cueFlash

Glossary of Gastrointestinal path, phys, and pharm

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What are the features of ulcerative colitis?
Limited to colon (except backwash into the ileum)
Limited to mucosa
Begins at rectum, progresses continuously and proximally

What is this process?
Acute viral hepatitis
What are the intestinal manifestations of UC?
Blood and mucus in stool
Cramping is WORSE with passage of stool
Pain more common in LLQ
Tenesmus while there isn't anything in rectum (feeling is from inflammation)

What process is this?
Coagulative necrosis (from toxic injury)
What is cirrhosis?
A diffuse process throughout the liver in which nodules of regenerating hepatocytes are surrounded by bands of fibrosis
What are the biopsy findings of UC?
Crypt distortion (not unique to UC), Acute and chronic infiltrate of PMN’s and lymphocytes

What condition of the liver is this?
Cirrhosis

What disease is this?
Ulcerative colitis - notice the inflammatory cells in the mucosa.
Crypts are sparse and branching.
Crypt abscesses
What is mallory hyaline?
A dense condensation of cytoskeletal proteins in the cytoplasm of hepatocytes
What are the systemic complications of UC?
episcleritis, uveitis, eythema nodosum, pyoderma gangrenosum, peripheral arthritis (seronegative), ankylosing spondylitis and sacro-iliits, sclerosing cholangitis, cholangiocarcinoma

What liver pathology is this?
Steatosis
What are the features of Crohn's disease?
Involves any part of the GI tract
May be skip lesions
Can be transmural
GRANULOMA is pathognomonic, but not sine qua non

What liver pathology is represented by the cell in the center?
Mallory hyaline
What are the intestinal manifestations of Crohn's Disease?
Depend on location, extent, and severity
Pain may be periumbilical or RLQ
Inflammatory mass may be palpated
Nausea/vomiting if in stomach or duodenum, also early satiety, epigastric pain, dysphagia
Perianal skin tags, fissures, fistulae
Increased pain, distension, borboyrgmi are signs of stenosis and obstruction

What type of cells are these?
Acidophils - apoptotic hepatocytes
What are linear ulcers indicative of?
Crohn's

What are the big, pale cells?
Ballooning degeneration

What disease is this?
Crohn's (see granuloma, significant inflammation of all layers
What are systemic complications of small bowel syndrome?
Gallstones, malabsorption, fatty diarrhea, oxalate stones in kidney

What does this slide show?
Dysplasia (big, disorganized nuclei)
And frank cancer
What is the potential pathogenesis of IBD?
Inappropriate activation of mucosal immune system
Caused by autoimmunity to luminal or mucosal antigen? Response to normal flora?
Dysfunctional suppressor T cells
Inability to mount reciprocal cytokine response
Infection
Genetic and environmental contributants
What are the specific aspects of the pathogenesis of Crohn's disease?
Cell-mediated! -Macrophages and dendritic cells
Induced by Th1 cells --> IFN-g, TNF-a, IL-12
What are the specific aspects of the pathogenesis of ulcerative colitis?
Humoral! Autoantigens cross-react with bacterial Ags from normal flora
Lack of regulatory cells
Excess CD4 effector cells
Th2 response
pANCA in 70%
What is the stepwise approach for treatment of IBD?
1. Aminosalicylates (5-ASA)
2. Corticosteroids
3. Immunomodulatory (6-MP + azothiaprine)
4. Infliximab (for CD)
5. Other agents that sometimes work (methotrexate, cyclosporine)
there is no question here
Thank God.

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