Gi (Ibd)

Front 1

After a stressful life event, 30 y/o man has diarrhea and blood per rectum; intestinal biopsy shows transmural inflammation.

dx?

Back 1

Crohn's disease

For Crohn’s,think of a fat granny and an old crone skipping down a cobblestone road
away from the wreck(rectal sparing)

gross morphology = transmural inflammation, COBBLESTONE mucosa, creeping FAT

Microscopic morphology = noncaseating GRANulomas

location = any portion of the GI tract, usually terminal ileum and colon. SKIP lesions, RECtal sparing

Front 2

what are the two main conditions that fall under the umbrella term "inflammatory bowel disease?"

what are the differentiating pathological findings of each?

Back 2

Crohn's disease and chronic ulcerative colitis

Crohn's dz = transmural inflammation (all the way through the bowel wall), +/- granulomas, discontinuous/skip lesions; location is throughout the entire GI tract

CUC = colonic inflammation ONLY (only involves the mucosa, the first layer), always with rectal involvement; crypt abscess and ulcers, bleeding, NO GRANULOMAS

Front 3

what's the main difference b/w Crohn's dz and CUC in terms of location that they affect in the body?

Back 3

Crohn's dz = involves entire GI tract (from mouth to anus), usually terminal ileum and colon (including anal canal)

CUC = restricted to the colon, ALWAYS involves the rectum and has no involvement of the small bowel

Front 4

tell me about the role of genetic susceptibility in IBDs.

Back 4

Genetic susceptibility is huge. There’s a strong link b/w family members. There are genes that control gut immune response to an incident/infection (acute inflammation) that predisposes us to develop chronic, out of control condition…rather than resolving.

normally, our immune system will control the infection and reset our gut into a state of "tolerance." but with genetic disposition, our immunoregulatory system fails (failure of repair or bacterial clearance) and we don't come back to a state of tolerance...and we're left with chronic inflammatory state.

Front 5

tell me about a specific genetic association with IBD

Back 5

IBD1 is on Chromosome 16q12 that predisposes an individual to Crohn's disease. if you have 2+ allele changes, the risk of CD goes up 50% or more. also tend to develop at an earlier age, and forms more severe complications (ie fistulas).

Front 6

what is the most sensitive marker of Crohn's dz?

Back 6

ASCA IgA + G (Anti-Saccharomyces cerevisiae Ab's)

We can detect in the blood and look for Ab’s that point specifically to Crohn’s dz.

Saccharomyces = Brewer’s yeast (most of us don’t get antibodies to this…but those who get Ab’s to this antigen, it shows that something has happened to tell body’s immune system that saccharomyces is there and it doesn’t like it.

Front 7

what's the most sensitive marker of ulcerative colitis?

Back 7

NSNA
Neutrophil-specific nuclear autoantibody (IBD-specific pANCA)

Front 8

what's the differentiating feature on biopsy b/w crohn's dz vs ulcerative colitis?

Back 8

granuloma formation!!

Front 9

describe the clinical picture of a pt with Crohn's dz

Back 9

pt comes in with moderate diarrhea (4-5 BM/day), moderate fever (<102 F), steady RLQ (near ileum), superimposed colic

though the pain can be anywhere, it's often persistent and they have cramps on top of that

Front 10

is there bloody diarrhea in Crohn's dz?

what about in ulcerative colitis?

Back 10

no bloody diarrhea in Crohn's

there is bloody diarrhea in ulcerative colitis (there's a feeling of always needing to go back to the bathroom)

Front 11

15 y/o comes into the clinic with acute pain in the RLQ. he has nausea and fever accompanying his abdominal sx's. is this likely to be IBD?

Back 11

no, check for rebound tenderness...as it's likely to be acute appendicitis

Front 12

what's the best way to dx Crohn's dz?

Back 12

1) culture the stool for possible infection

if there's no specimens found, then need to image...

2) CT scan of abdomen/pelvis (to rule out appendicitis) -- this is first line

if pts don't get better...

3) endoscopy with biopsy (to look at the lining (Crohns = cobblestone, CUC = pseudopolyps)

4) barium enema

5) capsule endoscopy (swallow a pill that has a camera on it)

Front 13

what is useful diagnostic tool for small bowel ulceration for a pt with possible Crohn's dz?

Back 13

capsule endoscopy

Front 14

is there a cure for Crohn's dz? what about for ulcerative colitis?

Back 14

no cure for Crohn's; you can use steroids to bring into remission, but doesn't cure. role of surgery is to remove local complications of a diffuse disorder

taking out the entire colon is curative for CUC.

Front 15

what are the complications of crohn's dz?

Back 15

FOCAL: Obstruction
Fistula
Abscess / Perforation
Perianal

SYSTEMIC: Growth Retardation
Chronic anemia
Weight loss-malabsorp.
Arthritis

Front 16

what is the clinical picture of a pt with chronic ulcerative colitis?

Back 16

young adult pt presents with long history of bloody diarrhea, always feeling the need to go back to the bathroom (bc feel the urge to evacuate). he has no history of travel in the past few years. he has associated cramping pain and fever.

Front 17

where does ulcerative colitis usually begin?

Back 17

in the rectum (and goes up from there throughout variable lengths of the colon)

Front 18

toxic megacolon is a complication of:

a. ulcerative colitis
b. crohn's disease

Back 18

A. this is a surgical emergency!! unless this improves in 72 hrs, then these will perforate and pt is likely to die.

Front 19

what is the most severe complication of ulcerative colitis? why?

Back 19

toxic megacolon (can perforate and have massive hemorrhage...so you must surgically correct this problem)

Front 20

T or F. after years of chronic ulcerative colitis, there's a greatly increased risk of developing colon cancer.

Back 20

T.

Front 21

what are the clinical differnces b/w UC and CD?

Back 21

UC = rectal bleeding, rectal disease, continuous disease

CD = abdominal mass (often feel a fullness), perianal dz, cigarette smoking history, usually a SKIP disease

Front 22

what are the pathological feature differences b/w UC and CD?

Back 22

UC = crypt abscess

CD= transmural inflammation, granuloma, skip lesions