Inflammatory Bowel Disease

Question 1

Inflammatory Bowel Disease

Answer 1

Characterized by chronic, recurrent inflammation
of the intestinal tract
 Clinical manifestations are varied for both
conditions
 Long periods of remission interspersed with
episodes of acute inflammation
 Both diseases can be debilitating

Question 2

Causes

Answer 2

 Cause is unknown
 Possible causes:
 Infectious agent (virus, bacteria)
 Autoimmune reaction
 Food allergies
 Heredity

Question 3

Ulcerative Colitis

Answer 3

Characterized by inflammation and ulceration of
the colon and rectum
 May occur at any age
 Peaks between ages 15 and 25 years
 Equally affects both sexes

Question 4

Pathophysiology of Ulcerative Colitis

Answer 4

Diffuse inflammation
 Involves mucosa and submucosa
 Alternate periods of exacerbations and
remissions
 Usually begins in the rectum and sigmoid colon and
spreads up the colon in a continuous pattern
 Mucosa is hyperaemic and oedematous in the
affected area

Question 5

Pathophysiology (cont.)

Answer 5

Multiple abscesses develop in the
intestinal glands
Abscesses break through into the
submucosa, leaving ulcerations

Question 6

Ulcerative Colitis

Etiology and Pathophysiology

Answer 6

Ulcerations destroy the mucosal
epithelium, causing bleeding and
diarrhoea
Fluid and electrolyte losses
Protein loss
Pseudopolyps

Question 7

Ulcerative Colitis

Etiology and Pathophysiology continued…

Answer 7

Granulation tissue develops
 Mucosa musculature becomes thickened,
shortening the colon

Question 8

Ulcerative Colitis

Clinical Manifestations

Answer 8

Most commonly presents as a chronic disorder
with mild-to-severe acute exacerbations that
occur at unpredictable intervals over many years
 Major symptoms:
Bloody diarrhoea
Abdominal pain

Question 9

Ulcerative Colitis

Complications

Answer 9

Complications may be classified as:
Intestinal – haemorrhage, strictures,
perforation
Extra intestinal – may be non-specific
complications mediated by a
disturbance in the immune system

Question 10

Crohn’s Disease

Description

Answer 10

A chronic, nonspecific inflammatory bowel disorder
of unknown origin that can affect any part of the
GI tract from the mouth to the anus.
Can occur at any age
 Most often between ages 15 and 30 years
 Both genders are affected
 Similar to ulcerative colitis

Question 11

Crohn’s Disease

Etiology and Pathophysiology

Answer 11

 Characterized by inflammation of segments of
the GI tract
 Can affect any part of the GI tract but is most
often seen in the terminal ileum, jejunum, and
colon
 Inflammation involves all layers of the bowel wall
 Ulcerations are deep and longitudinal and
penetrate between islands of inflamed
oedematous mucosa, causing the classic
cobblestone appearance

Question 12

Crohn’s Disease

Etiology and Pathophysiology, continued…

Answer 12

Thickening of the bowel wall
 Narrowing of the lumen with stricture development
 Abscesses or fistula tracts that communicate with
other loops of bowel, skin, bladder, rectum, or
vagina may develop

Question 13

Crohn’s Disease

Clinical Manifestations

Answer 13

Onset is usually insidious
 Nonspecific complaints:
Diarrhoea (non-bloody) & abdominal pain
are the major manifestations
Fatigue
Weight loss
Fever

Question 14

Crohn’s Disease

Clinical Manifestations, continued…

Answer 14

 Pain (severe and intermittent)
 Abdominal cramping and tenderness
 Abdominal distension
 Arthritis
 Finger clubbing

Question 15

Crohn’s Disease

Complications

Answer 15

Strictures and obstruction from scar tissue
 Fistulas
 Peritonitis
 Fat intolerance
 Gluten intolerance

Question 16

Compare and contrast ulcerative colitis and

Crohn’s disease under the following headings:  Age at onset and Location of disease?

Answer 16

Age at onset
 Young to middle age with ulcerative colitis
 Young in Crohn’s disease
 Location of disease
 Ulcerative colitis, the disease starts distally and spreads
in a continuous pattern up the colon
 Crohn’s, the disease occurs anywhere along the GI tract.
Most frequent site is terminal ileum

Question 17

Peptic Ulcer Disease is a condition characterised by?

Answer 17

Condition characterized by
 Erosion of GI mucosa resulting from the digestive
action of HCl and pepsin
 Any portion of GI tract that comes in contact with
gastric secretions is susceptible to ulcer development
including lower oesophagus, stomach, & duodenum
 Includes gastric and duodenal ulcers

Question 18

Aetiology & Pathophysiology

Answer 18

Develop only in presence of acid environment
 Excess of gastric acid not necessary for ulcer
development
 Person with a gastric ulcer has normal to less than
normal gastric acidity compared with person with a
duodenal ulcer

Question 19

Peptic Ulcer

Answer 19

Some acid does seem to be essential for a gastric
ulcer to occur
 Under specific circumstances the mucosal barrier can
be broken and HCL freely enters the mucosa & injury
to tissues occurs
 This results in cellular destruction & inflammation
 Histamine is released
 Vasodilation, ↑ capillary permeability
 Further secretion of acid and pepsin

Question 20

Peptic Ulcer - Agents known to destroy the mucosal barrier include:

Answer 20

H. Pylori - causes chronic inflammation making
mucosa more vulnerable to noxious agents
 Drugs (aspirin, NSAIDs, corticosteroids) – cause
abnormal permeability

Question 21

Identify risk factors for the development of

peptic ulcers

Answer 21

H Pylori
 Alcohol
 Smoking
 Stress
 Use of NSAIDs

Question 22

Compare and contrast gastric and duodenal

ulcers under the following headings: Location of lesion and Gastric secretion incidence?

Answer 22

Location of lesion
 Gastric ulcers found predominantly in the antrum
but also the body and fundus of stomach.
 Duodenal ulcers found in the first 1-2 cm of the
duodenum
B. Gastric secretion incidence
 Normal to decreased in gastric ulcers
 Increased in duodenal ulcers

Question 23

Compare and contrast gastric and duodenal

ulcers under the following headings:

Answer 23

Clinical Manifestations
 Gastric ulcers burning or gaseous pressure in high left
epigastric region, back & upper abdomen. Pain occurs
1-2 hrs after meals & may experience aggravation of
discomfort with food. Occasional nausea & vomiting
and weight loss
 Duodenal ulcers burning, cramping, pressure like pain
across the mid-epigastric region & upper abdomen.
Pain occurs 2-4hrs after meals & middle of the night.
Pain can be relieved by antacids & food. Occasional
nausea & vomiting