Path Block 3 (GId)

  1. 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
  2. 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.
  3. 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.
  4. 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
  5. Another name for Crohns disease is?
    Granulomatous Colitis
  6. Crohn disease
    Global location?
    Risk factors?
    Males White Jews peaks in 2-3rd decade

    Western nations

  7. Crohn Disease
    Pattern of infection?
    Pattern of Bowel involvement?
    -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
  8. Image Upload 2
    This is Crohns Disease

    See Aphthous Ulcer
  9. Image Upload 4what is this? What are the Names of the Nodules?
    This is Crohns disease with " Cobblestone" nodules
  10. 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
  11. Image Upload 6What is the arrow pointing to? what does this patient have?
    It is a granuloma

    patient has Crohns disease
  12. Image Upload 8 What can you say about this pic?
    See Transmural involvment

    Think Crohns disease
  13. 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.
  14. Patient comes in with
    Migratory arthritis, erythema nodosum, clubbing of fingertips, ankylosing spondylitis.
    What do they have?
    Crohns disease
  15. 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
  16. Ulcerative Colitis
    Age, sex, race?
    Risk factors?
    • 20-25 yr, White Females
    • Non-smoking
  17. 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.
  18. Ulcerative Colitis
    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
    • -Pancolitis
    • -See ulcers of the Mucosa (Pseudopolyps)
    • -Toxic megacolon
    • -
  19. Image Upload 10What is this? What are they called?
    This sis Ulcerative Colitis

    See numerous pseudopolyps
  20. 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
  21. Image Upload 12What do you see?
    See Crypt abcesses?

    Ulcerative Colitis
  22. What are the Vasscular diseases of the Bowel?
    • GI hemorrhage
    • Ischemic bowel disease
    • Angiodysplasia
    • Hemorrhoids
  23. What could cause ischemic Bowel disease?
    • Arterial Thrombosis
    • Arterial Embolism
    • Venous thrombosis
    • Non-occlusive Ischemia
  24. Image Upload 14What is going on here?
    This is Ischemia of the Small Bowel
  25. 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
    • -Non-neoplastic
    • -Dilation in the submucosa and mucosa
    • -accounts for 20% of LIB
  26. Image Upload 16What is this?
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Path Block 3 (GId)
Path Block 3 (GId)