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Questions and Answers
Which of the following is a characteristic of Crohn disease?
Which of the following is a characteristic of Crohn disease?
- Submucosa is primarily affected
- Always involves the rectum
- Can affect any part of the GI tract (correct)
- Affects only the mucosa layer of the colon
Ulcerative colitis can lead to fibrotic strictures.
Ulcerative colitis can lead to fibrotic strictures.
False (B)
What inflammatory conditions are included under the term inflammatory bowel disease (IBD)?
What inflammatory conditions are included under the term inflammatory bowel disease (IBD)?
Ulcerative colitis and Crohn disease
The inflammatory process of ulcerative colitis usually begins at the ______.
The inflammatory process of ulcerative colitis usually begins at the ______.
Match the disease with its characteristic feature:
Match the disease with its characteristic feature:
Which statement correctly describes the incidence rates in North America for ulcerative colitis?
Which statement correctly describes the incidence rates in North America for ulcerative colitis?
Approximately 3 million adults in the United States have either ulcerative colitis or Crohn disease.
Approximately 3 million adults in the United States have either ulcerative colitis or Crohn disease.
What happens to the mucosa in patients with ulcerative colitis?
What happens to the mucosa in patients with ulcerative colitis?
Which of the following is a common complication associated with Crohn's disease?
Which of the following is a common complication associated with Crohn's disease?
Crohn's disease results in continuous inflammation throughout the affected bowel regions.
Crohn's disease results in continuous inflammation throughout the affected bowel regions.
What is the appearance of the bowel lumen in Crohn's disease due to fissures and ulcers?
What is the appearance of the bowel lumen in Crohn's disease due to fissures and ulcers?
The initial lesions in Crohn's disease may regress or progress to involve all __________ of the intestinal wall.
The initial lesions in Crohn's disease may regress or progress to involve all __________ of the intestinal wall.
Match the type of fistula with its description:
Match the type of fistula with its description:
Which nutrient absorption may be impaired when the jejunum and ileum are affected in Crohn's disease?
Which nutrient absorption may be impaired when the jejunum and ileum are affected in Crohn's disease?
Smoking is associated with an increased risk of developing ulcerative colitis.
Smoking is associated with an increased risk of developing ulcerative colitis.
What age group typically experiences the onset of Crohn's disease?
What age group typically experiences the onset of Crohn's disease?
Fibrotic changes in the bowel wall lead to a __________ appearance as it becomes thickened and less flexible.
Fibrotic changes in the bowel wall lead to a __________ appearance as it becomes thickened and less flexible.
What role do genetic and environmental factors play in inflammatory bowel disease (IBD)?
What role do genetic and environmental factors play in inflammatory bowel disease (IBD)?
Which statement accurately describes mild ulcerative colitis (UC)?
Which statement accurately describes mild ulcerative colitis (UC)?
Patients with moderate UC may experience severe anemia requiring blood transfusions.
Patients with moderate UC may experience severe anemia requiring blood transfusions.
What is considered a hallmark of severe ulcerative colitis?
What is considered a hallmark of severe ulcerative colitis?
In mild ulcerative colitis, there are usually ______ stools per day.
In mild ulcerative colitis, there are usually ______ stools per day.
Match the level of ulcerative colitis severity with its characteristics:
Match the level of ulcerative colitis severity with its characteristics:
What is a common feature of Ulcerative Colitis regarding stool characteristics?
What is a common feature of Ulcerative Colitis regarding stool characteristics?
Crohn's disease usually involves continuous inflammation throughout the affected bowel regions.
Crohn's disease usually involves continuous inflammation throughout the affected bowel regions.
What area of the bowel is primarily affected by Ulcerative Colitis?
What area of the bowel is primarily affected by Ulcerative Colitis?
The depth of involvement in Crohn's disease is ______.
The depth of involvement in Crohn's disease is ______.
Match the following symptoms with the respective inflammatory bowel disease:
Match the following symptoms with the respective inflammatory bowel disease:
What possible complications are associated with Crohn's disease?
What possible complications are associated with Crohn's disease?
Both Ulcerative Colitis and Crohn Disease have similar nutritional deficits.
Both Ulcerative Colitis and Crohn Disease have similar nutritional deficits.
During what age range do Ulcerative Colitis and Crohn Disease typically peak?
During what age range do Ulcerative Colitis and Crohn Disease typically peak?
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Study Notes
Inflammatory Bowel Disease (IBD)
- An umbrella term for two chronic inflammatory conditions of the intestines: Ulcerative Colitis (UC) and Crohn’s Disease
- Approximately 3 million adults in the US have either UC or Crohn's Disease.
- Affects the mucosa layer of the colon and almost always includes the rectum (UC)
- Affects any portion of the GI tract from the mouth to the anus (Crohn's Disease)
- Can lead to fibrotic strictures, micropermutations, and fistulas (Crohn’s Disease)
Ulcerative Colitis (UC)
- Remitting and relapsing inflammatory process
- Usually begins at the rectosigmoid area of the anal canal and progresses proximally
- Inflammation at the base of the crypts of Lieberkühn in the distal large intestine and rectal mucosa
- Leads to necrosis and sloughing of bowel mucosa
- Mucosa becomes red and edematous, friable, and ulcerated
- Chronic inflammation leads to atrophy, narrowing, and shortening of the colon
Crohn's Disease
- Transmural inflammatory disease
- Typically begins as a small inflammatory aphthoid lesion of the mucosa and submucosa
- Deeper ulcerations, granulomatous lesions, and fissures develop
- Inflammatory process involves the entire bowel wall
- Lumen of the affected bowel assumes a cobblestone appearance
- Inflammatory lesions are not continuous; “skip” lesions occur, with intervening areas of normal-appearing bowel
- Fibrotic changes in the bowel wall cause it to thicken and lose flexibility
- Can lead to local obstruction, the development of abscesses, and the formation of fistulas
Etiology
- Cause is unknown
- Genetic and environmental factors are implicated
- Infectious agents and altered immune responses thought to play a role
- Autoimmunity thought to play a role
- Lifestyle factors, like smoking, may affect development
Risk Factors
- Age: Usually between 15 and 30 years of age, and possibly another peak between 50 and 80
- White populations have a higher rate of both Crohn disease and UC
- Smoking can increase the risk of developing Crohn's Disease
- Lack of physical activity can increase the risk of Crohn's Disease
- High-fiber diets seem to lower the risk of Crohn's Disease
- Previous antibiotic use increases the risk of Crohn's Disease
Prevention
- No specific recommendations for prevention
- A healthy lifestyle including physical activity, adequate sleep, and a healthy diet is advised
Inflammatory Bowel Disease
- Ulcerative colitis (UC) and Crohn’s disease (CD) present with similar clinical manifestations but differ in their presentation.
- Both UC and CD involve periods of remission with sporadic periods of active disease (flare-ups).
Ulcerative Colitis
- The predominant manifestation of UC is diarrhea.
- UC severity is defined as:
- Mild UC: Patients experience up to 4 stools per day with or without small amounts of blood, no systemic toxicity, normal CRP and ESR. Mild cramping, tenesmus, and constipation are common.
- Moderate UC: Patients experience frequent loose, bloody stools (4-6 per day), mild anemia, abdominal pain that is not severe. No or minimal systemic toxicity.
- Severe UC: Patients experience frequent loose, bloody stools (6 or more per day), severe cramps and evidence of systemic toxicity: fever (temperature ≥ 37.8 °C), tachycardia (heart rate ≥ 90 beats per minute), anemia (hemoglobin <10 g/dL), and weight loss.
Crohn's Disease
- CD and UC patients experience similar symptom patterns - with remissions and flare-ups.
- Diarrhea is common, but usually less severe than UC with no obvious blood or mucus in stool.
- Abdominal pain is cramping or steady in the right lower quadrant (RLQ), and periumbilical pain. Tenderness and mass may be noted in the RLQ.
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