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WHat are two Inflammatory Bowel diseases?
What are the causese of theses (General)
and Ulcerative Colitis
Inappropriate and persistent activation of the mucosal immune system
, driven by presence of normal intraluminal flora
- and Defects in epithelial barrier function
Inflamatory Bowel disease
Where is it most common?
Location in the GI?
These are common in developing areas and european decent
- UC- primaraly in the Colon/ Rectum
- CD- Any part of the GIT, but most commonly in the distal small intestine and colon.
inflammatory bowel disease
Is there a genetic component?
What is the Immune response in these diseases?
When is it hard to tell UC and CD apart?
Yes, there is a genetic associated for both CD and UC
You see abnormal T-cell response ( the prime culprit is CD4+ T-cells
Hard when they are both limited to the colon.
pANCA + in?
Ab for polysaccharide of Saccharomyces cerevisiae (ASCA) in?
see p ANCA more commonly in UC (75%)
See ASCA in some CD patients
Another name for Crohns disease is?
Males White Jews peaks in 2-3rd decade
Pattern of infection?
Pattern of Bowel involvement?
, see Transmural involvement
with linear mucosal ulcers
- -40% Small bowel only, 30% SB and Colon, 30% colon only
- -See Non-caseating granulomas
- -see Fissuring with Formation of Fistulas
This is Crohns Disease
See Aphthous Ulcer
what is this? What are the Names of the Nodules?
This is Crohns disease with " Cobblestone" nodules
Name the 4 big things you will see hystologicall in crohns disease?
- Mucosal inflammation-(see alot of PMNs)
- Chronic mucosal damage
- Transmural involvement
- Non-caseating granulomas
What is the arrow pointing to? what does this patient have?
It is a granuloma
patient has Crohns disease
What can you say about this pic?
See Transmural involvment
Think Crohns disease
What are the Clinical Symptoms of Crohns disease?
What are some Complications?
Does cancer risk increase?
- –Relatively mild diarrhea, NOT bloody
- –Abdominal pain
- –Weight loss
- *strictures, fissures, and malabsorption- 5 to 6 time increase in chance of cancer.
Patient comes in with
Migratory arthritis, erythema nodosum, clubbing of fingertips, ankylosing spondylitis.
What do they have?
Location of the infection in the Bowel?
is it continous?
What is it associated with systemically?
Location: Affects only the mucosa and the submucosa.
Extends continously from rectum
Associated with Systemic diseases: Polyarthritus, ankylosing sondylitis, uVeitis and Primary sclerosing cholangitis
Age, sex, race?
- 20-25 yr, White Females
Ulcerative Colitis Clinical Symptoms
- -Relapsing, Bloody Diarrhea
- -Cramping abdominal pain
- -30% require Cplectomy
- -Increased risk of Adenocarcinoma--greatest with those who have pancolitis of 10 or more years.
Location of involvement?
Does it skip?
When it involves the entire colon it is called?
What might you see?
- -Rectum and extends proximally in retrograde fashion
- -No skiped areas
- -See ulcers of the Mucosa (Pseudopolyps)
- -Toxic megacolon
What is this? What are they called?
This sis Ulcerative Colitis
See numerous pseudopolyps
What will you see Hystologically?
What is it associated with?
See involvment of the Mucosa and sometimes submucosa
- Crypt abcesses
, it is often infiltrative with out exophytic mass to identify the location
What do you see?
See Crypt abcesses?
What are the Vasscular diseases of the Bowel?
- GI hemorrhage
- Ischemic bowel disease
What could cause ischemic Bowel disease?
- Arterial Thrombosis
- Arterial Embolism
- Venous thrombosis
- Non-occlusive Ischemia
What is going on here?
This is Ischemia of the Small Bowel
What is Angiodysplasia?
is it Left or Right sided?
Dilation of What layers?
What percent of lower intestinal bleeding?
It is a problem of Vascular dilation and malformation
- -Right sided
- -Dilation in the submucosa and mucosa
- -accounts for 20% of LIB
What is this?