| Characteristics | Crohn's Disease | Ulcerative Colitis |
|---|---|---|
| Incidence | Bimodal – young girls and old women especially caucasians. | White young females (females) |
| Areas affected | From the mouth to the anus.. all over
Generally, starts at the distal small bowel and colon. |
Example |
| Pre-dominance | Terminal Ileitis
Regional ileitis |
Involves the colon as a diffuse mucosal disease with distal predominance. |
| Granulomas | Non-caseating Granulomatous Colitis | Absent |
| Inflammation | Transmural Inflammation – All layers affected | Only the mucosa and submucosa affected |
| Complications | Fistulas and Fissures can form | ** NOT FOUND IN SMOKERS OR RARE** :
TOXIC MEGACOLON CAN PRECIPITATE |
| Lesion Progression | SKIPPER – Skip lesions are present with intermittent areas of healthy intestine. | The Rectum is virtually always involved, and additional portions of colon
PAN COLITIS |
| Pathology | CREEPING FAT – the serosa is granular and dull gray with mesenteric fat wrapping the bowel.
RUBBERY INTESTINAL WALL and THICK due to Edema, inflammation and fibrosis. APTHOUS ULCERS – Focal mucosal ulcers develop that later form LONGITUDINAL ULCERS NOTE: BOWEL THICKNESS IS GREATER! |
Typically starts in the rectum and ascends to the ileocecal valve. *Backwash Ileitis)
CRYPTS ABSCESSES: defined as a localized collection of PMNS within the lumen of the intestinal crypt, with distortion of crypt architecture. INFLAMMATORY PSEUDOPOLYPS – result of ulceration and healin with granulation tissue and regenerative hyperplasisa NOTE: BOWEL THICKNESS IS NORMAL |
| X-RAY | STRING SIGN | Non-specific |
| Cancer Risk | Minimal | 10 fold increase risk of colon cancer;
10 years of pancolitis – 10 X risk of colon cancer risk of developing sclerosing cholangitis and bile duct carcinoma. |
| Clinical Features | Presentations: The clinical manifestations are variable
Cramping abdominal pain WATERY DIARRHEA (SI involvement) BLOODY (Large intestine involvement) Fever Weight loss PERINICIOUS ANEMIA (ileum usu 1st affected) Generalized malabsorbtion Perirectal disease (fistula, fissure, abscess) Extraintestinal manifestations of arthritis, uveitis, erythema nodosum, and ankylosing spondylitis. Increased risk for intestinal cancer (5-6 fold increase) |
Bloody mucoid diarrhea, electrolyte imbalances
Relapsing episodes, flaring up during emotional stress Pain, fever, weight loss |
| Lab Tests | Anti-Saccharomyces Cerevisia antibody (ASCA)
DR1 – Crohns |
pANCA – 75% of UC
DR2 - Ulcerative Colitis |
| Treatment | Example | Example |