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GI - PATHOLOGY - IBDs (CD + UC) (IBD (Inflammatory Bowel Disease) (*DIRTY…
GI - PATHOLOGY - IBDs (CD + UC)
IBD (Inflammatory Bowel Disease)
10% Indeterminant
mix of ULC and Chron's
General IBD Treatment
Goal 1
: treat the dominant symptom:
--> constipation & diarrhea
Goal 2
: anti-inflammatory treatment:
--> derivatives of aminosalicylic acid
(aspirin metabolite)
Anti-Inflammatory
Treatment
Mild/Maintenance
mesalazine
--> pro-drug activated by gut bacteria
--> 5 - Aminosalicylic acid (5-ASA) metabolite
gives anti-inflammatory effect
--> inhibits COX1, IL-1,TNF-Alpha
Moderate-->Severe IBD
sulfasalazine
Symptom Treatment
Anti-Constipation (laxatives)
see
Constipation
for details
Bulk, Osmotic, Stimulant laxatives
feces softener (docusate sodium)
newer Cl- CIC2 channel stims
--> lubiprostone
Anti-diarrhea
anti-muscarinics --> target M3 receptors
Mu oppioid agonists (codeine=morphine & laporimide)
*Crohn's Disease
NOD2 gene mutation
Treatment
Moderate-->Severe IBD
sulfasalazine
Mild/Maintenance
mesalazine
--> pro-drug activated by gut bacteria
--> 5 - Aminosalicylic acid (5-ASA) metabolite
gives anti-inflammatory effect
--> COX1, IL-1,TNF-Alpha
Prognosis
ONLY slight risk in developing cancer
Clinical Cases
Clinical Case
Notes
:
note that
Clinical Case
Chron's Clinical Case
Case presentation:
Notes
:
3 major bacteria that can cause skin diseases are:
note that Chron's Disease most common site is the distal illeum, right before the Cecum, though it is a mouth to anus disease so can present anywhere
because Chron's is a transmural disease of the GI, it has many secondary sequalae from this
--> fissures
--> fistula
--> cysts forming in mucosa
key in the presentation above also are the mouth ulcers = apthous ulcers
Signs and Symptoms
Key Features
Chron's --> chronic inflammatory cells
granulomas from chronic immune cells
--> granulomas are NON-CASEATING
--> opposite to TB CASEATING granulomas
giant cells
Chron's --> Constricted more than UC
--> constricted/normal lumen size
"
cobblestone
" mucosa
--> FISSURE type ulcers
Transmural inflammation
--> FISSURE type ulcers
entire GIT
from mouth --> anus
most common terminal illeum
(before the illeocecal junction)
key feature is
aphthous ulcer
--> typically a recurrent round or oval mouth ulcer
Skip Lesions
not continuous
Clinical
.
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abdominal pain
mild diarrhea
fever
intermittent attacks
Sequalae of Crohns
high GB stones and also kidney stones
Malabsorption of Fat Soluble Vitamins in Crohn's disease
--> Fat soluble Vit = ADEK
Crohns can give other autoimmune diseases like ankylosing spondylitis
CD have high risk of Gallstones
enterohepatic cycle of bile salts
bile salts are reabsorbed in the terminal illeum
terminal illeum worst spot for CD
stop bile salt absorption and lost in the feces
ratio of cholesterol to bile salts increases
--> form Gallstones
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CD have high risk of Kidney stones
oxalate in the gut normally binds with Ca++ that is an insoluble salt that is eliminated in the feces
in Crohns the reduced bile salt reabsorbed from the illeum
--> causes less bile and malabsorption of fat
Ca++ gets caught in the fat
--> oxalate can't bind with Ca++ and is thus absorbed into systemic circulation
oxalate then is filtered into the kidney and forms the salts there with Ca++
thus any disorder with low fat absorption and high fats in the bowels have a high risk of kidney stones since they can't absorb the oxalate
oxalate is high in spinach
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Malabsorption of Fat Soluble Vitamins in Crohn's disease
Fat soluble Vit = ADEK
these can give fatigue generally due to low nutrients
Vit K in particular is a major clotting cofactor
--> Factors 2,7,9,10
--> presents with easy bruising = echymoses
*Ulcerative Colitis
colon ONLY
LARGE risk in developing cancer
Treatment
Moderate-->Severe IBD
sulfasalazine
Mild/Maintenance
mesalazine
--> pro-drug activated by gut bacteria
--> 5 - Aminosalicylic acid (5-ASA) metabolite
gives anti-inflammatory effect
--> COX1, IL-1,TNF-Alpha
Signs and Symptoms
Histology
Rectal Bleeding
Ulcers --> pseudopolyps
inflammation only in mucosa
--> HORIZONTAL LARGE type ulcers
Ulcers --> wider lumen
Continuous --> NO Skip Lesions
always begins in the rectum and moves up colon
Clinical
cramps
abdominal pain
bloody and stringy mucus stool
*DIRTY USMLE
IBDs = CD and UC
*CD
*UC
CD
Skip lesions
mouth to anus
UC
ulcerative = only superficial ulcers
pseudopolyps
UC
ulcerative = lose haustra
lead pipe
CD
transmural
creeping fat + thickenned bowel wall
string sign
CD
TH1 cells
thick due to NON CASE
GRANULOMAS
UC
UC CRYPT ABCECSSES
CD
CD = SKIP = C ASCA
UC
UC = Pseudo = P ANCA
AZIZ for PrPP
6M car with ALLO for a BOOST
Purine synthesis
allopurinol gives toxicity
--> DISinhibition of the inhibitor XO
INFLIXIMAB = Tinfliximab A
TNF - alpha
SULFASALZINE for UC and CD
recall SULFA DRUGS
SCARY SULFA PHARM FACTS
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