Questions and Answers
Which of the following is a characteristic feature of ulcerative colitis?
The primary lesion begins with inflammation at the base of the crypt of Lieberkühn
What is a common extraintestinal manifestation of ulcerative colitis?
Cutaneous lesions
Which complication is associated with long-standing ulcerative colitis?
Increased risk of colon cancer
What is the recommended approach for detecting dysplasia and colorectal cancer in long-standing ulcerative colitis?
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What is the primary location of ulceration in ulcerative colitis?
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Which of the following is a symptom of severe ulcerative colitis?
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What is the primary factor leading to damage of the epithelial mucosal barrier in ulcerative colitis?
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In which type of UC does the disease involve less mucosa and may be limited to proctitis?
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What is the basis for the diagnosis of ulcerative colitis?
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Which gene mutation has the strongest association with Crohn disease?
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What is the most common site of Crohn disease?
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Which cytokines are associated with Th1-mediated inflammation in Crohn disease?
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What is a risk factor for Crohn disease?
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Which type of lesions are characteristic of Crohn disease?
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What is a potential extraintestinal manifestation of Crohn disease?
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What is a common clinical manifestation of Crohn disease?
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What can surgical resection of small intestinal segments for Crohn disease lead to?
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What is a component of Crohn disease therapy?
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What should be performed for long-standing Crohn disease?
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Which of the following is a potential consequence of unknown environmental factors or infections in inflammatory bowel disease?
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Which proinflammatory molecule is involved in damaging the intestinal epithelium in inflammatory bowel disease?
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After how many years of inflammatory bowel disease does the risk of colon cancer significantly increase?
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What is the estimated prevalence of inflammatory bowel disease in the United States?
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Which population shows a higher prevalence of inflammatory bowel disease?
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What is thought to activate dendritic cells in response to inflammatory bowel disease?
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Which type of cells are triggered to transport to mesenteric lymph nodes in response to inflammatory bowel disease?
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What is the primary factor thought to lead to damage of the epithelial mucosal barrier in inflammatory bowel disease?
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Which immune response cells are involved in damaging the intestinal epithelium in inflammatory bowel disease?
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Study Notes
Crohn Disease Overview and Management
- Crohn disease is an idiopathic inflammatory disorder affecting any part of the gastrointestinal tract and involves "skip lesions" with inflamed areas mixed with uninflamed areas, noncaseating granulomas, fistulas, and deep penetrating ulcers.
- Risk factors for Crohn disease include family history, cigarette smoking, Jewish ethnicity, urban residency, age less than 40 years, and an altered gut microbiome.
- The CARD15/NOD2 gene mutations have the strongest association with Crohn disease, although many other genes have been identified, and their mutation may promote dysbiosis and reduced levels of defensins.
- Th1-mediated inflammation with activation of TNF-α, IFN-γ, IL-12, and Th17-associated cytokines causes mucosal injury in Crohn disease.
- Inflammatory lesions begin in the intestinal submucosa and spread with discontinuous transmural involvement, and the ascending colon and the transverse colon are the most common sites of the disease.
- Clinical manifestations of Crohn disease include diarrhea, rectal bleeding, anemia, malabsorption of vitamin B12, deficiencies in folic acid, vitamin D absorption, and calcium, weight loss, and anal manifestations.
- Individuals with Crohn disease are at risk for intestinal adenocarcinoma and extraintestinal manifestations such as arthropathies, skin, oral, and ocular lesions.
- Diagnosis and treatment of Crohn disease involve imaging of the small intestine, corticosteroids, 5-aminosalicylates, immunomodulatory agents, and new biologic agents under development.
- Smoking cessation is a component of Crohn disease therapy, and surgery is generally performed to manage complications or to relieve obstruction.
- Surgical resection of small intestinal segments for Crohn disease can lead to complications related to short bowel syndrome, including malabsorption, diarrhea, and nutritional deficiencies.
- Cancer screening should be performed for long-standing Crohn disease.
- Crohn Disease can be evaluated through endoscopic imaging techniques to detect dysplasia and colorectal cancer with long-standing disease.
