Week 7 IBD Flashcards
What treatment of UC is contraindicated in Crohn’s?
Small bowel pouch
What is the The Sydney System?
uses a combination of endoscopic
features, histology and aetiology
to standardise classification of gastritis
Two clasifications of gastritis based on onset?
Along with causes
Chronic gastritis:
– Non-atrophic gastritis
* Chronic H. pylori infection
– Atrophic gastritis
* Autoimmune gastritis
* Chronic H. pylori infection
Acute gastritis:
– Acute erosive / haemorrhagic gastritis
* Ingestion of irritant chemicals
– Acute H. pylori infection
* Usually no or minor symptoms, so seldom seen in
biopsies
What would be histological signs of atrophic gastric body mucosa
- Loss of parietal cells
- Plasma cells and lymphocytes
in lamina propria - Goblet cells indicating
intestinal metaplasia
What are you more at risk from after coeliac disease?
Along with other ascosciated conditions
- 30 x increased risk of small bowel adenocarcinoma
- 20 x increased risk of enteropathy associated T-cell
lymphoma (EATL)
Ascociated conditions:
– Endocrine e.g. type I diabetes, thyroid disorders
– Liver e.g. primary biliary cirrhosis and autoimmune hepatitis
– Skin e.g. dermatitis herpetiformis
– Neurological
– Cardiac
Histological features of coeliac disease
Histological features
– Variable villous atrophy
– Chronic inflammation
– Increased CD8+ T-lymphocytes in epithelium
– Epithelial damage
– Crypt hyperplasia
What is Pseudomembranous colitis?
Colitis caused by post-antibiotic bacterial overgrowth (usually c. diff)
What is the histological sign of pseudomembranous colitis?
“Volcano” lesions
Ruptured crypts with
fibrinopurulent exudate
What is the histological sign of fungal enteropaphy?
Cryptosporidiosis
spores and hyphae in the crypts
Histological signs of
cytomegalovirus (CMV) infection
Intranuclear and cytoplasmic
inclusions typical of
cytomegalovirus (CMV)
What are the four distributions of UC?
What are the histological signs of UC?
Epithelium:
- Epithelial damage / erosion / ulceration
- leading to psuedopolyps
- Mucin depletion
- Neutrophil infiltration (“cryptitis” and “crypt abscesses”)
- Metaplasia
Lamina propria:
- Inflammatory cell infiltrate
- Cell types (plasma cells, neutrophils etc.)
- Presence of granulomas
General architecture:
- Surface topography e.g. villous change in colon
- Crypt architectural abnormalities, crypt atrophy/ abscesses
What is a psuedopolyp in UC?
This is where the surrounding muscosa has eroded either side leaving behind a psuedalpolyp island of mucosa
Prominence of distribution of crohn’s
Granuloma’s in Crohn’s overview
Present in up to 70% of cases
- Fewer in right colon than left colon
- Commoner in children
- Tend to be larger in adults
- Fewer after 2 years of illness
- Particularly helpful in the diagnosis of CD when present deeper within the wall of the GI tract or within draining
lymph nodes
Difference in granulomas in crohn’s in children vs adults
Adults:
Larger
Children:
More common
In crohn’s affecting colon what is the difference in granulations between left and right colon
Fewer in right colon than left colon
What happens to granuloma’s in crohn’s with time?
Fewer after 2 years of illness
Granulomas in crohn’s vs UC
Granulomas mostly a sign of crohn’s
But can appear in UC.
However in UC granulomas are usually associated with damaged crypts in the lamina propria.
Whereas in Crohn’s can be anywhere in bowel wall and lymph nodes
What is the gross appearence of crohn’s disease?
Patchy, strictures, fistulae
Fill out this relationship between crohns and UC and associated conditions
What is microscopic colitis?
Microscopic colitis
* Usually presents as chronic watery diarrhoea
* Normal appearance of colonic and rectal mucosa at endoscopy
* Pathology: Increase in chronic inflammatory cells in lamina propria
- Two patterns:
– Collagenous colitis
– Lymphocytic colitis - Cause often not identified
