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28 Cards in this Set
- Front
- Back
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In terms of epidemiology, differentiate UC and Crohn's in terms of:
1) male: female ratio 2) smoking 3) OCP 4) appendectomy 5) monozygotic twins |
1) male: female ratio-1:1 in uc, slightly higher in men for crohns.
2) smoking-prevents UC 3) OCP-increase risk of crohns 4) appendectomy-protective in UC 5) monozygotic twins -higher in crohns. |
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In terms of epidemiology, differentiate UC and Crohn's in terms of:
1) male: female ratio 2) smoking 3) OCP 4) appendectomy 5) monozygotic twins |
1) male: female ratio-1:1 in uc, slightly higher in men for crohns.
2) smoking-prevents UC 3) OCP-increase risk of crohns 4) appendectomy-protective in UC 5) monozygotic twins -higher in crohns. |
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What is the gene associated with Crohns?
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CARD15 gene on chromosome 16.
Loss-of-function mutations in CARD15 are highly associated with CD and may account for up to 10% of CD risk. |
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Describe the role of CD4+ T cells in IBD.
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Three major types:
1) TH1 cells induce transmural granulomatous inflammation that resembles CD, 2) TH2 cells and related natural killer T cells that secrete IL-13 induce superficial mucosal inflammation resembling UC. 3) TH17 cells may be responsible for neutrophilic recruitment |
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What is the immune mechanism behind the use of antibodies (e.g., anti-TNF, anti-IL-12, anti-IL-23, anti-IL-6, anti-IFN-gamma) to block proinflammatory cytokines in IBD?
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- Th1 induced by IL12
- Th2 and Th17 induced by IL-4,IL-23,IL-6 and TGF-B. - Activated macrophages secrete tumor necrosis factor (TNF). |
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what is the percentage distribution of UC?
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40–50% disease limited to the rectum and rectosigmoid
30–40% disease extending beyond the sigmoid but not involving the whole colon. 20% have a total colitis. |
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Describe UC pathologically?
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UC is a mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon
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Which part does UC involve histologically?
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Mucosa and superficial submucosa-deep layer usually unaffected.
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Describe 2 major histologic features that distinguishes UC from acute colitis.
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1) Distorted crypt architecture of the colon.
2) Presence of basal plasma cells and multiple basal lymphoid aggregates |
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Describe the precentage of involvement in crohns.
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30–40% small-bowel disease alone,
40–55% have disease involving both the small and large intestines, 15–25% have colitis alone. In the 75% of patients with small-intestinal disease, the terminal ileum is involved in 90%. |
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which part is spared in CD?
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Rectum.
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Mucosal involvement in CD?
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CD is a transmural process.
"cobblestone" appearance |
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What is the pathognomonic feature of CD histologically?
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Presence of granulomas.
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What is the earliest radiologic change of UC seen on single-contrast barium enema?
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Fine mucosal granularity
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What are the lab findings indicating active disease of UC?
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raised ESR,CRP,platelet
low Hb low albumin |
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What is the role of fecal calprotectin level in UC?
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Fecal calprotectin levels correlate well with histological inflammation, predict relapses, and detect pouchitis
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What is the definition of Toxic megacolon?
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Toxic megacolon is defined as a transverse colon with a diameter of >5–6 cm, with loss of haustration in patients with severe attacks of UC.
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What are the complications of UC?
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toxic megacolon
perforation stricture occasionally develop anal fissures, perianal abscesses, or hemorrhoids. BUT the occurrence of extensive perianal lesions should suggest CD. |
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A patient with CD initially presented with recurrent episodes of colicky Rt lower quadrant pain with is relieved by defecation.
Now presents with high grade fever. Which is the most likely location of her CD and what would you be worried about with the high fever? |
Iliocolitis (most common is terminal ileum)
High-spiking fever suggests intraabdominal abscess formation |
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A patient who has CD for many years presents with pneumaturia and fecaluria.What is the most likely reason?
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CD complicated by the development of enterovesical fistulas.
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A patient with CD diagnosed many years ago initially presented with diarrhea now presents with increasing symptoms of postprandial pain.
What is the possible mechanism behind this? |
Bowel wall edema and spasm.
After several years,persistent inflammation gradually progresses to fibrostenotic narrowing and stricture causing chronic bowel obstruction. |
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What is the cause for vertebral fractures in patients with CD?
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Vertebral fractures are caused by a combination of vitamin D deficiency, hypocalcemia, and prolonged glucocorticoid use.
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A patient with jejunoileitis will present with what?
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malabsorption and steatorrhea
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A patient with colitis and perianal disease will present with what?
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Colitis:
low-grade fevers, malaise, diarrhea, crampy abdominal pain, hematochezia Perianal: incontinence, large hemorrhoidal tags, anal strictures, anorectal fistulae, perirectal abscesses |
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What is the endoscopic features of CD?
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rectal sparing,
aphthous ulcerations, fistulas, skip lesions. |
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A patient is suspected to have active CD.Which investigation is the best?
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wireless capsule endoscopy.
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What is the role of detecting pANCA and ASCA in IBD patients.
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Predicts patients who will likely develop early complications from IBD.
Antibody positivity may help predict disease phenotype. pANCA positivity is more often associated with pancolitis, early surgery, pouchitis, PSC. ASCA in CD is associated with colonic disease that resembles UC. |
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Name the 2 antibodies found in patients with IBD?
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pANCA-more common in UC
ASCA-more common in CD |
