Flashcards in GI: Inflammatory Bowel Disease Deck (12):
What are the causes of inflammatory bowel disease?
Begins with a genetic predisposition then there is thought to be an immune trigger
Trigger is idiopathoc but possibly antibiotics, infection, smoking, diet
Where in the GI does crohn's and ulcerative colitis affect?
Crohn's: anywhere from mouth to anus - usually the ileum is involved and usually there is rectal sparing. (skip lesions)
Ulcerative colitis: begins in rectum and extends to involve anywhere in the large bowel (continuous)
What problems can pts experience outside of the GI tract?
MSK pain such as arthritis (50%)
Skin problems such as tender red lumps, psoriasis (30%)
Eye problems (5%)
How does Crohn's present?
Loose non bloody stools - area of absorption inflamed so there is a large osmotic load that draws in water
Weight loss - not absorbing nutrients
Right lower quadrant pain - terminal ileum
What is the pathology of Crohn's?
There are discrete superficial ulcers and deeper ulcers - transmural inflammation leads to thickening of the bowel wall and narrowing of the lumen.
There is cobblestone appearance - oedema surrounded by ulceration
Can get fistulae
What is the microscopic appearance of crohns?
There is granuloma formation which is a strong indicator of crohns
How would you investigate crohns?
- Bloods to test for anaemia
- CT and MRI scans to look for bowel wall inflammation, obstruction and extramural problems
- colonoscopy + biopsy
- barium enema less used
How does ulcerative colitis present?
Bloody, mucousy, loose stools
Mild lower abdo pain
What is the pathology of UC?
Chronic inflammation of lamina propria
Get crypt abscesses
Decreased goblet cells so lose protective mucus
Loss of haustra - lead pipe colon
Mucosa is friable - bleeds on contact
What is the microscopic appearance of UC?
Crypt abscesses with lots of inflammatory cells
How would you investigate UC?
Bloods to test for anaemia
CT/MRI (less useful for UC)