Please enable JavaScript.
Coggle requires JavaScript to display documents.
Inflammatory Bowel Disease - Coggle Diagram
Inflammatory Bowel Disease
Imaging
Modalities
Plain Film
Supine and upright
Rule out toxic megacolon, bowel obstruction, pneumoperitoneum
Enema
Water soluble for Perforation/leak
Single contrast barium enema for mechanical obstruction vs pseudo-obstruction
Limited double contrast barium enema (obsolete)
CT enterography, MRI Enterography
Ingest large volume of oral contrast distend small bowel to find complications
CT Colonography
Find polyps, and colon cancer
Ulcerative Colitis
Proximal extension from colon, no skip lesions, "lead pipe" appearance
CT
Colon wall thickening
Crohn's
Frequently in terminal ileu
Fistula, sinus tract, abscess
Skip lesions
Layered appearance of bowel wall, submucosal edema (target sign)
Sacroilitis
Perianal Fistula
Toxic Megacolon
Perforatiion
Dilated colon with thumb printing
Pathology
Acute Colitis
Crypt Abscess
Chronic Colitis
Crypt architectural distortion, plasmacytosis
Metaplasia
Pyloric Gland Metaplasia
Paneth Cell metaplasia
Basal Plasmacytosis
Granulomas
Ulcerative Colitis
Rectum is always involved, proximal from rectum, sharp transition between diseased and normal colon, many pseudopolyps or inflammatory polyps
Microscopic Features
Inflammation limited to mucosa, surface ulcerations
Crohn's Disease
Relatively normal rectum (thick walled colon/bowel), fistula tracts, intramural abscesses, kinking of bowel loops
Fat Wrapping
Bear Claw Ulcers
Fissuring Ulcers
Ulcerative Colitis
Characteristics
Inflammatory Disease involving large intestine (never small)
Continuous Inflammation starting at rectum
Bleeding more common, better with smoking, surgery is curative
Crohn's Disease
Characteristics
Can Affect any part of GI Tract, patchy disease that penetrates lining of GI tract and lead to fistulas/perforations
Fistulas, Focal Lesions, Granuloma, Strictures, Skip lesions, rectal sparing
Transmural Inflammation, weight loss and pain more common, worse with smoking, surgery is non curative
General IBD Characteristics
Impaired Barrier Function and aberrant immune response
Imbalance of Effector and Regulatory T Cells leads to mucosal damage
Extra-intestinal Manifestations
Occular inflammation, Oral ulceration, Primary sclerosing cholagitis, Erythema nodusum, Pyodema Gangrenosum, Peripheral and axial arthropathy, sacrillitis
Complications
Toxic Megacolon, Obstruction Fistulae Abscess (Crohns), Metabolic bone disease, Kidney stones
Diagnosis
Clinical Symptoms, Lab findings (CRP, ESR, ASCA, ANCA, Stool inflammatory markers), Diagnostic imaging, Endoscopy (Colonoscopy/flexible sigmoidoscopy), EGD
Treatment
Goals: Histological remission, mucosal healing, steroid-free remission, clinical remission, improved symptoms
Budesonide -> MTZ, AZA/6-MP, Systemic Steroids -> Surgery, Biologics, JAK inhibitors
Microscopic Colitis
Pathogenesis
Unkknonw, likely inflammatory diorder from epitheliual immune response
Clinical Features
Chronic watery, non blood diarrhea, abdominal cramps, bloating, fecal incontinence, diarrhea fluctuates with remissions and exacerbations
Lymphocytic Colitis
Diagnosis Requirements
Increase intraepithelial lymphocytes, 20/100 epihtelial cells, lamina propria contained increased immune cells
Collagenous Colitis
Diagnosis Criteria
Broad, eosinophillic, collagten band below surface epithelium, intraepithelial lymphocytosis
Treatment
Budesonide, antidiarrheal agents, bulking agents, bismuth, bile acid resins, 5-asa
Ischemic Colitis
Pathophysiology
Occurs when not enough oxygen/nutrients for cellular integrity (hypotension, decrease CO)
Clinical Features
Painful lower GI bleed, sudden abdominal pain, bright red blood per rectum
Diagnosis
Low Hb, albmin, Metabolic acidosis, high wbc/BUN/lactate dehydrogenase
Imaging
Air in wall of ascending colon
Thumbprinting in transverse colon
Pathology
Hemorrhagic Mucosa
Pseudomembrane composed of mucin, PMN, fibrin