Bowel Name
Inflammatory Disease
Incidence Pathology
Bacteria; Virus; Chlamydia; Parasites; Fungi; Antibiotic Associated; Ischemia; Radiation Tx; GVHD; Solitary Rectal Ulcer Syndrome Lymphocyti c inflammatio n of surface epithelium and thickened subepithelial collagen table. (Lymphocyti c colitis otherwise similar histologicall y and clinically but lacks collagen band) Diffuse mucosal disease w/distal predominanc e (does not go through the mucosa); only involves
Clinical
Extraintestina l manifestation s: Arthritis, Uveitis, Erythema nodosum, Ankylosing spondylitis, Sclerosing cholangitis Chronic watery diarrhea
Histology
Findings non specific; Active acute inflammation; Chronic = architectural changes of crypt distortion and scarring; crypt abscesses
Px
Tx
Surgery is reserved for: intractable disease, obstruction, perforation and prophylactic resection to prevent colon cancer (UC)
Collagenous Colitis (IBD)
Middleaged women; probably autoimmune
Colonic mucosa w/thickened pink collagen below surface epithelium
Ulcerative Colitis (UC)
Idiopathic; whites; women; young (2025); developed countries
Bloody mucoid diarrhea and lower abdominal pain relieved by defection; (some constipation)
Friable mucosal pseudopolyps w/ freely hanging mesentery; lesions continuous; Crypt abscesses and ulcers; NO granulomas
Complication: colorectal cancer (esp w/prolonged UC 20yrs after onset); recurrent after monthsdecades; flare-ups by stress; 60% mild disease; 30% require colectomy w/ in 3 years; risk for sclerosing cholangitis and bile duct carcinoma.
Sulfasalazine (5aminosalicyla te derivatives) is first line Tx.
colon
Crohns
Women; whites;
of patients will have colonic crohns disease.
Intermittent attacks of mild diarrhea, fever, abdominal pain; stress can precipitate attack; fecal blood loss anemia; acute RLQ pain; can mimic appendicitis or bowel perforation; weight loss, weakness
Normal for comparison Inflammation is segmental; any part except rectum; cobble-stone appearance; non-caseating granulomas; fibrosis and transmural inflammation; creeping fat;
5-6x increased incidence of cancer; risk is less than in chronic UC; complications from fibrosing strictures fistulas; to if extensive involvement of small bowel, marked loss of albumin, generalized malabsorption pernicious anemia; steatorrhea (malabsorption of bile salts);
Adenomatous (familiar) polyposis coli (APC) (FAP)
Adolescenc el; Autosomal dominant; Chromosom e5
NHPCC (Hereditary non-polyposis colon carcinoma)
Young individuals; microsatellit e instability
Developmen t of numerous (> 100) colonic adenomas (attenuated form fewer polyps, older onset) Gardeners = extraintestinal (epidermal inclusion cysts, oseomas, desmoid tumors and dental abnormalitie s) Right-sided colon cancer; extraintestin al malignancie
GI bleeding; change in bowel habits; abdominal pain; anorexia/weig ht loss
Mostly tubular, some have villous features
Nearly all develop adenocarcinoma; less than 1% of colorectal cancers arise from FAP; over 90% of FAP families from mutations of APC gene. Avg age of Dx = 39 years.
Tx of choice colectomy
Fewer polyps than APC; polyps aggressive
Lifetime risk of cancer = 80% (if polyps present); 35% of colon cancers arise; endometrial 40%, ovarian 10-20%
Adenocarcino ma
5% of all deaths; 2nd most common cancer in US; high meat and animal fat, low fiber; genetic changes in APC, ras, p53
s (endometriu m, upper urinary tract) Genetic changes cause progression from normal mucosa to...