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37 Cards in this Set
- Front
- Back
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__ is the most common cause of chronic colitis in the
USA. It affects exclusively the ______ intestine and appendix, and the rectum is invariably affected. The inflammatory changes are limited to the mucosa and _________. |
UC is the most common cause of chronic colitis in the
USA. It affects exclusively the large intestine and appendix, and the rectum is invariably affected. The inflammatory changes are limited to the mucosa and submucosa. |
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UC:
HLA ___ |
UC:
HLA DR2 |
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Crohn's Disease:
HLA ___/ DQ5 |
Crohn's Disease:
HLA DR1/ DQ5 |
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Ulcerative colitis and Crohns
More common in whites or blacks? |
whites
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Ulcerative colitis:
Moderate to markedly active chronic cecal involvement is associated with ____wash ileitis |
Ulcerative colitis:
Moderate to markedly active chronic cecal involvement is associated with backwash ileitis |
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Ulcerative colitis:
Associated with increased _____ ____ synthase expression in both normal and diseased bowel, suggesting that disease extension is greater than normally thought (AJCP 2006;126:113) |
Ulcerative colitis:
Associated with increased fatty acid synthase expression in both normal and diseased bowel, suggesting that disease extension is greater than normally thought (AJCP 2006;126:113) |
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UC symptoms:
Symptoms: relapsing, ______ mucoid diarrhea (stringy mucus) with pain/cramps relieved by defecation; lasts days/months, then remission for months/years; initial attack may cause medical emergency for ______ and ___________ imbalance |
UC symptoms:
Symptoms: relapsing, bloody mucoid diarrhea (stringy mucus) with pain/cramps relieved by defecation; lasts days/months, then remission for months/years; initial attack may cause medical emergency for fluid and electrolyte imbalance |
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UC:
Almost always ______ involvement at disease onset, but may develop rectal sparing and patchiness after treatment or chronic disease, resembling Crohn’s colitis (AJCP 2004;122:94) |
UC:
Almost always rectal involvement at disease onset, but may develop rectal sparing and patchiness after treatment or chronic disease, resembling Crohn’s colitis (AJCP 2004;122:94) |
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Pediatric ulcerative colitis
More likely than adults to have patchiness of microscopic chronicity. relative or absolute ______ sparing, relatively normal ______ biopsies; more likely to have initial ___colitis (42%,) Poorer prognosis AJSP 2004;28:190) |
Pediatric ulcerative colitis
More likely than adults to have patchiness of microscopic chronicity. relative or absolute rectal sparing, relatively normal rectal biopsies; more likely to have initial pancolitis (42%,) Poorer prognosis AJSP 2004;28:190) |
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UC extraintestinal manifestations
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migratory polyarthritis
clubbing sacroiliitis ankylosing spondylitis primary sclerosing cholangitis pericholangitis uveitis pyoderma gangrenosum |
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Skip areas:?
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typically associated with Crohn’s
disease, but occur in UC with long term oral or topical therapy; |
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UC Gross
Early - mucosa is hemorrhagic, granular, friable; changes usually diffuse (similar intensity throughout) Late - extensive ulceration along bowel axis but usually not __________ as in Crohn’s; have ______polyps (isolated islands of regenerating mucosa) and flat mucosa; usually normal wall thickness and normal serosa; severe cases may have ____colon or fibrotic, narrow or shortened colon |
UC Gross
Early - mucosa is hemorrhagic, granular, friable; changes usually diffuse (similar intensity throughout) Late - extensive ulceration along bowel axis but usually not serpentine as in Crohn’s; have pseudopolyps (isolated islands of regenerating mucosa) and flat mucosa; usually normal wall thickness and normal serosa; severe cases may have megacolon or fibrotic, narrow or shortened colon |
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Chronic ulcerative colitis. Note the deep ulcer
in the center, the ___________ appearance of the mucosa, and the ______-polyps (yellow arrow). I |
Chronic ulcerative colitis. Note the deep ulcer
in the center, the cobblestone appearance of the mucosa, and the pseudo-polyps (yellow arrow). I |
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Goljan assoc cobblestone with Crohn's
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FYI
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UC Micro:
Affects primarily mucosa and submucosa, except in most severe cases Active changes include diffuse ___________ inflammatory infiltrate in lamina propria, crypt abscesses (neutrophils in glandular lumen) and cryptitis but usually no ___________ in lamina propria and reduced intraepithelial mucin |
UC Micro:
Affects primarily mucosa and submucosa, except in most severe cases Active changes include diffuse mononuclear inflammatory infiltrate in lamina propria, crypt abscesses (neutrophils in glandular lumen) and cryptitis but usually no neutrophils in lamina propria and reduced intraepithelial mucin |
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If there are ___________ in the lP, then it is not ulcerative colitis
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If there are neutrophils in the lP, then it is not ulcerative colitis
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UC Definitive diagnostic
criteria: diffuse disease limited to colon, involvement of rectum, no _____mural lymphoid aggregates or g_________ Children: initial rectal biopsies show diffuse architectural abnormalities in fewer (32%) cases and have a shorter duration of symptoms. |
UC Definitive diagnostic
criteria: diffuse disease limited to colon, involvement of rectum, no transmural lymphoid aggregates or granulomas Children: initial rectal biopsies show diffuse architectural abnormalities in fewer (32%) cases and have a shorter duration of symptoms. |
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The colonic mucosa of active ulcerative colitis shows "c____ abscesses" in which a neutrophilic exudate is found
in glandular lumens. The submucosa shows intense inflammation. The glands demonstrate loss of ______ cells and hyperchromatic nuclei with inflammatory atypia. |
The colonic mucosa of active ulcerative colitis shows "crypt abscesses" in which a neutrophilic exudate is found
in glandular lumens. The submucosa shows intense inflammation. The glands demonstrate loss of goblet cells and hyperchromatic nuclei with inflammatory atypia. |
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UC Differential diagnosis
_______ disease Indeterminate ___itis, D___________ disease (rectal sparing, colitis only present in areas of diverticula), ______philic colitis |
UC Differential diagnosis
Crohn’s disease Indeterminate colitis, Diverticular disease (rectal sparing, colitis only present in areas of diverticula), Eosinophilic colitis |
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UC Favorable prognostic
1 or 2 negative surveillance colonoscopies, s______, use of ___________oids, aspirin or _____s |
UC Favorable prognostic
1 or 2 negative surveillance colonoscopies, smoking, use of corticosteroids, aspirin or NSAIDs |
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Ulcerative proctitis
Gross: resembles extensive ulcerative _______ Micro: resembles ulcerative colitis, but may have mucosal ________ follicles DD: lymphoid follicular proctitis (no ulceration, no acute inflammation) |
Ulcerative proctitis
Gross: resembles extensive ulcerative colitis Micro: resembles ulcerative colitis, but may have mucosal lymphoid follicles DD: lymphoid follicular proctitis (no ulceration, no acute inflammation) |
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aka regional enteritis because it affects sharply
delineated segments, or granulomatous colitis due to granulomas |
Crohn's Disease
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Crohn's
May affect ANY portion of the alimentary tract,from the mouth to the anus, but it most commonly affects the _____ and the colon characterized by the presence of __________ inflammation, STRICTURES, FISTULAS, and G_________. |
Crohn's
May affect ANY portion of the alimentary tract,from the mouth to the anus, but it most commonly affects the ileum and the colon characterized by the presence of TRANSMURAL inflammation, STRICTURES, FISTULAS, and GRANULOMAS. |
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Crohn's
Symptoms: episodic mild diarrhea, fever, pain; may be precipitated by ______; if colon affected, may have ______ 20% have abrupt onset of symptoms resembling acute ____________ or bowel perforation Extra-intestinal symptoms: migratory polyarthritis, sacroiliitis, ankylosing spondylitis, erythema nodosum, ________ of fingertips, primary sclerosing cholangitis (not as common as with ulcerative colitis); occasionally uveitis, pericholangitis and renal disorders secondary to periureteral fibrosis. |
Crohn's
Symptoms: episodic mild diarrhea, fever, pain; may be precipitated by stress; if colon affected, may have anemia 20% have abrupt onset of symptoms resembling acute appendicitis or bowel perforation Extra-intestinal symptoms: migratory polyarthritis, sacroiliitis, ankylosing spondylitis, erythema nodosum, clubbing of fingertips, primary sclerosing cholangitis (not as common as with ulcerative colitis); occasionally uveitis, pericholangitis and renal disorders secondary to periureteral fibrosis. |
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Crohn's complications
Fbrosing s________s (common in terminal ileum); fistulas to loops of bowel, bladder, vagina and perianal skin; also protein losing enteropathy, generalized malabsorption, Vitamin ___ deficiency, ____ salt malabsorption with steatorrhea, toxic ____colon (4%), carcinoma |
Crohn's complications
Fbrosing strictures (common in terminal ileum); fistulas to loops of bowel, bladder, vagina and perianal skin; also protein losing enteropathy, generalized malabsorption, Vitamin B12 deficiency, bile salt malabsorption with steatorrhea, toxic megacolon (4%), carcinoma |
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Gross Crohns:
Dull and granular serosa, creeping fat (mesenteric fat wraps around bowel surface), thick/rubbery intestinal wall (due to edema, inflammation, fibrosis, hypertrophy of muscularis propria), Strictures (______ sign on barium enema), sharp demarcation of affected segments from uninvolvedareas) |
Gross Crohns:
Dull and granular serosa, creeping fat (mesenteric fat wraps around bowel surface), thick/rubbery intestinal wall (due to edema, inflammation, fibrosis, hypertrophy of muscularis propria), Strictures (string sign on barium enema), sharp demarcation of affected segments from uninvolvedareas) |
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Gross Crohns...
Aphthous mucosal ulcers coalesce into long, serpentine linear ulcers along bowel axis to acquire ___________ appearance; fissures in mucosal folds lead to fistulas or sinus tracts Usually ______ sparing; disease overall is less severe in distal vs. proximal colon (i.e. preferential _____-sided involvement) |
Gross Crohns...
Aphthous mucosal ulcers coalesce into long, serpentine linear ulcers along bowel axis to acquire cobblestone appearance; fissures in mucosal folds lead to fistulas or sinus tracts Usually rectal sparing; disease overall is less severe in distal vs. proximal colon (i.e. preferential right-sided involvement) |
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Micro Crohns
_____mural inflammation with lymphoid aggregates throughout bowel wall; s______-like, non-caseating, poorly formed ______omas in all tissue layers (50-70%), usuallyadjacent to blood vessels or lymphatics initially focal PMNs in epithelium and overlying lymphoid aggregates and plasmacytosis, then cryptitis, crypt abscesses, but usually no ____ in lamina propria |
Micro Crohns
transmural inflammation with lymphoid aggregates throughout bowel wall; sarcoid-like, non-caseating, poorly formed granulomas in all tissue layers (50-70%), usuallyadjacent to blood vessels or lymphatics initially focal PMNs in epithelium and overlying lymphoid aggregates and plasmacytosis, then cryptitis, crypt abscesses, but usually no PMNs in lamina propria |
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Crohn’s disease of colon resembles ulcerative
t Crohn’s also has f_______ / sinus tracts, skip lesions, deep ulcerations, marked lymphocytic infiltration, serositis, ______omas, fewer plasma cells |
Crohn’s disease of colon resembles ulcerative
t Crohn’s also has fistulas / sinus tracts, skip lesions, deep ulcerations, marked lymphocytic infiltration, serositis, granulomas, fewer plasma cells |
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Definitive diagnosis of Crohns:
Trans_____ lymphoid aggregates in areas not deeply ulcerated, Nonnecrotizing ______omas; Suggestive features are ____ lesions, linear ulcers, __________ing, ___ wrapping or terminal ileum inflammation Often requires multiple biopsies; difficult to diagnosis without terminal ileum involvement Other diagnostic criteria: transmural lymphoid aggregates in areas that are not deeply ulcerated or nonnecrotizing granulomas |
Definitive diagnosis of Crohns:
Transmural lymphoid aggregates in areas not deeply ulcerated, Nonnecrotizing granulomas; Suggestive features are skip lesions, linear ulcers, cobblestoning, fat wrapping or terminal ileum inflammation Often requires multiple biopsies; difficult to diagnosis without terminal ileum involvement Other diagnostic criteria: transmural lymphoid aggregates in areas that are not deeply ulcerated or nonnecrotizing granulomas |
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Differential diagnosis of Crohns
ulcerative colitis (abnormal rectal biopsy, not transmural, no fissures/ fistulas, no granulomas but occasionally may have granulomas around ruptured cysts; Ileal inflammation, ________ ulcers, ________ bowel disease, T__________s |
Differential diagnosis of Crohns
ulcerative colitis (abnormal rectal biopsy, not transmural, no fissures/ fistulas, no granulomas but occasionally may have granulomas around ruptured cysts; Ileal inflammation, Aphthous ulcers, Ischemic bowel disease, Tuberculosis |
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Always in Ulcerative colitis:
Diffuse change Irregular luminal surface Basal _____cytosis |
Always in Ulcerative colitis:
Diffuse change Irregular luminal surface Basal plasmacytosis |
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PMNs in th LP occurs with what?
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infectious colitis
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______________ colitis
Diagnosis when cannot distinguish between Crohn’s and ulcerative colitis (J Clin Pathol 1978;31:567) Not a specific disease entity as it has no diagnostic criteria 5-15% of cases of inflammatory bowel disease; up to 30% of pediatric cases (Inflamm Bowel Dis 2006;12:258) |
Indeterminate colitis
Diagnosis when cannot distinguish between Crohn’s and ulcerative colitis (J Clin Pathol 1978;31:567) Not a specific disease entity as it has no diagnostic criteria 5-15% of cases of inflammatory bowel disease; up to 30% of pediatric cases (Inflamm Bowel Dis 2006;12:258) |
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IC pathology
Gross: relative ______ sparing in fulminant disease; longitudinal ulcers in refractory disease Micro: associated with fulminant disease - mild architectural changes and inflammation; deep ulcers; undermining ulcers; _____oid-like ulcers at the bases of in________ grooves other - crypt associated granulomas may be a reaction to _____ extravasation |
IC pathology
Gross: relative distal sparing in fulminant disease; longitudinal ulcers in refractory disease Micro: associated with fulminant disease - mild architectural changes and inflammation; deep ulcers; undermining ulcers; aphthoid-like ulcers at the bases of innominate grooves other - crypt associated granulomas may be a reaction to mucin extravasation |
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Dysplasia in IBD:
Risk may be reduced by 5-amino__________ use |
Dysplasia in IBD:
Risk may be reduced by 5-aminosalicylate use |
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High Grade Dysplasia in IBD
•The dysplastic cells have crowded enlarged hyperchromatic nuclei •There is loss of function evidenced by decreased _____ production •The marked architectural disarray with prominent __________ of nuclei is the basis for classifying this as severe dysplasia |
High Grade Dysplasia in IBD
•The dysplastic cells have crowded enlarged hyperchromatic nuclei •There is loss of function evidenced by decreased mucin production •The marked architectural disarray with prominent palisading of nuclei is the basis for classifying this as severe dysplasia |
