Inflammatory Bowel Disease Crohns and Ulcerative Colitis for USMLE Step 1

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Comprehensive review of the Inflammatory Bowel Disease, Ulcerative Colitis and Crohn's Disease. • • BONUS question: Which vitamin is frequently deficient in Crohn’s after resection of terminal ileum? Vitamin B12 • Check out our Study Spot Shortcast! https://open.spotify.com/episode/5lE6... • Both of these disease are autoimmune conditions. • Location: Ulcerative Colitis is primarily located in the rectum and descending Colon. In Crohn's there are skip lesions which can affect any area. However, it primarily affect ileum and ileocecal area. • Pathology: In Ulcerative Colitis there is damage to mucosa and submucosa leading to broadbased ulcer also known as psuedopolyp. In Crohn's the lesion goes all the way through also known as transmural. • Symptoms: Ulcerative Colitis patients have Bloody Diarrhea and Abdominal Pain. There are some extra-intestinal symptoms, primarily Migratory polyarthritis, Ankylosing Spondylitis, Sacroilitis, Uveitis and skin lesions. With Crohn's is also associated with abdominal pain and diarrhea, Right Lower Quardrant pain and fever. Also Crohn's disease is associated with Iron deficiency anemia because this area is associated with the area where iron and B12 is absorbed • Histology: Damage to the muscularis propria (leads to toxic megacolon). In Crohn's Disease the morphology is a little different. This is associated with strictures, creeping fat in the colon area. Also these are associated with string sign on the radiograph, which is just the finding of the strictures on x-ray. • Complications: Ulcerative colitis can lead to Toxic Megacolon and Colon Cancer. Crohn's disease is associated with fistulas and colon cancer. • Treatment: With Ulcerative Colitis you can use sulfasalazine (aspirin) infliximab (TNF alpha blocker) 6 Mercaptopurine and finally colectomy. Crohn's the mainstay of treatment is corticosteroids, methotrexate, azothiprine and also infliximab.

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