IBD Pathology, Patient Assessment

What is IBD?

inflammatory bowel disease; chronic idiopathic inflammatory disease of the GI tract that is relapsing/remitting

When is the peak onset of IBD?

15-30 years old

What two disease states are under the umbrella of IBD?

ulcerative colitis and Chron’s disease

What happens to mucus in IBD?

decreased from defective mucin genes

What happens to cell junctions in IBD?

they’re leaky

What does inappropriate antigen presentation through M-cells and toll like receptors lead to in IBD?

triggers antigen presenting cell to activate acquired immune response

t-cells and cytokines at an inappropriate rate

due to an imbalance in Thelper cells and Treg cells resulting in Thelper cells continuing to propagate and recruit more lymphocytes & cytokines

What is the hallmark of IBD?

profound infiltration of innate & adaptive immunity cells into the lamina propria

What is IBD in general?

an inappropriate inflammatory immune response to intestinal microorganisms in a genetically susceptible host

What other risks get increased in IBD?

VTE, anemia, osteoporosis, ocular issues

What are the signs and symtpoms that are common in IBD?

abdominal pain, cramping, bloody diarrhea, weight loss, fatigue, change in daily activity

What labs can be used in IBD diagnosis?

ESR, CRP, Hgb/Hct

What does ESR and CRP indicate in IBD diagnosis?

non-specific inflammatory markers

What stool studies can be done in an IBD diagnosis?

lactoferrin, calprotectin

What do lactoferrin and calprotectin indicate in IBD?

breakdown products of WBCs in the stool

What level of lactoferrin and calprotectin are in line with an IBD diagnosis?

>50 mg/g

True or False: stool samples testing for lactoferrin and calprotectin are helpful in distinguishing between IBS vs IBD

true

What imaging can be done to diagnose IBD?

CT scans, upper and/or lower endoscopies

What layer of the GI tract does UC involve?

continuous superficial mucosal involvement

Where does UC usually start?

rectum

True or False: UC only affects the colon

true

What is true about Chron’s Disease’s GI tract involvement?

patchy, deep, and discontinuous

What pattern is usually seen in Chron’s?

cobblestone

What location is proctitis referring to?

rectum

What location is proctosigmoiditis referring to?

rectum + sigmoid

What location is left sided colitis referring to?

rectum + sigmoid + descending colon

What location is extensive colitis referring to?

going past the splenic flexure

What location is pancolitis referring to?

the entire colon

What location does Chron’s disease effect the most (2/3 of patients)?

terminal ileum

Which type of IBD is peri-anal involvement common in?

Chron’s Disease

What range of locations can Chron’s be?

from mouth to anus

What sequelae does ulcerative colitis have?

toxic megacolon, rectal abscesses, colectomy, colon cancer

What sequalae does Chron’s Disease have?

strictures, fistulas, malnutrition, vitamin deficiency, intestinal surgeries, increased risk of colon cancer

What kinds of fistulas are common in Chron’s?

enterovesical (bowel → bladder)

enteroenteric (bowel → bowel)

perianal; enterocutaneous (bowel → skin)