Crohn's Disease Pathophysiology

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Questions and Answers

Which of the following mechanisms contributes to the pathogenesis of Crohn's disease?

  • Innate immune response activation due to increased NOD2 function.
  • Th2 T-cell mediated activation of eosinophils.
  • Th1 T-cell and cytokine mediated chronic inflammation. (correct)
  • Decreased adaptive immune response due to NOD2 mutation.

What is the role of the NOD2 receptor in the context of Crohn's disease pathophysiology?

  • It directly activates the adaptive immune response, leading to increased inflammation.
  • It inhibits the release of pro-inflammatory cytokines, suppressing the inflammatory response.
  • It binds to lipopolysaccharide (LPS), leading to NF-kB pathway activation. (correct)
  • It triggers the formation of caseating granulomas in the affected tissues.

Which of the following is a characteristic distribution pattern of lesions in Crohn's disease?

  • Patchy inflammation known as 'skip' lesions occurring anywhere from the mouth to the anus. (correct)
  • Continuous inflammation extending from the rectum proximally.
  • Confined inflammation primarily affecting the stomach and duodenum.
  • Uniform inflammation of the colon, sparing the terminal ileum.

Which of the following complications arises directly from transmural inflammation in Crohn's disease?

<p>Epithelialization across the bowel wall leading to sinus tract formation and fistulas. (B)</p> Signup and view all the answers

What are the expected long-term consequences of chronic inflammation in Crohn's disease?

<p>Fibrosis, wall thickening, and narrowed lumen. (C)</p> Signup and view all the answers

Which of the following factors is known to increase the risk of developing Crohn's disease?

<p>Smoking. (A)</p> Signup and view all the answers

A patient with Crohn's disease presents with RLQ pain and chronic diarrhea. What other symptom is closely associated with malabsorption in Crohn's disease?

<p>Vitamin B12 deficiency. (B)</p> Signup and view all the answers

Which of the following extraintestinal manifestations is commonly associated with Crohn's disease?

<p>Uveitis (A)</p> Signup and view all the answers

What hepatobiliary complication are patients with Crohn's disease at an increased risk of developing?

<p>Gallstones (C)</p> Signup and view all the answers

Which of the following histological findings is characteristic of Crohn's disease?

<p>Lymphoid aggregates and noncaseating granulomas (A)</p> Signup and view all the answers

Which of the following serological markers is most specific for Crohn's disease?

<p>Positive anti-Saccharomyces cerevisiae antibodies (ASCA) (A)</p> Signup and view all the answers

What would be a key finding on imaging, particularly on X-ray, suggestive of Crohn's disease?

<p>&quot;String&quot; sign (C)</p> Signup and view all the answers

What endoscopic finding is characterized by the appearance of normal mucosa surrounded by areas of inflammation?

<p>&quot;Cobblestone&quot; mucosa (C)</p> Signup and view all the answers

Which class of medications is often the first-line treatment to induce remission in Crohn's disease?

<p>Corticosteroids. (B)</p> Signup and view all the answers

Which of the following drug classes directly targets TNF-α to reduce inflammation in Crohn's disease?

<p>TNF-α inhibitors (C)</p> Signup and view all the answers

What is a potential long-term complication following surgical resection (colectomy/ileectomy) for Crohn's disease?

<p>Short bowel syndrome. (A)</p> Signup and view all the answers

Which of the following statements best describes the mechanism of action of 5-ASA preparations like mesalamine and sulfasalazine in managing Crohn's disease?

<p>They suppress the production of inflammatory cytokines, reducing inflammation in the gut lining. (A)</p> Signup and view all the answers

What is the primary mechanism by which immunosuppressors like azathioprine and 6-mercaptopurine help manage Crohn's disease?

<p>Suppressing the immune system's activity to reduce inflammation. (B)</p> Signup and view all the answers

What is the significance of elevated fecal calprotectin and lactoferrin levels in the context of Crohn's disease diagnostics?

<p>They suggest active intestinal inflammation. (D)</p> Signup and view all the answers

A patient with Crohn's disease has developed an enteroenteric fistula. What does this complication involve?

<p>An abnormal connection between two parts of the intestine. (C)</p> Signup and view all the answers

Flashcards

Crohn's Disease Pathophysiology

Th1 T-cell and cytokine mediated chronic inflammation. Mutation in NOD2 leads to decreased innate immunity and increased adaptive immunity.

NOD2 Receptor Role

Receptor that binds lipopolysaccharide (LPS), activating the NF-kB pathway. Mutation leads to increased adaptive immune response in Crohn's.

"Skip" Lesions

Discontinuous areas of inflammation occurring anywhere from mouth to anus, commonly in the terminal ileum.

Fibrosis and Wall Thickening in Crohn's

Chronic inflammation leading to fibrosis and wall thickening, resulting in a narrowed lumen.

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Transmural Inflammation

Inflammation that extends through the entire bowel wall, potentially creating sinus tracts and fistulas.

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Crohn's Disease Presentation

Presents with RLQ pain, chronic diarrhea, abscesses, and malabsorption of B12 and fat-soluble vitamins.

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Fistulas in Crohn's Disease

Abnormal passages that form between the intestine and other organs or skin surfaces.

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Extraintestinal Manifestations of Crohn's

Uveitis, arthritis, erythema nodosum, and pyoderma gangrenosum. Also: perianal disease, gallstones, nephrolithiasis, and increased risk of colorectal cancer.

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Histological Findings of Crohn's

Include lymphoid aggregates and noncaseating granulomas.

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Positive ASCA

Presence of anti-Saccharomyces cerevisiae antibodies (ASCA).

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Lab Findings in Crohn's

Elevated ESR, CRP, fecal calprotectin, and fecal lactoferrin

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"String" Sign

Represents narrowing of the intestinal lumen on X-ray.

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Medical Management of Crohn's

Treatment involves corticosteroids, TNF-⍺ inhibitors (Infliximab, adalimumab), 5-ASA preparations (Mesalamine, sulfasalazine), and immunosuppressors (Azathioprine/6-mercaptopurine).

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Surgical Management of Crohn's

Colectomy or ileectomy may be necessary, potentially leading to short bowel syndrome.

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Study Notes

  • Crohn's disease pathophysiology involves Th1 T-cell and cytokine-mediated chronic inflammation.
  • A mutation in NOD2 leads to decreased innate immune response and increased adaptive immune response.
  • The NOD2 receptor binds lipopolysaccharide (LPS), activating the NF-kB pathway.
  • Skip lesions can occur anywhere from the mouth to the anus.
  • The terminal ileum is the most commonly affected location.
  • The rectum and stomach are less common sites for Crohn's disease.
  • Chronic inflammation results in fibrosis and wall thickening, leading to a narrowed lumen.
  • Transmural inflammation leads to epithelialization across the bowel wall, forming sinus tracts and fistulas.
  • Smoking and HLA-B27 increase the risk of Crohn's disease.

Presentation

  • Patients may experience RLQ pain, chronic diarrhea, and abscesses.
  • Malabsorption of B12 and fat-soluble vitamins can occur.
  • Fistulas can be enteroenteric, enterocutaneous, or enterovesical.
  • Extraintestinal manifestations include uveitis, arthritis, erythema nodosum, and pyoderma gangrenosum.
  • Other presentations include perianal disease, gallstones, nephrolithiasis, and increased risk for colorectal cancer.

Diagnostics

  • Histology reveals lymphoid aggregates and noncaseating granulomas.
  • Anti-Saccharomyces cerevisiae antibodies (ASCA) are often positive.
  • Elevated ESR, CRP, fecal calprotectin, and fecal lactoferrin are common.
  • A "string" sign may be visible on X-ray.
  • "Knife-like" fissures, creeping fat, and cobblestone mucosa can be observed.

Management

  • Corticosteroids and TNF-⍺ inhibitors (Infliximab, adalimumab) can be used.
  • 5-ASA preparations (Mesalamine, sulfasalazine) are treatment options.
  • Immunosuppressors like Azathioprine/6-mercaptopurine might be prescribed.
  • Colectomy or ileectomy may be necessary, potentially leading to short bowel syndrome.

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