Inflammatory Bowel Disease (IBD): a chronic condition resulting from inappropriate mucosal activation 2 types CROHNS DISEASE and

ULCERATIVE COLITIS -Differentiate b/w ulcerative colitis and crohns disease based on the distribution of affected sites and the morphologic expression of disease at those sites PATHOGENESIS: - NOD2 as a susceptibility gene in crohns -NOD2, ATG16L1, and IRGM support the hypothesis that inappropriate immune rxns to luminal bacteria are an important component of IBD pathogenesis -defects in intestinal epithelial tight junction barrier function are present in Crohn disease patients -Defects in the extracellular barrier formed by secreted mucin may also contribute -the Paneth cell granules, which contain antibacterial peptides termed defensins, are abnormal in Crohn disease patients carrying ATG16L1 mutations -REVIEW HOST IMMUNE REACTIVITY p-ANCA; ASCA-ab (saccromycese cerevisae) -Ulcerative colitis: A severe ulcerating inflammatory disease that is limited to the colon and rectum and extends only into the mucosa and submucosa -Crohns disease: (aka regional enteritis) may involve any area of the GI tract and is typically transmural (frequently involves the ileum) -can have anal-rectal/peri-anal fistulas

Crohns disease -sharply delineated affected bowel segments w/presence of skip lesions -ileum and colon (50%) -terminal ileum alone (30%) -colon alone (20%) 1. serosa is granular, dull gray 2. mesenteric fat wraps around the bowel surface (creeping fat) 3. intestinal wall is rubbery and thick (edema, inflammation, fibrosis, and hypertrophy of muscularis propria) 4. lumen is narrowed (string sign) 5. mucosal ulcers (aphtous ulcers) 6. deep linear ulcers, fissures 7. cobblestone appearance -transmural inflammation affecting all layers -noncaseating granulomas -mucosal inflammation and chronic mucosal damage -cryptitis, crypt abscesses and crypt distortion

Ulcerative colitis -extends in a continuous fashion proximally from the rectum 1. serosal surface usually normal 2. no mural thickening (severe cases toxic damage to muscularis propria & neural plexus colon progressively swells and becomes gangrenous [toxic megacolon]) 3. continous involvement 4. mucosa shows reddening, friability and ulceration 5. pseudopolyps isolated islands of regenerating mucosa bulging upward -ulcers and crpyt abscesses containing neutrophil -spectrum of epithelial changes signifying dysplasia or cancer

CROHNS DISEASE -begins with intermittent attacks of relatively mild diarrhea, fever, and abdominal pain - periods of active disease are typically interrupted by asymptomatic periods that last for weeks to many months -smoking is a strong exogenous risk factor -extraintestinal manifestations uveitis, migratory polyarthritis, sacroiliitis, ankylosing spondylitis, erythema nodosum, and clubbing of the fingertips, any of which may develop before intestinal disease is recognized. -RARELY BLEEDS

ULCERATIVE COLITIS -A relapsing disorder characterized by attacks of bloody diarrhea with stringy, mucoid material, lower abdominal pain, and cramps that are temporarily relieved by defecation. - symptoms may persist for days, weeks, or months before they subside -common extra-intestinal manifestations overlap with those of Crohns disease and include migratory polyarthritis, sacroiliitis, ankylosing spondylitis, uveitis, skin lesions, and primary sclerosing cholangitis