UC And Crohns Disease

Question 1

IBD

Answer 1

Chronic inflammatory and ulcerating disorders of the GIT due to dysregulated, over-exuberant response to flora

• Diarrhoea, abdominal pain, rectal bleeding, extra-intestinal manifestations
• Ulcerative colitis and Crohn’s disease are the two major forms

Question 2

Ulcerative colitis

Answer 2

• Chronic inflammatory disease of the colon only, a defining feature of which is involvement of the rectal mucosa and varying portions of the large intestine in continuity with rectum
• Usually occurs as a chronic disease with mild to severe exacerbations but occasionally occurs in an acute fulminating form

Question 3

Clinical features of UC

Answer 3

• Diarrhoea, blood loss, abdominal pain

- Systemic signs such as fever, joint pains and inflammatory of the eye

Question 4

Macroscopic changes in UC

Answer 4

• Mucosa- hyperaemic, granular or shallow ulceration with mucosal bridges which later re-epithelialise as healing occurs resembling polyps (pseudopolyps)
• Colon shortened and without haustra
• Wall of normal thickness
• Serosa intact
• Ileum spared

Question 5

Microscopic changes in UC

Answer 5

• Distorted tubular architecture and irregular mucosal surface with luminal pus
• Goblet cell depletion and reactive hyperplasia of epithelium
• Focal polymorph infiltration of crypt epithelial lining and crypt abscesses
• Increased chronic inflammatory cell content of lamina propria with oedema
• Vascular congestion
• Loss of epithelium with ulceration

Question 6

Salient features of colitis in remission

Answer 6

• Loss of tubular parallism with branching
• Short tubules, separated from one another and from the muscularis mucosae
• Thickening of the muscularis mucosae
• Paneth cell metaplasia
• Epithelial dysplasia
• can lead to cancer

Question 7

Dysplasia inIBD

Answer 7

Dysplasia is an unequivocal neoplastic transformation of the intestinal epithelium confined by the basement membrane that can be recognised by abnormal cellular and architectural alterations

Question 8

Histological features of dysplasia

Answer 8

• Glands lined by cells showing loss of mucin, nucear enlargement, nuclear pleomorphism, loss of polarity, pseudostratification and abnormal mitoses
• May see villous transformation or glands lying back to back
• Classified as low or high grade dysplasia

Question 9

Factors determining development of carcinoma in UC

Answer 9

• Disease of longer than 10 years duration
• Onset of disease in childhood
• Severe first attack and evidence of continuing activity
• Extent of colitis (pan colitis)

Question 10

Crohn’s disease

Answer 10

• Chronic inflammatory condition, potentially involving any part of the alimentary tract from anus to mouth; most commonly the distal small intestine and the proximal colon, with the rectum frequently spared
• Characterised by segmental areas of involvement, with normal intervening bowel and trans-mural extension of the disease process

Question 11

Features of CD

Answer 11

• Diarrhoea, abdominal pain and fever
• Extraintestinal manifestations may be present
• Complications include fistula formation and structures

Question 12

Macroscopic features of CD

Answer 12

• Aphthoidulcers, shallow and small
• Long or short strictured segments with thickened indurated wall, inflammation or serosa, fibrinous and fibrous and fibrous adhesions, extensions of mesenteric fat around the intestine (fat wrapping) with normal intervening areas- segmental lesions are called “skip lesions”
• Cobble stone appearance of mucosa due to oedema and cleft-like ulcers (fissures)
• Fissures may extend through the entire wall and into an adjacent loop of bowel, bladder or skin (fistula formation)
• Draining lymph nodes are enlarged

Question 13

Non-infective ulcers-inflammatory bowel disease

Answer 13

• Inflammatory bowel disease (IBD)
• ulcerative colitis
• crohns disease
• Ischaemic enterocolitis
• Radiation-induced enterocolitis
• Drug, chemical or foodstuff related
• Immune mediated, graft vs host disease

Question 14

Microscopic features of CD

Answer 14

• Transmural (ull thickness of bowel wall) inflammation with lymphoid aggregates
• Oedema with dilation of lymphatics
• Granulomas with epithelioid histiocytes and multinucleated giant cells seen in 75% of caases
• Mucosa in affected areas may show pyloric gland metaplasia