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WHat are two Inflammatory Bowel diseases?
What are the causese of theses (General)
Crohns disease 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
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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.
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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.
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Inflammatory Diseases
pANCA + in?
Ab for polysaccharide of Saccharomyces cerevisiae (ASCA) in?
see p ANCA more commonly in UC (75%)
See ASCA in some CD patients
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Another name for Crohns disease is?
Granulomatous Colitis
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Crohn disease
Sex/Race/age?
Global location?
Risk factors?
Males White Jews peaks in 2-3rd decade
Western nations
Smoking
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Crohn Disease
Pattern of infection?
Pattern of Bowel involvement?
Granulomas?
-Skips areas, 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
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This is Crohns Disease
See Aphthous Ulcer
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 what is this? What are the Names of the Nodules?
This is Crohns disease with " Cobblestone" nodules
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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
- Ulcerations
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What is the arrow pointing to? what does this patient have?
It is a granuloma
patient has Crohns disease
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What can you say about this pic?
See Transmural involvment
Think Crohns disease
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What are the Clinical Symptoms of Crohns disease?
What are some Complications?
Does cancer risk increase?
- –Relatively mild diarrhea, NOT bloody
- –Fever
- –Abdominal pain
- –Weight loss
- *strictures, fissures, and malabsorption
- - 5 to 6 time increase in chance of cancer.
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Patient comes in with
Migratory arthritis, erythema nodosum, clubbing of fingertips, ankylosing spondylitis.
What do they have?
Crohns disease
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Ulcerative Colitis
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
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Ulcerative Colitis
Age, sex, race?
Risk factors?
- 20-25 yr, White Females
- Non-smoking
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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.
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Ulcerative Colitis
Location of involvement?
Does it skip?
When it involves the entire colon it is called?
Ulcers?
What might you see?
- -Rectum and extends proximally in retrograde fashion
- -No skiped areas
- -Pancolitis
- -See ulcers of the Mucosa (Pseudopolyps)
- -Toxic megacolon
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What is this? What are they called?
This sis Ulcerative Colitis
See numerous pseudopolyps
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Ulcerative Colitis
What will you see Hystologically?
What is it associated with?
See involvment of the Mucosa and sometimes submucosa
- Crypt abcesses
- Pseudopolyps
Associated Adenocarcinoma, it is often infiltrative with out exophytic mass to identify the location
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See Crypt abcesses?
Ulcerative Colitis
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What are the Vasscular diseases of the Bowel?
- GI hemorrhage
- Ischemic bowel disease
- Angiodysplasia
- Hemorrhoids
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What could cause ischemic Bowel disease?
- Arterial Thrombosis
- Arterial Embolism
- Venous thrombosis
- Non-occlusive Ischemia
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This is Ischemia of the Small Bowel
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What is Angiodysplasia?
is it Left or Right sided?
Neoplastic?
Dilation of What layers?
What percent of lower intestinal bleeding?
It is a problem of Vascular dilation and malformation
- -Right sided
- -Non-neoplastic
- -Dilation in the submucosa and mucosa
- -accounts for 20% of LIB
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