Partial 5 - Inflammatory Bowel Disease

Question 1

Cardinal symptoms of Chron’s disease

Answer 1

Diarrhea
Abdominal pain
Weight loss

Question 2

Which immune cells are recognized in Crohn’s disease?

Answer 2

Th1 which release IL-2 and TNF
Th2 which release IL-4, IL-5 and IL-10
Macrophages produce IL-2, IL-1 and TNF

Question 3

Risk factors for Crohn’s disease include

Answer 3

High socioeconomic status
Oral contraceptives
NSAIDs
Increased intake of refined sugars
Paucity of fresh and vegetables in diet
Increased dietary fiber intake 
Smoking

Question 4

Macroscopic features of Crohn’s disease

Answer 4

• May effect any part of GI
• 30-40% effects the small bowel
• 40-55% effects the large and small bowel
• 15-25% it is colitis alone
• Terminal ileum is involved in 90% of cases where there is small bowel inflammation

Question 5

Microscopic features of Crohn’s disease

Answer 5

• Earliest lesions are aphtoid ulcerations and focal crypt abscesses
• Granuloma can be seen in lymph nodes, mesentery, peritoneum, liver and pancreas

Question 6

What is the cause of fistulas in Crohn’s diesease

Answer 6

It is caused by release of proteases and matrix metalloproteinases that lead to tissue destruction, sinus tract formation, and penetration to adjacent tissue planes

Question 7

Musculoskeletal manifestations of Crohn’s disease

Answer 7

(A) Disorders of the bone and joints (knee and ankles are affected first)
(B) Clubbing of the fingertips
(C) Pauciarticular arthropathy
(D) peripheral arthralgia (16-20%)
(D) Axial arthropathies (less common)
(E)Ankylosing spondylitis
(F) Symmetric sacroileitis
(G) Complication include granulomatous vasculitis, periostitis, and amyloidosis
(H) Metabolic bone disease such as osteopenia/osteoporosis.

Question 8

Mucocutaneous manifestations of Crohn’s disease

Answer 8

(A) Pyoderma gangrenosum

(B) Erythema nodosum

Question 9

Ocular manifestations of Crohn’s disease

Answer 9

(A) Episcleritis
(B) Scleritis
(C) Uveitis

Question 10

Hepatobiliary manifestations of Crohn’s disease

Answer 10

(A) Gallstones (25%)
(B) Asymptomatic and mild elevations of liver biochemical tests
(C) Primary sclerosing cholangitis (4%)
(D) Pericholangitis
(E) Fatty liver and autoimmune hepatitis

Question 11

Renal and genitourinary manifestations of Crohn’s disease

Answer 11

(A) Uric acid and oxalate stones (which result from volume depletion and hypermetabolic state)
(B) Rare membranous nephropathy, glomerulonephritis and renal amyloidosis.

Question 12

Coagulation and vascular complications of Crohn’s disease

Answer 12

(A) Prothrombotic tendency (venous thromboembolism or less commonly arterial thrombosis)
(B) Circulating immune complexes, increased levels of plasminogen activator inhibitors, and decreased levels of tissue plasminogen activator and spontaneous platelet aggregation
(C) Folate and Vitamin B12 deficiency is linked with Hyperhomocysteinemia which in turn predisposes to thrombosis

Question 13

Which immune cells are recognized in Ulcerative colitis?

Answer 13

• IgG1 and IgG2
• CD-8 T
• Macrophages will release IL-1, TNF, IL-6
• INFg
• TGF-b