ULCERATIVE COLITIS
- age of onset
- ethnicity
- gender
- smoking
- oral contraceptives
- appendectomy
- Monozygotic twins
- dizygotic twins
- Infections in the 1st yr of life
- age of onset: 2nd-4th decades and 7th-9 decades
- ethnicity: jewish> non> black>latin>asian
- gender: male
- smoking: may prevent
- oral contraceptives: no increased risk
- appendectomy: protective
- Monozygotic twins: 6-18%
- dizygotic twins: 0-2%
- Infections in the 1st yr of life: more risk by the age of 10 and 20
CROHN’S DIEASE
- age of onset
- ethnicity
- gender
- smoking
- oral contraceptives
- appendectomy
- Monozygotic twins
- dizygotic twins
- Infections in the 1st yr of life
- age of onset: 2nd-4th decades and 7th-9 decades
- ethnicity: jewish> non> black>latin>asian
- gender: male
- smoking: may cause
- oral contraceptives: hazardous
- appendectomy: not protective
- Monozygotic twins: 38-58%
- dizygotic twins: 4% concordance
- Infections in the 1st yr of life: more risk by the age of 10 and 20
- Involves the rectum and extend proximally to
involve all or part of the colon - Limited to the mucosa and superficial
submucosa
ULCERATIVE COLITIS
2 major histology [catures: ULCERATIVE COLITIS
- Distorted crypt
architecture, basal plasma cells - multiple basal lymphoid aggregates
- Erythematous mucosa with fine granular surface that resembles “sandpaper”
- Backwash ileitis
- Pscudopalyps
- Toxic megacolon
ULCERATIVE COLITIS
ULCERATIVE COLITIS : Signs and symptoms
- Diarrhea
- Rectal bleeding
- ‘Tenesmus *
- Passage of mucus
- Crampy abdominal pain
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
EXTENT
E1: Ulcerative proctitis
INVOLMENT:
limited to the rectum
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
EXTENT
E2: Left-sided UC (distal UC)
INVOLMENT:
limited to the colorectum distal to the splenic flexure
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
EXTENT
E3: Extensive UC (pancolitis)
INVOLMENT:
extends proximal to the splenic
flexure
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
DEFINITION
Absence of symptoms
SEVERITY
S0: Clinical remission
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
DEFINITION
=4 stools/d (with or without blood), absence of systemic illness, normal inflammatory markers (ESR)
S1: Mild disease activity
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
DEFINITION
>/=4 stools/d but minimal signs of systemic toxicity
S2: Moderate disease
activity
Montreal Classification of Extent and Severity of Ulcerative Colitis (UC)
DEFINITION
>/=6 bloody stools/d, pulse >/= 90 beats/min,
temperature >/=37.5°C, hemoglobin <10.5 g/100 mL, and ESR 230 mm/h
S3: Severe disease activity
ULCERATIVE COLITIS
Diagnostics
- CRP
- PLT
- ESR
- FECAL LACTOFERRIN
- CALPROTECTIN
- pANCA
- Surgeries
Elevated
- CRP
- PLT
- ESR
- FECAL LACTOFERRIN
- CALPROTECTIN
- pANCA
Surgeries
- Sigmoidoscope
- colonscopy
- Affects any part of the GI tract from the mouth to the anus
- Rectum is often spared
- Segmental w/ skip areas
- Transmural
- Aphthoid ulceration and focal crypt abscesses w/ loose
aggregations of macrophages forming non caseating
granuloma —> earliest lesion - Cobblestone appearance
- Creeping fat
- Pseudopolyps
CROHN’S DISEASE
CROHN’S DISEASE
2 patterns of disease:
- Fibrostenotic obstructing pattern
- Penetrating fistulous pattern
- mc site of inflammation is Terminal Ileum
- RLQ pain (colicky) and diarrhea
- Low grade fever, weight loss
Ileocolitis
CROHN’S DISEASE
* DIAGNOSTICS
- ESR
- CRP
- ASCAs
Elevated
Endoscopic feature of Crohn’s Disease
- rectal sparing,
- aphthous ulcerations,
- fistulas,
- skip lesions
Infectious Etiologies of Crohn’s Disease
BACTERIAL
- Salmonella
- Shigella
- Toxigenic
- Escherichia coli
- Campylobacter
- Yersinia
- Clostridium difficile
- Gonorrhea
- Chlamydia trachomatis
Infectious Etiologies of Crohn’s Disease
VIRAL
- Cytomegalovirus
- Herpes simplex
Infectious Etiologies of Crohn’s Disease
Mycobacterial
- Tuberculosis
- Mycobacterium avium
Infectious Etiologies of Crohn’s Disease
PARASITIC
- Amebiasis
- Isospora
- Trichuris trichiura
- Hookworm
- Strongyloides
Infectious Etiologies of Crohn’s Disease
FUNGAL
- Histoplasmosis
- Candida
- Aspergillus
