Difference Between Ulcerative Colitis And Chrons

Question 1

1. Location

Answer 1

*Ulcerative Colitis: Affects only the colon (large intestine) and always involves the rectum. Inflammation spreads continuously from the rectum upwards.
1-proctitis…rectum فقط
2-proctosigmoiditis
3-lt sided colitis
4-extensive colitis
5-pancolitis

*Crohn’s Disease: Can affect any part of the GI tract from mouth to anus, commonly the terminal ileum. Inflammation is patchy (“skip lesions”). With Rectal sparing..
1-ileal
2-iliocolonic
3-colon only(chrons colitis)
4-perianal disease

Question 2

2- Depth of Inflammation

Answer 2

*UC: Involves only the mucosa and submucosa (superficial layers).
So, in barium it appear as led pipe and loss of haustrations

*Crohn’s: Involves all layers of the bowel wall (transmural), which can lead to fistulas and strictures.

Question 3

Appearance on Endoscopy

Answer 3

UC: Continuous inflammation with ulcers, erythema, and loss of vascular markings,pseudopolyps
Pathology…cryptitis,crypt abcess,crypt atrophy and decrease in number and on long standing dysplasia may occur

Crohn’s: “Cobblestone” appearance, skip lesions, deep ulcers, and strictures.
*Pathology….non caseating granuloma

Question 4

Complications

Answer 4

UC: Higher risk of colorectal cancer, toxic megacolon.

Crohn’s: Fistulas, abscesses, strictures, malabsorption.

Question 5

Surgery

Answer 5

UC: Surgery (colectomy) is curative.

Crohn’s: Surgery is not curative, and disease often recurs at new sites.

Question 6

Extraintestinal Manifestations

Answer 6

Both can have joint, skin, eye, and liver involvement, but Crohn’s more commonly causes nutritional deficiencies due to small bowel involvement.

Question 7

Genetic associations

Answer 7

ULCERATIVE…P anCa
Chrons….aSca

Question 8

Extraintestinal Manifestations

Answer 8

التحشيشة…
Colon is the sac of a pie
S…..Sclerosing cholangitis, Sacroiliitis, Spondylitis
A…Aphthous ulcers, Ankylosing Spondylitis / Amyloidosis
C…Cholelithiasis (GB stone), ca stone in urine, Clubbing of finger
P…Pleurisy, Pericarditis, Peritonitis, pyoderma gangrenosum
I…Iritis, Uveitis, Episcleritis, iridocyclitis
E…Erythema nodosum, Episcleritis

Question 9

A 39-year-old man with active CD develops a transient “ache” in his right eye, followed by red-
ness (Figure 5-1). There are no visual changes, photophobiaWhat is the most likely diagno, or headache.

Answer 9

*What is the most likely diagnosis?
Episcleritis
*Will treating the CD itself also improve this lesion?
Yes

Question 10

42-year-old man with UC managed by mesalamine and 6-MP is hospitalized for an acute
flare and is started on intravenous corticosteroids. After 4 days of therapy, there is little progress,
with 8 to 10 bloody bowel movements daily, fecal incontinence, and abdominal cramping. He is
made nil per os (NPO) and is continued on steroids, but the symptoms persist. Abdominal com-
puted tomography (CT) reveals evidence of severe pancolitis but no abscess, small bowel involve-
ment, or other intra-abdominal pathology. The transverse colon diameter is 4 cm. The maximal
temperature has been 100.4°F, blood pressure (BP) has remained stable, pulse is consistently below
120 beats per minute, and the white blood cell count ranges from 9000 to 12,000, with 85% + poly-
morphonuclear leukocytes (PMNs). Colonoscopy with biopsy is performed. A representative
endoscopic image is shown in Figure 4-1, and micrograph is shown in Figure 4-2.
What is the next step to manage this patient?

Answer 10

Steroids resistant in ibd, think about cmv or cl.difficile infection

Question 11

6-year-old man has recurrent rectal bleeding and tenesmus in the setting of chronic con-
stipation. Colonoscopy reveals a lesion in the rectum and an otherwise normal sigmoid colon
(Figure 10-1). The rest of the examination is unremarkable. Biopsy of the rectal lesion reveals no
crypt distortion or organisms, but evidence of granulation tissue and a fibrinopurulent exudate.
There’s no history of anal intercourse or foreign bodies. He’s initially diagnosed with ulcerative
proctitis and receives mesalamine suppositories and enemas, although this does not improve
the symptoms. He subsequently receives intrarectal steroid foam applications, which also don’t improve the bleeding and tenesmus.

Answer 11

*What is the most likely diagnosis?
This is solitary rectal ulcer syndrome (SRUS) from chronic constipation
How should this be treated?

Life style modification
Bowel habit modification
Enema
Topical mesalamine
Surgical

Question 12

A 56-year-old man undergoes a routine, average-risk screening colonoscopy. There’s extensive
diverticulosis in the sigmoid colon. A 5-cm patch of diverticulosis is surrounded with erythema and ulcerations, especially between the diverticula themselves. The remainder of the colonoscopy
is unremarkable. Biopsies of the affected area reveal cryptitis, crypt abscesses, granulomas, and chronic architectural distortion of the glands. Random segmental biopsies of the colon are other-
wise normal. The rectum is spared. On further history, you learn that he has experienced inter-mittent IBS-like symptoms for more than a decade, but no rectal bleeding, weight loss, anemia, skin rashes, eye symptoms, or arthralgias. Laboratories include a normal CBC, normal ESR and
CRP, and no evidence of infection on stool studies. IBD serologies, including perinuclear antineu-trophil cytoplasmic antibodies (p-ANCA) and anti-saccharomyces cerevisiae antibodies (ASCA),
aren’t consistent with UC or CD. Subsequent investigations include a normal upper endoscopy and
a normal small bowel follow-through study.

Answer 12

What is the most likely diagnosis?
This is SCAD. It also goes by diverticular-associated segmental colitis.

Question 13

68-year-old man undergoes an urgent right hemicolectomy and ileostomy for acute right-
sided diverticultis complicated by a peridiverticular abscess. The surgeon plans to perform a
subsequent reanastomosis of the ileum and remaining colon, but there is a delay in reoperating
due to concurrent medical illnesses.
Three months after the operation, the patient develops rectal bleeding, tenesmus, left-sided
abdominal pain, and a thick mucous discharge from his rectum. The output from his ileostomy
is liquid, brown, and without blood. The patient reports no previous history of similar symptoms
at any time prior to his operation.
The rectal effluent is sent for bacterial cultures, ova and parasites, and C difficile toxin, all of
which are negative. The symptoms persist, leading to evaluation by a gastroenterologist and sub-
sequent colonoscopy, which reveals friable mucosa and diffuse aphthous ulcerations, suggestive
of diffuse colitis. Biopsies reveal preservation of the crypt architecture, but evidence of cryptitis
with crypt abscesses, neutrophilic infiltrate in the lamina propria, and an increased density of
lymphocytes and plasma cells.

Answer 13

▶ What is the most likely diagnosis?
Diversion colitis
▶ What treatment should be initiated and why?
Short chain fatty acids+reanastomosis

Question 14

Recurrent bloody diarrhea after ileostomy that improves with short chain
fatty acid enemas

Answer 14

Diversion colitis

Question 15

Bloody diarrhea and colonic ulcers with “owl’s eye” inclusion bodies.

Answer 15

CMV

Question 16

Bloody diarrhea with multiple “flask-shaped” colonic ulcers and motile trophozoites with
ingested erythrocytes on wet mount of the stool.

Answer 16

E.histolytica