Crohn's and Ulcerative colitis Pathophysiology Flashcards
(23 cards)
What does IBD increase risk of getting (i.e complications) (5)
- bowel cancer
- liver disease
- VTE
- CV disease
- premature death
What is the etiology of IBD dsiease (3)
- Infectious agents
- microorgnaisms prob play a role
- maybe viruses, protozoa, mycobacteria, listeria, chlamydia
- bacteria produces toxins -> cause mucosal damage -> influx of inflammatory cells + T-cell activation - Genetic predisposition
- common in monozygotic twins (60%)
- 20x risk if 1st degree relatives have it
- common races: eastern european, jewish, south asians - Environmental factors
- diet
- norther climates
- urban areas, developed countries
Differentiate between the infiltration location of CD and UC. What does it infiltrate with
Infiltration: lymphocytes, plasma cells, mast cells, macrophages, neutrophils
CD:
- Effects are transmural (throughout all the tissue layers)
UC:
- Effects are only in the mucosa and submucosa
Differentiate between Crohn’s and UC in terms of presentation and inflammation effects
CD
- Inflammation causes fissures into tissues
- DIScontinuous segments “skip lesions” of large intestine
(can occur in ANY part of GI, from mouth-anus)
UC
- Inflammation causes missing segments of tissue (pseudopolyp)
- CONTinuous segments affected
- usually descending colon to rectum
- sometimes short segment of terminal ileum (backwash ileitis)
Differentiate between the cytokine dysregulation of CD and UC (2)
CD
- Th1 cytokine excessive production
- mediates responses against PATHOGENS
UC
- Th2 cytokine excessive production
- mediates responses against ALLERGENS
TNFa expression increased in both
What are other lifestyle factors than cause flare ups in IBD (3)
- Psychological
- stress - Diet
- avoid over-restrictive diets - Smoking
- Protective for UC, exacerbates CD
What does the clinical presentation of UC look like? (5)
- Diarrhea (often w/ blood), cramping. can lead to weight loss
- Fever, tachycardia (due to severe diarrhea)
- blurred vision, eye pain, photophobia
- arthritis
- raised red tender skin nodules
T/F Fistulas, perforation, or obstruction are common in UC
False
What do primary lesions look like in UC
Crypt abscesses
- goblet cells and crypts within mucosal layer get effected
What are common complications of UC
- Extension and coalescence (merge) of ulcers
- Pseudopolyps: areas of uninvolved mucosa
Local: - hemorrhoids
- perirectal abscesses
- anal fissures
- colonic hemorrhage
What do typical lab values look like in UC?
Severe diseases
Low hematocrit
Low hemoglobin
Increased ESR (indicator of inflammation)
Leukocytosis - severe
Hypoalbuminemia - severe
Define what mild, mod, severe, fulminant UC looks like
Mild
- up to 3 stools/day (+/- blood)
- No systemic disturbances
- Normal ESR
Moderate
- 4-6 stools per day
- minimal systemic disturbances
Severe
- 7-10 stools/day
- Fever, tachycardia, anemia
- ESR over 30 mm/h
Fulminant
- 11+ stools/day
- continuous bleeding
- toxicity
- abdomen tenderness, needs transfusions
- Colonic dilation
What are poor prognostic features for UC? (5)
- Diagnosed at 41+
- Low hemoglobin
- Low albumin
- Extensive disease
- Elevated inflammatory markers CRP, ESR
T/F Crohn’s can narrow then lumen
True (cobblestone appearance)
- Mesentery becomes thickened and edematous and eventually fibrotic
Which clinical presentation is more unique to Crohn’s and more common in Crohn’s
- Malaise, fever
- Abdominal pain
- fistula
- weight loss and malnutrition
Is bleeding more common in UC or CD
UC
- Crohn’s is not that severe
What are the 3 distinct disease courses that a Crohn’s patient can have
- Inflammatory
- Strictures/obstruction
- Abnormal narrowing of intestine (due to muscle hypertrophy/scarring)
- May lead to fistulas or perforation of bowel - Fistulas
- crack going from one part of the body to another (eg. from the intestine through mucosa/muscle/skin)
- Essentially bowel contents are leaking out onto the skin, leading to infection
- must be covered with a hydro conductive wick to minimize flow of enteric contents
What are lab values indicative of CD?
- Increased ESR
- increased WBC
- Increased CRP
What is the target CDAI score for CD?
What does it look at? (6)
Target: <150
Looks at
- frequency of stools
- severity of abdo pain
- overall wellbeing
- complications (arthritis, eye)
- Hematocrit
- Weight loss
Define a mild, moderate-severe, severe- fulminant CDAI score in CD
Mild: CDAI 150-220
- ambulatory
- no evidence of dehydration, systemic toxicity, obstruction etc..
Moderate- severe: CDAI 220-450
- failed mild treatment
- fever, weight loss, abdo pain,
- obstruction, tenderness, vomiting
- sig. anemia
Severe-fulminant: CDAI 450+
- Persistent sx despite corticosteroid or biologic treatment
- presence of cahexia, rebound tenderness, intestinal obstruction
- abscess
What does the mayo clinic score look at? (3)
In the past 3 days:
- Frequency of stools
- Rectal bleeding
Physician assessment
What mayo clinic score indicates
Remission
Mild disease
Moderate disease
Severe disease
Remission = 0-1
Mild disease = 2-4
Moderate disease = 5-6
Severe disease= 7-9
What are the systemic complications of IBD (6)
- Arthritis
- asymmetrical (unlike RA) common in small joints of hands, knees, elbows - Eye manifestations
- iritis, episcleritis - Skin lesions
- erythema nodosum (knee spots)
- pyoderma gangrenosum (outside ulcer)
- Apthous ulcer (canker sore) - Liver disease
- Renal stones
- Gallstones
- Malnutrition
- B12, folate, iron deficiency
- hypokalemia
- low albumin
