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Pathology & Clinical IBD Flashcards

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1
Q

what 2 diseases cause inflammatory bowel disease (IBD)?

A
  • Crohn’s disease

- ulcerative colitis

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2
Q

True or False.

IBD is chronic.

A

True

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3
Q

what is Crohn’s disease?

A

= chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus

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4
Q

where is Crohn’s disease most common?

A

= terminal ileum and colon

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5
Q

who does Crohn’s disease affect?

A

= young patients

- more common in males

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6
Q

where can you get Crohn’s disease?

A

= some have only small bowel involvement
= some have colonic/anal disease only
= some have both
- viable involvement of stomach, oesophagus and mouth

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7
Q

what are 7 symptoms of Crohn’s?

A
  • abdominal pain
  • small bowel obstruction
  • diarrhoea
  • bleeding PR
  • anaemia
  • weight loss
  • tender abdomen
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8
Q

describe the clinical course of Crohn’s disease?

A
  • chronic
  • exacerbations & remission
  • un-predictable response to therapy

(some patients go into lasting remission within 3 years of diagnosis)

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9
Q

what 2 tests should be done in patients with suspected Crohn’s disease?

A
  • endoscopy

- mucosal biopsy

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10
Q

what would an endoscopy show in Crohn’s disease?

A

= patchy, segmented disease with skip areas (lesions) anywhere in GI tract

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11
Q

what is a histological feature of Crohn’s disease?

A

= chronic active colitis with (non-caseating) granuloma formation

= increased chronic transmural inflammatory cells in the lamina propria and crypt branching with granulomas

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12
Q

describe Crohn;s disease in an unlucky patient?

A

= doesn’t respond to medical therapy (steroids)
= bowel obstruction
= require surgery

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13
Q

describe the typical late stage appearance of Crohn;s disease?

A

= stricturing of terminal ileum with thickening of bowel wall & fat wrapping

= deep fissuring ulceration destroying mucosa

= deep fissuring producing cobble-stoning of mucosa

= pseudo polyps may be seen (not common)

= deep fissures (knife like in appearance)

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14
Q

what is a key feature seen in Crohn’s disease?

A

= transmural inflammation

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15
Q

what are 9 complications of Crohn’s disease?

A

1) malabsorption
2) Fistulas
3) Anal disease
4) Intractable disease
5) Bowel obstruction
6) perforationn
7) malignancy
8) amyloidosis
9) others (extra-intestinalassociation)
- rarely toxic megacolon

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16
Q

describe the causes and effects of malabsorption as a consequence of Crohn’s disease?

A

Causes
= iatrogenic (short bowel syndrome) due to repeated resections and recurrences

Effects
= hypoproteinemia, vit defieicny, anaemia
= gallstones

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17
Q

describe fistulas, as a complications to Crohn’s disease?

A 
= vesicocolic
= enterocolic
= gastrocolic
= recto vaginal 
= tuboovarian abscess
= blind loop syndrome
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18
Q

describe 5 anal diseases that can occur as a complication of Crohn’s disease?

A
  • sinuses
  • fissures
  • skin tags
  • abscesses
  • perineum falls apart
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19
Q

describe intractable disease as a complication of Crohn’s disease?

A
  • failure to tolerate or respond to medical therapy
  • continuous diarrhoea or paint
  • may require surgery
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20
Q

what genes are Crohn’s associated with?

A

= HLA-DR1 and HLA-DQw5

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21
Q

what are 5 environmental triggers of Crohn’s disease?

A
  • smoking increases risk
  • infectious agents (viral, mycobacterial) causes similar pathology
  • vasculitis (could explain segmental distribution)
  • sterile environment therapy
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22
Q

Describe the aberrant immune response in Crohn’s disease?

A

= persistent activation of T cells and macrophages
= excess pro-inflammatory cytokine production
= maybe alterable by change intestinal microflora “probiotics”

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23
Q

what is ulcerative colitis?

A

= chronic inflammatory disorder confined to colon and rectum

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24
Q

where does inflammation occur in ulcerative colitis?

A

= mucosal and sub-mucosal inflammation

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25
describe who can present with ulcerative colitis?
- young people + can occur in any age - more common in males
26
where about does ulcerative colitis occur?
= confined to colon & rectum - nearly always involves the rectum = continuous & confluent extending proximally for varying lengths.
27
True or false. | Ulcerative colitis is continuous and confluent not segmented.
True
28
what are 3 features of ulcerative colitis and describe the clinical course of it?
- diarrhoea - mucus - blood PR = chronic course with exacerbations & remission = continuous low grade activity
29
what is acute fulminant colitis (toxic megacolonn)?
subgroup of patients with severe ulcerative colitis who have more than 10 stools per day, continuous bleeding, abdominal pain, distension, and acute, severe toxic symptoms including fever and anorexia
30
describe the appearance of ulcerative colitis in the mucosa?
= diffuse mucosal chronic active colitis & massive influx of inflammatory cells = basal lympho-plasmacytic infiltrate with irregular shaped branching crypts = acute cryptitis = crypt abscesses = severe ulceration with fibrino-purulent exudate (ulcers are broader based, pseudo polyps are seen) = superficial mucosal ulceration
31
describe the chronic state of ulcerative colitis?
= chronic inactive disease - low grade chronic inflammation - crypt distortion - low grade diarrhoea
32
what happens in an unlucky patient with ulcerative colitis?
= fails to response to therapy (steroids) | - subtotal colectomy
33
describe the inflammations even in ulcerative colitis?
= superficial inflammation only - inflammation confined to mucosa and sub-mucosa (except in toxic mega-colon)
34
what are 7 complications of ulcerative colitis?
1) intractable disease 2) toxic mega-colon 3) colorectal carcinoma 4) blood loss 5) electrolyte disturbance 6) anal fissures 7) extra GI manifestations - eyes( uveitis) - liver (primary sclerosing cholangitis) - joints (arthritis, and spondylitis) - skin (pyoderma ganrenosum, erythema nodusum)
35
describe intractable disease as a complication of ulcerative colitis? describe toxic mega-colon as a complication of ulcerative colitis? describe colorectal carcinoma as a complication of ulcerative colitis?
Intractable disease = continuous diarrhoea - flares may be due to inter-current infection by enteric bacteria or CMV = total colectomy ``` Mega-colon = acute or chronic fulminant colitis = colon swells up to massive size = will rupture unless removed = emergent colectomy ``` Colorectal carcinoma; = chronic inflammation leading to epithelial dysplasia and then carcinoma - risk increased if pan colitis and disease longer than 10 years
36
what genes are associated with ulcerative colitis?
= HLA-DR2 | - familial associated with NOD-2 gene
37
describe the aberrant immune response in ulcerative colitis?
- Persistent activation of T-cells and macrophages - Autoantibodies eg ANCA present - Excess proinflammatory cytokine production and bystander damage due to neutrophillic inflammation - Maybe alterable by changing intestinal microflora…”Probiotics”
38
what are 2 environmental triggers in ulcerative colitis?
= unknown | = smoking is not associated with UC
39
describe the many different types of colitis?
- Ulcerative Colitis - Crohn’s Colitis - Collagenous Colitis - Lymphocytic Colitis - Radiation Colitis - Diversion Colitis - Drug inducedIschaemic Colitis - Antibiotic induced Colitis - Infective Colitis - Indeterminate Colitis - Necrotizing enterocolitis - Others
40
LECTURE 2 - clinical of IBD
LECTURE 2 - clinical of IBD
41
when does inflammatory bowel disease occur?
when gut immune system becomes dysregulated
42
what does the gut need in order to maintain a healthy gut?
= trafficking immune cells Immune tolerante; - foreign proteins - hosts bacteria
43
what is the similarities and differences between crohn's and ulcerative colitis?
Share - epidemiology - some shared clinical and therapeutic characteristics Differ; - Clinical presentations; Crohn's = abdominal pain & peri-anal disease Ulcerative colitis = diarrhoea + bleeding = pathology will differ
44
what are the 3 key features of pathogenesis of IBD?
1) genetic predisposition 2) mucosal immune system 3) environmental triggers
45
what chromosome is disease susceptibility gene located on?
= chromosome 16q12
46
in caucasian patients with Crohn's disease, what mutated genes would they have?
= NOD2
47
what are 2 important genes in IBD?
- NOD2 | - CARD15
48
what inflammatory cells are associated with Crohn's disease?
- Th1 mediated
49
what inflammatory cells re ulcerative colitis associated with?
= mixed Th1/Th2 mediated disuse/NKTC
50
what environmental factor aggravates Crohn's disease but protects against ulcerate colitis?
= smoking
51
what drugs have an affect on IBD?
= NSAIDS
52
what is ulcerative colitis?
= inflammation of colon of unknown cause - relapsing course - always affects rectum and extends proximally
53
what are 3 types of ulcerative colitis?
- proctitis - left sided colitis - pancolitis
54
what are symptoms of ulcerative colitis?
- diarrhoea + bleeding - increased bowel frequency - urgency - tenesmus - incontinence - night rising - lower abdominal pain (esp left iliac fossa) - proctitis can cause connstipation
55
what are 6 important factors to gain in a history of ulcerate colitis?
- recent travel - antibiotics - NSAIDS - family history - smoking - skin, eyes, joints
56
what criteria allows you to determine severity of ulcerative colitis?
truelove and Witt criteria ``` > 6 bloody stools/24hours + 1 or more of; - fever (>37.8) - tachycardia > 90 - anaemia (Hb < 10.5g/dI) - elevated ESR (>30mm/hr) ```
57
what 4 investigations could be done for ulcerative colitis?
- bloods = C reactive proteins (CRP) = albumin (a negative acute phase reactant) - plan abdominal X-ray - endoscopy - histology
58
what sorts of things are you looking for in a plain abdominal x-ray of ulcerative colitis?
- stool distribution = absent in inflamed colon - mucosal oedema/thumb printing - toxic megacolonn = transverse > 5.5cm = caecum > 9cm
59
what sorts of things are you looking for in an endoscopy of ulcerative colitis?
- confluence inflammation extending proximally from anal margin to transition zone - loss of vessel pattern - granular mucosa - contact bleeding
60
what are longterm complications of ulcerative colitis?
= increased risk of colorectal cancer Determined by; - severity of inflammation - duration of disease - disease extent
61
what is extensive colitis?
= colitis beyond splenic flexure | - at risk and require surveillance after 10 years of disease
62
what are some extra-intestinal manifestations of ulcerative colitis?
- skin - joints, axial, peripheral joints - eyes - deranged LFTs - oxalate renal stones
63
what is primary sclerosing cholangitis (PSC)?
= chronic inflammatory disease of biliary tract = causing stenosis - mostly asymptomatic or itch or riggers - cholestatic LFTs
64
describe the distribution of Crohn's disease?
= can affect any region from mouth to anus - skip lesions - transmural inflammation
65
describe peri-anal disease?
= recurrent abscess formation - pain - can lead to fistula with persistent leakage - damage sphincters
66
what are the symptoms of Crohn's?
Small intestine - abdominal cramps - diarrhoea, weight loss Colon - abdominal cramps - diarrhoea with blood - weight loss Mouth - painful ulcers - swollen lips - angular chielitis Anus - peri-anal pain - abscess
67
what investigations should you do with someone with Crohn's?
- clinical exam = evidence of weight loss, RIF mass, peri-anal signs - bloods = CRP, albumin, platelets, B12 (t. ileum), ferritin - stage disease extent
68
describe the histological feature that would be seen with someone with Crohn;s?
= patchy disease with granulomas in some cases
69
what are 3 tests that could bee used to asses small bowel?
= barium follow through = small bowel MRI = technetium-labelled white cells can

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