1P.

01
SEPTEMBER
01,2021
TOPIC NAME
DR. COMPLETE NAME

Lymphoid aggregates
TOPICULCERATIVE
OUTLINE (CENTURY
COLITISGOTHIC, 9.0, CENTER)
VS CHRON’S DISEASE
I. TOPIC 1 (MAIN II. TOPIC 2 (MAIN Crypt abscesses
HEADING) HEADING) Crypt abscesses
A. Subheading MUST KNOWS:
A. Subheading
UC: Backwash ileitis
1. Sub-subheading 1. Sub-subheading CD: Creeping fat
B. Subheading III. TOPIC 3 Earliest lesions in CD: Aphthoid ulcerations
IV. ADDITIONAL INFOS
FROM LECTURER
V. REFERENCES

ULCERATIVE CHRON’S
COLITIS DISEASE

INVOLVEMEN Usually involves the Affect any part of

T rectum and extends the GT tract from
proximally to involve mouth to anus
all or part of the colon (rectal sparing)

Segmental
involvement (skip ULCERATIVE COLITIS: Diffuse (nonsegmental)mucosal disease,
lesion) with broad areas of ulceration. The bowel is not thickened, and
Perirectal fistulas, THERE IS NO COBBLE STONING.
fissures, abscesses,
and anal stenosis

MACROSCOPI MILD- erythematous MILD- aphtous or

C FEATURES mucosa with a fine small superficial
granular surface that ulcerations
resembles sandpaper
MORE ACTIVE-
SEVERE- stellate ulcerations
hemorrhagic, fuse longitudinally
edematous, and and transversely
ulcerated Projections of
inflammatory pseudo thickened mesentery
polyps encase the bowel CROHN’S DISEASE of the colon showing thickening of the wall,
with stenosis, linear serpiginous ulcers and COBBLE STONING of
“Creeping fat” the mucosa.
“Backwash ileitis”

MICROSCOPI Limited to the mucosa Transmural process A 24 y/o male presented with a 3-month history of diarrhea described
C FEATURES and superficial as semi formed, blood- streaked stools. On colonoscopy, there was a
submucosa with EARLIEST note of marked erythema, absent vascular markings and contact
deeper layers LESION- aphthoid bleeding. How would you classify the severity of her colitis?
unaffected except in ulcerations focal
fulminant disease. crypt abscesses with A. Mild
loose aggregations B. Moderate
of macrophages, C. Moderately severe
TWO MAJOR which form D. Severe
FEATURES OF noncaseating
CHRONICITY: granulomas in all
layers of the bowel CLINICAL PRESENTATION- ULCERATIVE COLITIS
-Distorted crypt wall  Major symptoms of UC: diarrhea, rectal bleeding, tenesmus,
Architecture passage of mucus, and crampy abdominal pain.
 UC can present acutely, sx usually have been present for weeks to
-Basal plasma cells
months.
and multiple basal

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 Diarrhea and bleeding are so intermittent and mild that the patient
does not seek medical attention
 Proctitisfresh blood or blood-stained mucus, either mixed with
stool or streaked onto the surface of a normal or hard stool.
 When the disease extends beyond the rectum, blood is usually
mixed with stool or grossly bloody diarrhea may be noted
 When the disease is severe, patients pass a liquid stool containing
blood, pus, and fecal matter
 More extensive diseasetenderness to palpation directly over the
colon.
 toxic colitishave severe pain and bleeding, and those with
megacolon have hepatic tympany.
ULCERATIVE COLITIS: DISEASE PRESENTATION
 Sigmoidoscopy: is used to assess disease activity and is
usually performed before treatment.
 Colonoscopy: used to assess disease extent and activity If
the patient is not having an acute flare.
Acute Phase Reactants, CRP, ESR, Platelet, WBC – Because
sometimes they are exacerbated with infections. These patients are
prone to develop infection in the GIT that’s why you are concerned
with patient.
Why albumin? Absorption of nutrients in the GI Tract is impaired.
How to you diagnose? Aside from the lab tests, you need to have a
very good patient history taking, a very extensive one, symptoms,
and ruling out other differentials.

Mild Moderate Severe (From Incendium trans)

Bowel <4 / day 4 - 6 / day >6 / day What is the earliest radiologic change in Ulcerative Colitis seen on
Movements single- contrast enema?
Blood in Stool Small Moderate Severe A. Ulcerations
Fever None <37.5C Mean >37.5C Mean B. Mucosal granularity
(<99.5F) (>99.5F) C. Pseudo polyp formation
D. Edematous haustral folds
Tachycardia None <90 Mean >90 Mean
Pulse Pulse

Anemia Mild >75% <75%

Sedimentation <30 mm >30mm

Rate

Endoscopic Erythema, Marked Spontaneous

Appearance Decreased Erythema, Bleeding,
vascular Coarse Ulcerations
pattern, Fine Granularity,
granularity Absent
Vascular
markings,
Constant
Bleeding, No
Ulcerations

Which acute phase reactant correlates well with histologic

inflammation and be predict relapses in IBD?

A. C- reactive protein
B. Fecal lactoferrin
C. Fecal calprotectin
D. Erythrocyte sedimentation rate

DIAGNOSTICS

 Increase: CRP, ESR, platelet, WBC

 Decrease: haemoglobin, albumin
 Fecal lactoferrin: highly sensitive and specific marker for
detecting intestinal inflammation.
 Fecal calprotectin: correlates well with histologic
inflammation, predict relapses, and detect pouchitis.
 fecal lactoferrin and calprotectin: integral part of IBD
management and are used frequently to r/o active
inflammation vs symptoms of irritable bowel or bacterial
overgrowth.

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