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