Chapter 17 Part 7

Question 1

What are the symptoms of IBS?

Answer 1

• abdominal pain
• bloating
• changes in bowel habits

-chronic, relapsing

Question 2

True or False: IBS can be seen grossly and histologically

Answer 2

False; endoscopic and microscopic evaluations are normal

Question 3

What are contributors to the possible pathogenesis of IBS?

Answer 3

• psychologic stressors
• diet
• gut microbiome
• abnormal GI motility
• increased enteric response to GI stimuli

Question 4

What is the most common patient population for IBS?

Answer 4

• -females aged 20-40

- -high-income countries

Question 5

What does the Rome Criteria for IBS?

Answer 5

-at least 3 months (with the onset at least 6 months prior) of recurrent abdominal pain/discomfort and two or more of the following:

• improvement w/ defecation
• onset was associated w/ change in stool frequency
• onset was associated w/ change in stool appearance

Question 6

What are the structures associated with Ulcerative Colitis?

Answer 6

-mucosa and submucosa of the rectum and colon

Question 7

What are the structures associated with Crohn Disease?

Answer 7

• anywhere in the GI tract, but ileum most frequently

- typically transmural

Question 8

What is the population normally affected by IBD?

Answer 8

• teenagers and early 20’s
• UC is slightly more common in females
• Caucasians
• 4x more common in Ashkenazi Jews

Question 9

What is seen at the epithelial surface of IBD?

Answer 9

• disruption of the mucus layer
• dysregulation of epithelial tight junctions
• increased intestinal permeability
• increased bacterial adherence to epithelial cells

Question 10

Which form of IBD has stronger genetic factors?

Answer 10

-Crohn Disease

–50% concordance in monozygotic twins, whereas there’s only a 15% concordance rate for UC in monozygotic twins

Question 11

CD or UC: Skip lesions

Answer 11

CD; patchy distribution results in cobblestone appearance of mucosa

Question 12

CD or UC: continuous diffuse lesions

Answer 12

UC

Question 13

CD or UC: Which has a thick wall and which has a thin wall?

Answer 13

CD - thick

UC - thin

Question 14

CD or UC: pseudopolyps

Answer 14

UC; tips of pseudopolyps can fuse to create mucosal bridges

Question 15

CD or UC: Which has deep, knife-like ulcers and which has superficial, broad-based ulcers?

Answer 15

CD - deep, knife

UC - superficial, broad

Question 16

CD or UC: fibrosis

Answer 16

CD

Question 17

CD or UC: granulomas

Answer 17

CD (in approx. 35%)

Question 18

CD or UC: fistulas

Answer 18

CD

Question 19

CD or UC: fat/vitamin malabsorption

Answer 19

CD

Question 20

CD or UC: shows no recurrence after surgery

Answer 20

UC

Question 21

CD or UC: toxic megacolon

Answer 21

UC

Question 22

CD or UC: “creeping fat”

Answer 22

CD

Question 23

True or False: multiple ulcers in CD can coalesce into elongated, serpentine ulcers oriented along the axis of the bowel.

Answer 23

True

-UC ulcers are also aligned along the long axis of the colon, but are not typically serpentine

Question 24

What are the presenting symptoms of Crohn Disease?

Answer 24

• abdominal pain (RLQ)
• diarrhea
• N/V
• weight loss

Question 25

CD or UC: which has smoking as a risk factor and which has smoking as a protective factor

Answer 25

CD - risk | UC - protective

Question 26

True or False: initial attack of UC may be severe enough to constitute a medical or surgical emergency

Answer 26

True

Question 27

What biliary tract disorder may be seen in UC patients?

Answer 27

-primary sclerosing cholangitis

Question 28

What is the primary cellular infiltrate in CD?

Answer 28

- neutrophils - -clusters in a crypt from "crypt abscesses"; repeated crypt destruction gives rise to bizarre branching and unusual orientations

Question 29

CD or UC: Paneth cell metaplasia

Answer 29

CD

Question 30

What are the presenting symptoms of Ulcerative Colitis?

Answer 30

- attacks of bloody diarrhea w/ stringy mucoid material - lower abdominal pain - relief w/ defecation

Question 31

CD or UC: perinuclear anti-neutrophil cytoplasmic antibodies

Answer 31

UC

Question 32

CD or UC: antibodies to Saccharomyces cerevisiae

Answer 32

CD

Question 33

True or False: IBD can always be diagnosed as either CD or UC

Answer 33

False; 10% of IBD cases are Indeterminate Colitis

Question 34

CD or UC: perinuclear anti-neutrophil cytoplasmic antibodies

Answer 34

UC

Question 35

CD or UC: antibodies to Saccharomyces cerevisiae

Answer 35

CD

Question 36

What three factors play into risk of neoplasia in patients with IBD?

Answer 36

1) duration of disease (increased risk at 9yrs) 2) extent of disease (pancolitis vs. left-sided) 3) nature of inflammatory response (neutrophils)

Question 37

What is diversion colitis?

Answer 37

-colitis that develops in a diverted segment of bowel

Question 38

What is microscopic colitis, collagenous type?

Answer 38

- -chronic, watery diarrhea w/o weight loss - -middle-aged and older women - -dense subepithelial collagen layer - -increased intraepithelial lymphocytes - -mixed inflammatory infiltrate

Question 39

What is microscopic colitis, lymphocytic type?

Answer 39

- -chronic, watery diarrhea w/o weight loss - -markedly increased intraepithelial lymphocytes --strong association w/ celiac disease and autoimmune diseases

Question 40

What are the GI implications of graft-versus-host disease?

Answer 40

-occurs following allogeneic hematopoietic stem cell transplantation - epithelial apoptosis of intestinal crypt cells - watery diarrhea; bloody diarrhea in severe cases

Question 41

What is sigmoid diverticular disease (diverticulosis)?

Answer 41

-multiple, acquired, pseudodiverticular outpouchings of colonic mucosa and submucosa

Question 42

What is the most common population for diverticulosis?

Answer 42

- rare in people younger than 30 - 50% of people over 60 in western world have it - -normally left-sided in the western world

Question 43

What are complications of diverticulosis (sigmoid diverticular disease)?

Answer 43

- diverticulitis - -inflammation and increased pressure can lead to perforation because the diverticula is only invested my the mucosa and submucosa

Question 44

While occurring in only 20% of patients, what are the symptoms of sigmoid diverticular diseases (diverticulosis)?

Answer 44

- intermittent cramping - continuous lower abdominal discomfort - constipation - distention - feeling of not being able to completely empty rectum