Flashcards in EXAM #1: SMALL BOWEL PATHOLOGY Deck (43)
What is the definition of IBD?
Inflammatory Bowel Disease
What two diseases comprise IBD?
What is the postulated etiology of IBD?
Abnormal immune response to gut flora
What lymophocyte is implicated as the "prime culprit" in IBD?
T-cells; there is an impairment of T-cell downregulation
What antibody is helpful in diagnosis of UC?
What antibody is helpful in diagnosing Chron's Disease?
In addition to T-cell dysregulation, what pathogenic feature is associated with CD?
Chronic Delayed Hypersensitivity
In addition to T-cell dysregulation, what pathogenic feature is associated with UC?
Excessive Th2 stimulation
What part of the GI tract is involved in Chron's Disease? What is least common?
Any region from "mouth to anus," but most commonly the terminal ileum
(Rectum is least common)
What are the hallmark symptoms of Chron's Disease?
- Intermittent diarrhea (non-bloody)
- Right lower quadrant abdominal pain
How many walls of the bowel are involved in Chron's Disease?
ALL-- i.e. this is "transmural" or full thickness inflammation of the bowel
What type of inflammation is associated with Chron's Disease?
Lymphoid aggregates with granulomas
Describe the gross appearance of Chron's Disease?
1) Skip lesions
2) Cobblestone mucosa (healing)
4) Rubber hose sign (fibrosis causing thickening of bowel wall)
5) Creeping fat (pulling in of mesenteric fat with fibrosis)
What is a string sign? What disease is this associated with?
In Chron's Disease, narrowing of the lumen due to fibrosis causes the appearance of a "string" on barium study
What are the major complications of Chron's Disease?
1) Malabsorption and nutritional deficiency
2) Calcium oxalate nephrolithiasis
3) Fistula formation
What are the extraintesintal manifestations associated with Chron's Disease?
- Erythema nodosum
What types of arthritis are associated with Chron's Disease?
1) Peripheral joint
2) Ankylosing spondyliitis
3) Migratory polyarthritis
What is the relationship between smoking and Chron's Disease?
Smoking INCREASES risk for Chron's
Where is the inflammation localized in Ulceractive Colitis?
How does Ulceractive Colitis differ from Chron's?
1) Extends in a cont. fashion i.e. NO SKIP LESIONS
2) NO granulomas
3) Thinning, not a thickening of the bowel
4) Involves all of the "tube"
What are the clinical features of Ulceractive Colitis?
1) Bloody mucoid diarrhea
2) Left lower quadrant abdominal pain relieved by defecation
What is pancolitis?
Involvement of the entire colon in Ulceractive Colitis
What is backwash ileitis?
Inflammation of the distal ileum in UC due to "backwash" of cecal contents
What are the major complications of Ulceractive Colitis?
1) Toxic megacolon
What are the class gross features of Ulcerative Colitis?
- Loss of haustra
What is a pseuodpolyp seen in Ulceractive Colitis?
Bumps on the surface of the bowel in UC--represents areas of healing
What radiologic sign is associated with UC?
Lead pipe sign on X-ray
****This represents the loss of haustra i.e. a smooth tube seen on X-ray****
What extraintestinal manifestation is associated with UC?
Primary sclerosing cholangitis (Disease/ blockage of the bile ducts due to fibrosis)
What are the two main factors that determine the progression of UC to carcinoma?
1) Extent of colonic involvement
2) Duration of disease (greater than 10 years= high risk)