Pathology of Inflammatory Bowel Disease fsm.ac.fj

'Happiness lies in the joy of achievement and the thrill of creative effort.‘ – less in the actual result..! --Franklin D. Roosevelt Pathology Series: Inflammatory Bowel Diseases: Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine. IBD - 3 Introduction Relapsing, Inflammtory Chronic, Bowel Disorders of ? etiology.  Ulcerative Colitis & Crohn’s Disease.  Any part of GIT. Colon & Ileum common.  Ending in inflammatory damage  Extra-intestinal manifestations.  Late complications include malignancy. Shashi-Apr-08 IBD - 4 Aetiology: Aetiology??  Familial, but no genetic evidence.  Infective etiology – ParaTB, Measles etc.  HLA Association is different – diff disorders?  Altered host immune response. - Crohn’s disease – DR1  Non-granulomatous - Ulcerative Colitis – DR2  Granulomatous Shashi-Apr-08  Ideopathic. IBD - 5 Crohn’s Disease: Terminal ileitis, Regional enteritis, Granulomatous colitis. Western countries, any age (teen), Females. Any part of Intestines can be affected. Patchy, transmural, granulomatous, Inflam. skip lesions - Intervening normal areas. Fissuring and fistulas. Shashi-Apr-08     1. 2. 3. IBD - 6 Crohn’s Disease: Shashi-Apr-08 IBD - 7 Linear ulcers and skip lesions in Crohn’s disease. Skip lesion Linear ulcer Shashi-Apr-08 IBD - 8 Fissuring, linear ulcers in Crohn’s Disease. Shashi-Apr-08 IBD - 9 Granulomas are often seen in Crohn’s disease, but not in ulcerative colitis. Shashi-Apr-08 IBD - 10 Crohn’s Disease: Morphology Intestine common (40, 30, 30%)  Rubbery thick walled with narrow lumen.  String sign – X-Ray  Small Shashi-Apr-08 IBD - 11 Ulcerative Colitis: in Rectum spreads up – continuous  Backwash ileitis – in severe pan colitis  Crypt abscess – common but not specific.  Pseudo polyps – edematous intact mucosa  Inflammation limits to mucosa – Serosa normal  No thickening – no narrowing  Toxic damage to muscular layer may lead to  Toxic Megacolon – dilated, stasis, gangrene.  Starts Shashi-Apr-08 Ulcerative Colitis IBD - 13 Diffuse mucosal friability in ulcerative colitis. Shashi-Apr-08 IBD - 14 Ulcerative colitis: Band-like lymphoplasmacytic infiltrate, glandular distortion, and crypt abscesses Shashi-Apr-08 IBD - 15 Ulcerative colitis: inflammatory pseudopolyps and Inflammation limited to the mucosa. Shashi-Apr-08 IBD - 16 Crypt abscesses in ulcerative colitis. Shashi-Apr-08 Ulcerative Colitis Ulcerative Colitis Crohn’s Disease Crohn’s & Ulcerative Colitis Small Intestine  Skip Lesions  Full thickness  Narrow lumen  Granulomatous infl.  Large Intestine  Continuous, Mucosal  Thin wall  Dilatation.  IBD - 21 Crohns - vs - U. Colitis:         Fibrous, granulomatous Thick wall, narrow lumen. Transmural – full thick. Skip Lesions common Acute inflammation Mainly mucosal Ulceration, dilated lumen. Continuous lesion Shashi-Apr-08 IBD - 22 Crohns - U. Colitis: Shashi-Apr-08 IBD - 23 Histopathology: Normal/UC Shashi-Apr-08 IBD - 24 Histopathology: Normal/UC Shashi-Apr-08 IBD - 25 Complications vitamin/fat - CD  Fluid & Blood loss, Medical emergency.  Toxic megacolon – Surgical emergency.  Dysplasia & Carcinoma – pancolitis >10years  Malabsorption, Shashi-Apr-08 UC-Toxic Megacolon: Gangrene  Carcinoma: IBD - 28 Conclusions: Relapsing, Inflammatory - Ideopathic  Ulcerative Colitis -Rectum, Mucosal, acute infl, dilated, thin wall.  Pseudopolyp, dilatation, toxic megacolon, Malabsorption, malignancy,  Crohn’s Disease - Ileum, full thick, granulomatous, narrow lu.  Obstruction, Skip lesions, string sign, fissures fistulas, sinuses, malabsorption, malignancy. Shashi-Apr-08  Chronic, IBD - 29 "Painful as it may be, a significant emotional event can be the catalyst for choosing a direction that serves us and those around us – more effectively. Look for the learning." Eric Allenbaugh Author of "Wake-Up Calls" Shashi-Apr-08