IBD: Howden

Question 1

T/F: you should be able to easily see submucosal blood vessels on colonoscopy.

Answer 1

True.
Inability to visualize submucosal vessels can indicate a pathological process of the mucosa, bc more “stuff” is present between the surface and the vessels, obscuring view.

Question 2

Ulcerative colitis “always” involves the _____ (location in GI tract).
Describe the endoscopic features of UC.

Answer 2

Rectum
Loss of submucosal vascular visibility.
Erythema, granularity, friability, exudates, bleeding.
*Don't typically see ulceration*
Contiguous- no "skip" lesions
Variable amount of colon involved.

Question 3

Describe the difference between UC and Crohn’s, histologically.

Answer 3

:: In UC, isolated islands of regenerating mucosa often bulge into the lumen to create pseudopolyps.
:: UC is limited to the mucosa and superficial submucosa whereas Crohn’s is transmural (full bowel wall thickness involved).

:: Both have acute inflammation

Question 4

What histological change denotes the progression from active colitis to ulcerative colitis?

Answer 4

Changes in mucosal and submucosal architecture.
These are signs of chronic inflammation, not just inflammatory infiltrates and ruptured crypts, as found in active colitis.

Question 5

Describe a very serious complication of UC involving neuromuscular function that can result in perforation of the bowel wall.

Answer 5

Inflammation and inflammatory mediators can damage the muscularis propria and disturb neuromuscular function.
—> chronic dilation and toxic megacolon, which carries a significant risk of perforation.

Question 6

What do you have to rule out as a possible cause of acute colitis in pts who do not improve with treatment?

Answer 6

CMV infxn secondary to immune suppression in tx of IBD.

Question 7

After 8-10 yrs of chronic colitis, it is recommended that pts have a colonoscopy performed every 2 yrs to screen for:

Answer 7

Cancer. Pts with longstanding inflammation are at risk for dysplasia.

Question 8

Tx for UC:

Is is often curative?

Answer 8

::Masalamine- anti inflammatory free radical scavenger.
Can admin orally and/or rectally.
Not curative, but may limit progression of dz.

:: SHORT-term use of GCs to mitigate inflammation.

Question 9

You see an X-ray showing lots of air pockets in the small bowel. What is this suggestive of?

Answer 9

Small bowel obstruction

Question 10

Grossly, Crohn’s dz is associated with:

Answer 10

:: Rubbery, thickening of the bowel wall, causing strictures.
:: Fissures that can lead to perforation.
:: Ulceration common, unlike in UC (uncommon, ironically)
:: Whole serosal surface of small bowel covered with mesenteric fat (not normal), referred to as “creeping fat”.

Question 11

Describe the histologic appearance of Crohn’s dz.

Answer 11

Neutrophilic infiltration of crypts, can abscess–> crypt destruction.
Architectural distortion.
- similar to UC

Presence of non-caseative granulomas diff. from UC.
Absence of granulomas does not preclude Crohn’s.
- although UC crypts can rupture–> granuloma

Question 12

When considering a DDx for Crohns dz, we need to rule out medication causes. One major cause of similar symptoms (ulcers, scaring/narrowing) is:

Answer 12

NSAIDs (Aspirin)

Question 13

How do you tx Crohn’s?

Answer 13

short-term GCs
Immunosuppressants, DMARDs
Surgery not curative

Question 14

Describe the associations of UC and Crohns with smoking.

Answer 14

UC: Strong negative correlation. Smoker less likely to have UC.
Crohns: Positive correlaton

Question 15

Describe the GI tract involvement of UC and Crohn’s.

Answer 15

UC: only colon, “always rectum”
Crohns: anywhere in GI tract