Lecture 9: Inflammatory Bowel Disease

Question 1

Recall the gastrointestinal tract.

Answer 1

Question 2

Recall the histological difference between small intestine and colon.

Answer 2

Question 3

Recall the cells of the gastrointestinal tract.

Answer 3

Question 4

Describe the classification of inflammatory condition of the intestine.

Answer 4

• Infections
  
  • Viral (rotavirus, norovirus)
  • bacterial (E. coli, Salmonella)
  • parasitic (amoebic, Schistosomiasis)
• Non-infectious
  
  • Inflammatory Bowel Disease (Ulcerative Colitis, Chron’s DIsease)
  • Ischaemic enterocolitis
  • Radiation-induced enterocolitis
  • drug, chemical, food-related
  • immune mediated

Question 5

Recall the difference between Crohn Disease and Ulcerative Colitis. Mention their symptoms.

Answer 5

Question 6

Describe ulcerative colitis.

Answer 6

A chronic inflammation disease of the colon, involving the rectal mucosa and varying portions of the large intestine. It usually occurs as a chronic disease with mild to severe exacerbation but occasionally occurs in the acute form. Symptoms include:

• diarrhea
• abdominal pain
• rectal bleeding
• extra-intestinal manifestation (fever, joint pain)

Question 7

Mention the visual characteristics of the intestinal lining in the case of ulcerative colitis.

Answer 7

• Mucosa - shallow ulceration with mucosal bridges
  
  • Later re-epithelialise as healing occurs resembling polyps (Pseudopolyps)
• Colon shortened
• Wall of normal thickness
• Serosa intact
• Ileum spared

Question 8

Mention the features of active ulcerative colitis.

Answer 8

Question 9

Mention the features of remission after ulcerative colitis.

Answer 9

Question 10

What is Chron’s Disease?

Answer 10

It is a chronic inflammatory condition, potentially involving any part of the alimentary tract from mouth to anus; most commonly the distal small intestine and proximal colon, with rectum frequently spared.

It is also characterised by segmental areas of involvement, with normal intervening bowel and trans-mural extension of the disease process.

Question 11

What are the symptoms and complications of Crohn’s disease?

Answer 11

Symptoms:

• diarrhea
• abdominal pain
• rectal bleeding
• extraintestinal manifestation (fever, joint pain)

Complications:

• fistula formation and strictures
• fat and vitamin malabsorption with small bowel involvement

Question 12

Mention the visual characteristics of Crohn’s Disease in the intestine.

Answer 12

Question 13

Mention the features of active Crohn’s Disease.

Answer 13

Question 14

Recall the comparison between ulcerative colitis and Crohn’s Disease.

Answer 14

Question 15

Recall the pathogenesis of IBD.

Answer 15

Question 16

Recall the difference in immune response between ulcerative colitis and Crohn’s Disease.

Answer 16

Question 17

Mention an example of IBD complication.

Answer 17

Question 18

Recall information regarding inflammation-associated cancers.

Answer 18

Definition

: when chronic inflammation promotes the onset and progression of cancer

• Colitis-associated cancer (CAC)
  
  • Factors determining development:
    
    • Disease of longer than 10 years
    • Onset of disease in childhood
    • Severe first attack and evidence of continuing activity
    • Extend of colitis
• Colorectal cancer
  
  • 2nd most common cancer in Australia
  • Risk factors: age, family history, IBD, obesity, diabetes
  • Only 20% are familial