DIG Exam 3 ILA Histopath of IBD Sos

Diseases characterized by chronic inflammation of the gastrointestinal tract resulting in permanent damage possibly leading to adenocarcinoma

IBD

Combination of genetic factors and up-regulated immunity

Cause of IBD

Abdominal pain

Persistent diarrhea

Rectal bleeding

bloody stools

Weight loss

Fatigue

IBD Symptoms

Starts in the rectum and progresses to the cecum in a linear fashion

UC

The large intestine grossly lose haustra and contains pseudopolyps (normal mucosa surrounded by erosion)

“lead pipe” appearance on imaging

UC

Inflammation restricted to the mucosa and submucosa

UC

Crypt abscesses (neutrophils)

UC

Symptoms focused on left lower quadrant abdominal pain and bloody diarrhea

UC

Associated with primary sclerosing cholangitis and pANCA

UC

Can develop toxic megacolon and adenocarcinoma (10-15 yrs of disease process)

UC

UC

pseudopolyps

UC

UC lead pipe

UC

Pseudopolyps

___________ consist of inflamed mucosa surrounded by erosion. Start at the rectum and progress linearly towards the cecum

pseudopolyps

UC

UC

pseudo polyp

erosions surrounding

UC

neutrophils in crypts

UC illustration

Toxic megacolon

Occurs in days

Segmental nonobstructive colonic dilatation and ischemia followed by necrosis

IBD is a common cause

Toxic megacolon

UC to adenocarcinoma

Increased risk of _______ adenocarcinoma with Ulcerative Colitis

Colorectal

Age 15-30 and 50-70 yrs

UC

Age 15 to 35 yrs

CD

Lesions found anywhere in the GI tract from oral cavity to rectum, the ileum and ascending colon region is most common site and the rectum is least common site

CD

Skip lesions

CD

The large intestine grossly contains thickened constricted intestinal wall with strictures, mucosal “cobblestone” appearance, mesenteric fat wraps around “creeping fat” the serosa

CD

Cobblestone

CD

Creeping fat

CD

string sign of Kantor

CD

transmural Inflammation with lymphoid aggregates and granulomas

CD

Symptoms focused on right lower quadrant abdominal pain and non-bloody diarrhea

CD

Associated with ankylosing spondylitis, sacroiliitis, uveitis, polyarthritis and erythema nodosum

CD

Can develop malabsorption with nutritional deficiency, fistula formation and calcium oxalate nephrolithiasis

CD

Fistula formation

CD

String sign of Kantor

CD

Erythema nodosum

Can be associated with CD

CD

cobblestone

CD

Ileum with thickened wall and

increased mesentery fat lines

CD

Thickened wall and creeping fat

CD

Cobblestone

Internal fistulae

• Enteroenteric

• Enterovesical

• Rectovaginal

External fistulae

• Perianal

• Enterocutaneous

• Peristomal

Types of fistulae in CD

CD

Lymphoid follicles within wall, transmural inflammation

CD

granuloma

CD vs UC

A common chronic disorder involving the large intestine, unknown cause

Most can control their symptoms with stress reduction, diet management, and healthy lifestyle choices

Symptoms include cramping, abdominal pain, bloating, gas and diarrhea or constipation or both

No histopathologic findings or increase chance of colorectal adenocarcinoma

IBS