Inflammatory Bowel Disease/Carcinoid, Gastrointestinal Stromal Tumor and Lymphoma Flashcards Preview

GI > Inflammatory Bowel Disease/Carcinoid, Gastrointestinal Stromal Tumor and Lymphoma > Flashcards

Flashcards in Inflammatory Bowel Disease/Carcinoid, Gastrointestinal Stromal Tumor and Lymphoma Deck (45)
Loading flashcards...
1

Inflammatory Bowel Disease

-group of chronic inflammatory conditions of colon and small intestine
-chronic relapsing immune activation and inflammation within the GI tract
-dysregulation of the immune response to GI luminal bacteria

2

2 major forms of IBD

1) Crohn Disease
2) Ulcerative Colitis

3

Environmental Risk Factors for IBD

-cigarette smoking (dec. UC, inc. CD)
-appendectomy (dec. UC, inc. CD)
-high-sanitation level in childhood (inc. CD)
-high-intake refined carbs (inc. CD)

4

"Hygiene Hypothesis"

--incidence of immune-mediated diseases rising in developed countries (related to modern hygiene or lack of exposure)
-Conflicting data in IBD (protective: exposure to pets), or maybe risk factor

5

Ulcerative Colitis

-chronic inflammatory disorder of the GI tract affecting the large bowel, relapsing
-begins in rectum and extends proximally continuously,no skin lesions
-rarely pericolonic abscess
-indolent, relapsing disease
-no skip lesions

6

Ulcerative Colitis: Endoscopically

-hyperemia, edema, granularity with friability, easy bleeding, broad based ulceration, pseudopolyps, tunnels with mucosal bridges, rarely perforation

7

Ulcerative Colitis: Toxic Megacolon

-shutdown of neuromuscular function secondary to exposure of fecal material to muscularis mucosae and neural plexus

8

Ulcerative Colitis: Gross Pathology

-edematous, congested and hemorrhagic mucosa with superficial ulceration and loss of normal folding pattern

9

Ulcerative Colitis: Microscopic Pathology

-edematous congested mucosa with more blue than normal = inflammatory cell nuclei, and with superficial ulceration
-cyrpt "abscesses"

10

Ulcerative Proctitis

-inflammation is confined to the rectum
-rectal bleeding may be the only sign
-rectal pain, feeling of urgency or an inability to move the bowels in spite of the urge to do so (tenesmus)
-this form of ulcerative colitis tends to be mildest

11

Proctosigmoiditis

-involves rectum/sigmoid
-bloody diarrhea, abdominal cramps and pain and tenesmus are common
-continuous

12

Left-sided colitis

-inflammation extends from rectum up the left side through the sigmoid and descending colon
-bloody diarrhea, abdominal cramping and pain on left side, and unintended weight loss
-continuous

13

Pancolitis

-entire colon
-bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue and significant weight loss

14

Fulminant Colitis

-uncommon, life-threatening
-entire colon
-severe pain, profuse diarrhea, dehydration and shock, SIRS
-extensive and deep colonic injury

15

Barium Contrast Studies

-superb instrument to observe fine mucosal detail
-dependent on skill of radiologist
-requires appropriate use of barium, air insufflation, palpation, positioning, compression and use of spot films

16

Ulcerative Colitis: CT

-increasing use in diagnosis
-most sensitive for evaluation of free air (toxic megacolon with perforation)
-See liver, mesenteric inflammation & lymphadenopathy
-CT dosen't show mucosal detail well (may miss subtle changes early in disease that can be seen with air contrast BE and endoscopy

17

Crohn's Disease

-chronic
-involves any location of GI tract
-propensity for distal small bowel & proximal colon
-can involve mouth to anus: apthoid ulcers in mouth, esophageal ulcers, gastric disease, small bowel

18

Main location for Crohn's?

illeum
small intestine alone (30%)
small intestine + colon (40%)
colon alone (40%)

19

Peak age for Crohn's?

20-29

20

Crohn's Colitis

1. asymmetrical disease where there is involvement
2. aphthous ulcers
3. rectal sparing
4. skin lesions
5. deep ulcerations
6. stricture formation
7. fistula
8. disease can be limited to right colon

21

Characteristics of Crohn's?

1. transmural involvement
2. noncaseating granuloma (40-60%)
3. Fissuring with fistula
4. Skip lesions

22

Crohn's Disease: Gross Pathology

-transmural
-"cobblestone" mucosa
-"skip lesions" alternating areas of involved and uninvolved bowel
-"creeping fat" on the serosa extending to seal off areas of transmural inflammation

23

Crohn's Disease: Microscopic Pathology

-fistula
-edema, inflammation w/neutrophils, lymphocytes, plasma cells, eosinophils & macrophages, forming granulomas (35%)
-rarely necrotizing, not as tightly cohesive as sarcoidosis

24

Endoscopy in Crohn's Disease

-ulcerations
-pseudopolyps

25

Gastric & Duodenal Crohn's

-gastric ulcers
-crohn disease in distal antrum & duodenal bulb

26

Crohn's Disease: Radiology

mucosal hyperenhancement and mesenteric hypervascularity
-fistulas

27

Erythema Nodosum: microscopic pathology

-type of panniculitis (inflammation of subcutaneous tissue) with lymphocytes, macrophages and multinucleated giant cells, leading to fibroblastic repair response and fibrosis

28

Pathophysiology of Gastric Carcinoid Tumors

-chronic gastritis or gastric acid suppression
-hypergastrinemia compensatory response
-gastric diffuse neuroendocrine hyperplasia

-comes from neuroendocrine cells

29

Gastric Neuroendocrine Tumor (Carcinoid) Immunostain

+ for chromogranin

30

Gastric Neuroendocrine Tumor

-80% associated with hypergastrinemia, indolent, metastases uncommon (can remove antrum)
-20% not associated with hypergastrinemia, aggressive, many with metastases at diagnosis, associated with carcinoid syndrome