = 30%
Dizygotic twin = 7-10%
Being genetically Jewish = 6.6%
Being white with 1 first degree relative affected = 3.3%
3 most commonly associated genes for IBD
NOD2
- role is defense from bacteri a
- shows severe CD
ATG16L1
- role is Autophagy for immune system
- often shows ileal CD or mild UC
IRGM
- role is Autophagy
- shows mild CD and/or UC
