Interactive Tutorial. Inflammatory
Bowel Disease- Practice & Learn
What are the two forms of inflammatory bowel disease? - answer1. Crohn's disease:
affects any part of the gastrointestinal tract from the mouth to the anus.
2. Ulcerative colitis: affects the large intestine &, rarely, the small intestine.
What is Inflammatory Bowel Disorder? - answerBoth Ulcerative Colitis (UC) & Crohn's
Disease (CD) are inflammatory conditions of the Gl tract that are most often initially
diagnosed in young adults, age 15 to 40, and are usually present with diarrhea and
weight loss.
Crohn's disease vs Ulcerative Colitis - answerCrohn's Disease:
Abdominal pain
Occurs at any point in the Gl tract
Inflammation occurs in separate lesions
Fistula development
Lesions extend through the intestinal wall
Abdominal pain, especially in the right lower quadrant.
Frequently involves the terminal ileum & /or ascending colon Manifests in distinct
lesions, & involves the entire thickness of the intestinal wall.
Ulcerative Colitis:
Rectal involvement
Restricted to the colon
Inflammation is continuous
Risk for toxic megacolon
Inflammation restricted to the mucosa
The diarrhea of UC is more likely to be bloody;
Explanation:
Both UC & CD are inflammatory conditions of the Gl tract that are mostly diagnosed in
young adults, aged 15 to 40 & present with diarrhea.
Describe the pathophysiology relevant to the development of Crohn's disease. -
answerCrohn's disease can affect the gastrointestinal tract from the mouth to the anus.
It can affect either gender equally and is most prevalent in individuals between 20 to 40
years of age, with a second peak in those aged 55 to 65 years.
- difficult to diagnose, & symptoms may become confused with irritable bowel
syndrome.
It is slow & progressive in nature with periods of remission & exacerbation.
- no exact known cause but is theorized to be an immune disorder: the immune system
responds to a virus or bacteria in the gastrointestinal tract. Other potential causes may
,be genetic factors (most often a sibling or parent suffers from the disease), allergies, &
infections, and smoking.
Stages of Crohn's disease - answer1. The lymph nodes enlarge
2. Lymph flow is obstructed
3. Peyer's patches become more prominent
4. Fibrosis occurs
5. Inflammation of the serous membrane develops
6. Adhesions develop
Lymphatic obstruction causes edema, mucosal ulceration, fissures, abscesses, &,
sometimes, granulomas.
Mucosal ulcerations are called skipping lesions because they are not continuous (as in
ulcerative colitis)
Peyer's patches, the oval, elevated patches of closely packed lymphoid follicles present
on the lining of the small intestine, are aggravated by inflammation & become more
prominent.
Fibrosis occurs, thickening the bowel wall & causing stenosis, or narrowing of the
lumen.
Inflammation of the serous membrane (serositis) develops.
Inflamed bowel loops adhere to other diseased or normal loops.
• Diseased bowel segments become interspersed with healthy ones.
Diseased parts of the bowel become thicker, narrower, & shorter & can lead to the
formation of strictures.
Pathophysiology of Ulcerative Colitis - answer- affects the large intestine &, rarely, the
small intestine.
- cause of ulcerative colitis: unknown
- the disease is linked to genetic factors, immune-system response to a virus or
bacteria, autoimmune reactions, & allergic reactions to food, milk, or other substances
that release inflammatory histamine in the bowel.
- Although emotional stress & anxiety can contribute to the aggravation of symptoms,
they are not the primary cause of the disease.
The disease process of ulcerative colitis begins in the rectum & lower portion of the
colon & may spread to other areas in a continuous manner.
Ulceration ensues with resulting bleeding, hemorrhage, & exudative inflammation.
Abscess formation in the mucosa drains purulent pus, necrosis, & ulceration. Next,
sloughing occurs, causing blood- & mucus-filled stools.
As ulceration progresses, the structure of the colon changes. Initially, the colon's
mucosal surface becomes dark, red, & velvety.
Abscesses form & coalesce into ulcers, & necrosis of mucosa occurs. As abscesses
heal, scarring & thickening may appear in the bowels' inner muscle layer. Granulation
tissue replaces the muscle layer, & the colon narrows, shortens, & loses its pouches.
Crohn's vs. Ulcerative Colitis: Type of inflammation - answerCrohn's Disease:
Granulomatous
, Ulcerative Colitis: Ulcerative and exudative
Level of involvement - answerCrohn's Disease: Primarily submucosal
Ulcerative Colitis: Primarily mucosal
Extent of involvement - answerCrohn's Disease: Skip lesions
Ulcerative Colitis: Continuous
Areas of involvement - answerCrohn's Disease: Primarily ileum, secondarily colon
Ulcerative Colitis: Primarily rectum and left colon
Diarrhea & Rectal bleeding - answerCrohn's Disease: Common
Ulcerative Colitis: Common
Fistulas, Strictures & Perianal Abscesses - answerCrohn's Disease: Common
Ulcerative Colitis: rare
Cancer - answerCrohn's Disease: Uncommon
Ulcerative Colitis: Relatively common
Crohn's Disease versus Ulcerative Colitis: Self-Assessment Exercise
The pathophysiology of Crohn's disease & ulcerative colitis is different.
Can you identify their pathophysiologic features?
Adhesions develop.
Abscesses are formed in the mucosa.
Complications related to fistulas often develop.
Granulomas are formed, leading to a cobblestone appearance.
The lower portion of the colon is affected.
Any part of the gastrointestinal tract is affected.
Exudative inflammation develops. - answerCrohn's Disease: Adhesions develop; Any
part of the gastrointestinal tract is affected; Complications related to fistulas often
develop; granulomas are formed, leading to a cobblestone appearance.
Ulcerative Colitis: The lower portion of the colon is affected; Exudative inflammation
develops; Abscesses are formed in the mucosa.
Clinical Manifestations of Cohn's Disease - answerThe symptoms of Crohn's disease
are dependent upon the section of the gastrointestinal tract that is affected as well as
the severity of the inflammation. Clinical manifestations may be mild & nonspecific; they
do not always follow the same pattern for each patient.
The most common symptoms are diarrhea & cramping due to the inability of the large
intestine to absorb excess fluid. This creates a loss of water & sodium. Loose, watery
stools can occur up to 12 times per day in the active phase of the disease.
Right lower quadrant pain is also a common complaint but patients may have other
abdominal complaints as well, such as tenderness upon palpation, nausea, & flatulence.
Low-grade fever, anorexia, & weight loss may occur related to the inflammatory
Bowel Disease- Practice & Learn
What are the two forms of inflammatory bowel disease? - answer1. Crohn's disease:
affects any part of the gastrointestinal tract from the mouth to the anus.
2. Ulcerative colitis: affects the large intestine &, rarely, the small intestine.
What is Inflammatory Bowel Disorder? - answerBoth Ulcerative Colitis (UC) & Crohn's
Disease (CD) are inflammatory conditions of the Gl tract that are most often initially
diagnosed in young adults, age 15 to 40, and are usually present with diarrhea and
weight loss.
Crohn's disease vs Ulcerative Colitis - answerCrohn's Disease:
Abdominal pain
Occurs at any point in the Gl tract
Inflammation occurs in separate lesions
Fistula development
Lesions extend through the intestinal wall
Abdominal pain, especially in the right lower quadrant.
Frequently involves the terminal ileum & /or ascending colon Manifests in distinct
lesions, & involves the entire thickness of the intestinal wall.
Ulcerative Colitis:
Rectal involvement
Restricted to the colon
Inflammation is continuous
Risk for toxic megacolon
Inflammation restricted to the mucosa
The diarrhea of UC is more likely to be bloody;
Explanation:
Both UC & CD are inflammatory conditions of the Gl tract that are mostly diagnosed in
young adults, aged 15 to 40 & present with diarrhea.
Describe the pathophysiology relevant to the development of Crohn's disease. -
answerCrohn's disease can affect the gastrointestinal tract from the mouth to the anus.
It can affect either gender equally and is most prevalent in individuals between 20 to 40
years of age, with a second peak in those aged 55 to 65 years.
- difficult to diagnose, & symptoms may become confused with irritable bowel
syndrome.
It is slow & progressive in nature with periods of remission & exacerbation.
- no exact known cause but is theorized to be an immune disorder: the immune system
responds to a virus or bacteria in the gastrointestinal tract. Other potential causes may
,be genetic factors (most often a sibling or parent suffers from the disease), allergies, &
infections, and smoking.
Stages of Crohn's disease - answer1. The lymph nodes enlarge
2. Lymph flow is obstructed
3. Peyer's patches become more prominent
4. Fibrosis occurs
5. Inflammation of the serous membrane develops
6. Adhesions develop
Lymphatic obstruction causes edema, mucosal ulceration, fissures, abscesses, &,
sometimes, granulomas.
Mucosal ulcerations are called skipping lesions because they are not continuous (as in
ulcerative colitis)
Peyer's patches, the oval, elevated patches of closely packed lymphoid follicles present
on the lining of the small intestine, are aggravated by inflammation & become more
prominent.
Fibrosis occurs, thickening the bowel wall & causing stenosis, or narrowing of the
lumen.
Inflammation of the serous membrane (serositis) develops.
Inflamed bowel loops adhere to other diseased or normal loops.
• Diseased bowel segments become interspersed with healthy ones.
Diseased parts of the bowel become thicker, narrower, & shorter & can lead to the
formation of strictures.
Pathophysiology of Ulcerative Colitis - answer- affects the large intestine &, rarely, the
small intestine.
- cause of ulcerative colitis: unknown
- the disease is linked to genetic factors, immune-system response to a virus or
bacteria, autoimmune reactions, & allergic reactions to food, milk, or other substances
that release inflammatory histamine in the bowel.
- Although emotional stress & anxiety can contribute to the aggravation of symptoms,
they are not the primary cause of the disease.
The disease process of ulcerative colitis begins in the rectum & lower portion of the
colon & may spread to other areas in a continuous manner.
Ulceration ensues with resulting bleeding, hemorrhage, & exudative inflammation.
Abscess formation in the mucosa drains purulent pus, necrosis, & ulceration. Next,
sloughing occurs, causing blood- & mucus-filled stools.
As ulceration progresses, the structure of the colon changes. Initially, the colon's
mucosal surface becomes dark, red, & velvety.
Abscesses form & coalesce into ulcers, & necrosis of mucosa occurs. As abscesses
heal, scarring & thickening may appear in the bowels' inner muscle layer. Granulation
tissue replaces the muscle layer, & the colon narrows, shortens, & loses its pouches.
Crohn's vs. Ulcerative Colitis: Type of inflammation - answerCrohn's Disease:
Granulomatous
, Ulcerative Colitis: Ulcerative and exudative
Level of involvement - answerCrohn's Disease: Primarily submucosal
Ulcerative Colitis: Primarily mucosal
Extent of involvement - answerCrohn's Disease: Skip lesions
Ulcerative Colitis: Continuous
Areas of involvement - answerCrohn's Disease: Primarily ileum, secondarily colon
Ulcerative Colitis: Primarily rectum and left colon
Diarrhea & Rectal bleeding - answerCrohn's Disease: Common
Ulcerative Colitis: Common
Fistulas, Strictures & Perianal Abscesses - answerCrohn's Disease: Common
Ulcerative Colitis: rare
Cancer - answerCrohn's Disease: Uncommon
Ulcerative Colitis: Relatively common
Crohn's Disease versus Ulcerative Colitis: Self-Assessment Exercise
The pathophysiology of Crohn's disease & ulcerative colitis is different.
Can you identify their pathophysiologic features?
Adhesions develop.
Abscesses are formed in the mucosa.
Complications related to fistulas often develop.
Granulomas are formed, leading to a cobblestone appearance.
The lower portion of the colon is affected.
Any part of the gastrointestinal tract is affected.
Exudative inflammation develops. - answerCrohn's Disease: Adhesions develop; Any
part of the gastrointestinal tract is affected; Complications related to fistulas often
develop; granulomas are formed, leading to a cobblestone appearance.
Ulcerative Colitis: The lower portion of the colon is affected; Exudative inflammation
develops; Abscesses are formed in the mucosa.
Clinical Manifestations of Cohn's Disease - answerThe symptoms of Crohn's disease
are dependent upon the section of the gastrointestinal tract that is affected as well as
the severity of the inflammation. Clinical manifestations may be mild & nonspecific; they
do not always follow the same pattern for each patient.
The most common symptoms are diarrhea & cramping due to the inability of the large
intestine to absorb excess fluid. This creates a loss of water & sodium. Loose, watery
stools can occur up to 12 times per day in the active phase of the disease.
Right lower quadrant pain is also a common complaint but patients may have other
abdominal complaints as well, such as tenderness upon palpation, nausea, & flatulence.
Low-grade fever, anorexia, & weight loss may occur related to the inflammatory
