Pathophysiology Week 12- Inflammatory Bowel Disease

total colitis

also known as pan colitis; the rectum and the whole entire colon is involved

IBD

chronic, relapsing inflammatory bowel disorder of unknown origin; can have systemic symptoms as well

Crohn's disease leads to

fissures

distal colitis

the rectum and the colon is involved up until the left upper quadrant

proctosigmoiditis

the rectum and the sigmoid part of the colon is involved

complications of Crohn disease

uveitis; ankylosing spondylitis; sclerosing cholangitis; erythema nodosum; malnutrition; arthritis (MOST COMMON); pyoderma gangrenosum

Crohn's disease vs UC

Crohn's disease can be anywhere (mouth-anus) while UC is only colon bound

treatment of UC

broad spectrum antibiotics and steroids; immunosuppressive agents; surgery

ulcerative colitis

chronic inflammatory disease that causes ulceration of the colonic mucosa; normally people ages 20-40 can get it (can be present in teen years as well); rectum is almost always involved

pathophysiology of UC

continuous lesions (once one area is infected, that entire area is infected with no healthy tissue in between); limited to mucosa but can go to submucosa (tends to be more superficial); thinner than normal and problem with epithelial layer; rectum is almost always involved; inflammatory response; can lead to erosions and form ulcers; polyps can form which can increase risk for colon cancer

UC symptoms

exacerbations and remission (periods of being ill, then after treatment good health and then back to being ill; can be once every 5 years or 5 times a year- depending on severity of disease); can be mild and may be just the rectum or can go through the entire colon); diarrhea can be about 10-20 times a day or mild as little as 3-4 times a day; can cause pain and be bloody and mucous filled stool with cramps; can have systemic symptoms as well

origin of IBD

genetic (autoimmune); alterations of epithelial barrier functions; activates the inflammatory cells mediators that cause disease (cytokines, histamine, bradykinin); immune reactions to intestinal flora; abnormal T-cell responses

transmural inflammation

goes deeper than superficial layer

classic feature of Crohn's disease

granuloma with cobblestoning projections of inflamed tissue surrounded by ulcers

crohn disease

granulomatous colitis, ileocolitis, or regional enteritis; idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus; similar risk factors and theories of causation for UC; women slightly greater than men; genetics is the likely foundation of the disease (NOD-1 gene)

causes of ulcerative colitis

infectious, immunologic (anti-colon antibodies) lymphocytes T cells have cytotoxic effects; inflammatory response, dietary; genetic (supported by family studies and identical twin studies)

pathophysiology of Crohn's disease

inflammatory process: all layers involved with submucosa affected the most; causes the "skip" lesions; can have asymmetric involvement; can cause crypt destruction and abscess formation; bowel wall thick and inflexible; fistula form in perianal area

proctitis

just the rectum is involved

cobblestoning

lining of the colon from chronic inflammation

treatment of Crohn's disease

mainly immunosuppression

risk of UC

people with UC can have an increased risk of colon cancer

fistula of Crohn's disease

side effect; fistula causes a crack from the rectum to the buttock or perineal area; pus and stool can come out of it causing it to be devastating; can get clogged, might need to be drained and might need surgery

clinical manifestations of Crohn's disease

similar to UC but more severe; presents in exacerbations and remissions; can have diarrhea, abdominal pain, weight loss, and malabsorption issues; also system symptoms are common (because it is systemic it can cause system symptoms on top of bowel changes; ex. lesion in esophagus can cause GERD on top of bowel issues)

environmental causes of Crohn's disease

smoking; infections and certain medications (antibiotics and NSAIDS)

most common site of Crohn's disease

terminal ileum; but anywhere can be involved from mouth to anus

extensive colitis

the rectum and the colon is involved up until the right upper quadrant