Chapter 17 Part 7 Flashcards by Leah Ritter

What are the symptoms of IBS?

abdominal pain
bloating
changes in bowel habits

-chronic, relapsing

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True or False: IBS can be seen grossly and histologically

False; endoscopic and microscopic evaluations are normal

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What are contributors to the possible pathogenesis of IBS?

psychologic stressors
diet
gut microbiome
abnormal GI motility
increased enteric response to GI stimuli

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What is the most common patient population for IBS?

-females aged 20-40

- -high-income countries

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What does the Rome Criteria for IBS?

-at least 3 months (with the onset at least 6 months prior) of recurrent abdominal pain/discomfort and two or more of the following:

improvement w/ defecation
onset was associated w/ change in stool frequency
onset was associated w/ change in stool appearance

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What are the structures associated with Ulcerative Colitis?

-mucosa and submucosa of the rectum and colon

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What are the structures associated with Crohn Disease?

anywhere in the GI tract, but ileum most frequently

- typically transmural

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What is the population normally affected by IBD?

teenagers and early 20’s
UC is slightly more common in females
Caucasians
4x more common in Ashkenazi Jews

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What is seen at the epithelial surface of IBD?

disruption of the mucus layer
dysregulation of epithelial tight junctions
increased intestinal permeability
increased bacterial adherence to epithelial cells

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Which form of IBD has stronger genetic factors?

-Crohn Disease

–50% concordance in monozygotic twins, whereas there’s only a 15% concordance rate for UC in monozygotic twins

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CD or UC: Skip lesions

CD; patchy distribution results in cobblestone appearance of mucosa

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CD or UC: continuous diffuse lesions

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CD or UC: Which has a thick wall and which has a thin wall?

CD - thick

UC - thin

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CD or UC: pseudopolyps

UC; tips of pseudopolyps can fuse to create mucosal bridges

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CD or UC: Which has deep, knife-like ulcers and which has superficial, broad-based ulcers?

CD - deep, knife

UC - superficial, broad

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CD or UC: fibrosis

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CD or UC: granulomas

CD (in approx. 35%)

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CD or UC: fistulas

CD or UC: fat/vitamin malabsorption

CD or UC: shows no recurrence after surgery

CD or UC: toxic megacolon

CD or UC: “creeping fat”

True or False: multiple ulcers in CD can coalesce into elongated, serpentine ulcers oriented along the axis of the bowel.

True

-UC ulcers are also aligned along the long axis of the colon, but are not typically serpentine

What are the presenting symptoms of Crohn Disease?

abdominal pain (RLQ)
diarrhea
N/V
weight loss

CD or UC: which has smoking as a risk factor and which has smoking as a protective factor

CD - risk | UC - protective

True or False: initial attack of UC may be severe enough to constitute a medical or surgical emergency

True

What biliary tract disorder may be seen in UC patients?

-primary sclerosing cholangitis

What is the primary cellular infiltrate in CD?

- neutrophils - -clusters in a crypt from "crypt abscesses"; repeated crypt destruction gives rise to bizarre branching and unusual orientations

CD or UC: Paneth cell metaplasia

What are the presenting symptoms of Ulcerative Colitis?

- attacks of bloody diarrhea w/ stringy mucoid material - lower abdominal pain - relief w/ defecation

CD or UC: perinuclear anti-neutrophil cytoplasmic antibodies

CD or UC: antibodies to Saccharomyces cerevisiae

True or False: IBD can always be diagnosed as either CD or UC

False; 10% of IBD cases are Indeterminate Colitis

CD or UC: perinuclear anti-neutrophil cytoplasmic antibodies

CD or UC: antibodies to Saccharomyces cerevisiae

What three factors play into risk of neoplasia in patients with IBD?

1) duration of disease (increased risk at 9yrs) 2) extent of disease (pancolitis vs. left-sided) 3) nature of inflammatory response (neutrophils)

What is diversion colitis?

-colitis that develops in a diverted segment of bowel

What is microscopic colitis, collagenous type?

- -chronic, watery diarrhea w/o weight loss - -middle-aged and older women - -dense subepithelial collagen layer - -increased intraepithelial lymphocytes - -mixed inflammatory infiltrate

What is microscopic colitis, lymphocytic type?

- -chronic, watery diarrhea w/o weight loss - -markedly increased intraepithelial lymphocytes --strong association w/ celiac disease and autoimmune diseases

What are the GI implications of graft-versus-host disease?

-occurs following allogeneic hematopoietic stem cell transplantation - epithelial apoptosis of intestinal crypt cells - watery diarrhea; bloody diarrhea in severe cases

What is sigmoid diverticular disease (diverticulosis)?

-multiple, acquired, pseudodiverticular outpouchings of colonic mucosa and submucosa

What is the most common population for diverticulosis?

- rare in people younger than 30 - 50% of people over 60 in western world have it - -normally left-sided in the western world

What are complications of diverticulosis (sigmoid diverticular disease)?

- diverticulitis - -inflammation and increased pressure can lead to perforation because the diverticula is only invested my the mucosa and submucosa

While occurring in only 20% of patients, what are the symptoms of sigmoid diverticular diseases (diverticulosis)?

- intermittent cramping - continuous lower abdominal discomfort - constipation - distention - feeling of not being able to completely empty rectum