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382 seCtion iii Gastrointestinal ` gastrointestinal—PatHology Gastrointestinal ` gastrointestinal—PatHology
Inflammatory bowel diseases
Crohn disease Ulcerative colitis
loCation Any portion of the GI tract, usually the terminal Colitis = colon inflammation. Continuous
ileum and colon. Skip lesions, rectal sparing. colonic lesions, always with rectal involvement.
gross morPHology Transmural inflammation fistulas. Mucosal and submucosal inflammation only.
Cobblestone mucosa, creeping fat, bowel wall Friable mucosa with superficial and/or
thickening (“string sign” on barium swallow deep ulcerations (compare normal B with
x-ray A ), linear ulcers, fissures. diseased C ). Loss of haustra “lead pipe”
appearance on imaging.
miCrosCoPiC morPHology Noncaseating granulomas and lymphoid Crypt abscesses and ulcers, bleeding, no
aggregates. Th1 mediated. granulomas. Th2 mediated.
ComPliCations Malabsorption/malnutrition, colorectal cancer ( risk with pancolitis).
Fistulas (eg, enterovesical fistulae, which can Fulminant colitis, toxic megacolon, perforation.
cause recurrent UTI and pneumaturia),
phlegmon/abscess, strictures (causing
obstruction), perianal disease.
intestinal maniFestation Diarrhea that may or may not be bloody. Bloody diarrhea.
eXtraintestinal maniFestations Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral
ulcerations (aphthous stomatitis), arthritis (peripheral, spondylitis).
Kidney stones (usually calcium oxalate), 1° sclerosing cholangitis. Associated with
gallstones. May be ⊕ for anti-Saccharomyces p-ANCA.
cerevisiae antibodies (ASCA).
treatment Corticosteroids, azathioprine, antibiotics (eg, 5-aminosalicylic preparations (eg, mesalamine),
ciprofloxacin, metronidazole), biologics (eg, 6-mercaptopurine, infliximab, colectomy.
infliximab, adalimumab).
For Crohn, think of a fat granny and an old Ulcerative colitis causes ULCCCERS:
crone skipping down a cobblestone road away Ulcers
from the wreck (rectal sparing). Large intestine
Stones are more common in Crohns. Continuous, Colorectal carcinoma, Crypt
abscesses
Extends proximally
Red diarrhea
Sclerosing cholangitis
A B C
Normal
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