IBD Pathology Flashcards Preview

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Flashcards in IBD Pathology Deck (20):
1

Name the layers of the GI tract

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2

Where does UC start and stop?

Starts at rectum

Stops at Ileocaecal valve- but there may be ‘reflux ileitis’

 

Large intestine (rectum, colon, appendix)
Starts in rectum
Extends proximally for a varying distance (10-20% total)
Continuous, diffuse

3

Pathology of UC

Mucosal disease
(unless there is ulceration)
Diffuse active chronic inflammation
Cryptitis, crypt abscesses
Regeneration
Crypt architectural distortion
Reduced goblet cells

 

CAN CAUSE TOXIC MEGACOLON

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4

Manifestations of UC?

Related to disease activity:
Erythema nodosum
Arthritis
Uveitis
Thromboembolism
Pyoderma gangrenosum

Unrelated to disease activity:

Sacro-iliitis
Ankylosing spondylitis

Liver:

Steatosis
Chronic hepatitis
Primary Sclerosing cholangitis
Cirrhosis

 

5

Probability of cancer with UC?

20 years 2.5%
30 years 7.6%
40 years 10.8%

6

Factors aiding Cancer in UC?

extent of disease (little increase in proctitis)
duration of disease
association with primary sclerosing cholangitis
family history of colorectal cancer

age of onset
persistent inflammation
number and severity of relapses
inflammatory polyps or strictures
long term effective treatment & chemo-prevention

7

Colitis Screening protocol?

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8

Pathology of cancer in UC?

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9

Signs of Crohns?

Any part of GI tract
colon
Ileum
perianal
Discontinuous (Skip lesions)
Aphthoid ulcers
Fissuring ulceration
Cobblestone mucosa

Strictures
Bacterial overgrowth
Obstruction
Fistulae
Enteric / enterocolic
Cutaneous
Vesical
Vaginal

Transmural disease
Focal lymphoid aggregates
Patchy, focal cryptitis, crypt abscesses
Granulomas (<50%)
Relative preservation of crypt architecture
Oedema
Fibrosis

Toxic dilatation of colon unusual
Extraintestinal and liver manifestations as UC
Colorectal cancer risk increased when widespread colonic involvement (as UC)

10

Causes of Crohns?

‘Western’ disease, increasing incidence
Smoking
Genetics (CARD15 - NOD2 protein)
Immunology
Ischaemia?
Initiated by infection? 
Mycobacteria
NOT MMR

11

Infective Entero-colitis causes?

Mimicking ulcerative colitis
Bacterial colitis
Pseudomembranous colitis
Amoebiasis
Schistosomiasis
Mimicking Crohn’s disease
Tuberculosis
Yersinia infection

12

Bacterial Colitis (Dysentry) causes?

Salmonella
Campylobacter
Shigella
Enterotoxigenic Escherichia coli (O159)

13

Pseudomembranous colitis causes?

Clostridium difficile
Antibiotic-associated colitis
Antibiotics disrupt normal bowel flora that inhibit C. diff overgrowth
Cytotoxin-mediated damage

Toxin detectable in stool
Volcano lesions on biopsy
Treated by metronidazole or vancomycin

14

Signs of Amoeba infection?

Entamoeba histolyticum
Developing countries
Bloody diarrhoea
Amoeboma
Amoebic liver abscess

15

Schistosomiasis infection information?

S. mansoni, japonicum
Africa, Far East
Chronic colitis
Predisposes to colorectal cancer

16

Intestinal TB info?

Mycobacterium tuberculosis or M bovis
Terminal ileum & caecum
Closely mimics Crohn’s disease
Granulomas usual and caseating (unlike Crohn’s disease)
May progress to peritoneal tuberculosis

 

17

Yersinia infection information?

Yersinia pseudotuberculosis and Y enterocolitica
Meat (pork) and dairy products
Acute self limiting ileo-caecitis with necrotising granulomas

18

Examples of Colitis?

Diverticular colitis
Ischaemic colitis
Diversion colitis
Deficiency of luminal (bacterial) nutrients
Microscopic colitis
Lymphocytic
Collagenous
Drug-induced colitis

19

Causes and signs of microscopic colitis?

Causes:

Chronic watery diarrhoea
General health good
Normal endoscopy and radiology
Abnormal histology

 

Signs:

Seronegative, non-destructive arthritis
Autoimmune disease
Coeliac disease
Drugs
non-steroidal anti-inflammatory drugs
ranitidine, lanzoprazole

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