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Difference between revisions of "Inflammatory bowel disease"
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Inflammatory bowel disease (view source)
Revision as of 03:47, 20 December 2010
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==Microscopic== | ==Microscopic== | ||
Features helpful for the diagnosis of IBD - as based on a study:<ref name=pmid10048734>{{cite journal |author=Tanaka M, Riddell RH, Saito H, Soma Y, Hidaka H, Kudo H |title=Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn's disease from ulcerative colitis |journal=Scand. J. Gastroenterol. |volume=34 |issue=1 |pages=55–67 |year=1999 |month=January |pmid=10048734 |doi= |url=}}</ref> | Features helpful for the diagnosis of IBD - as based on a study:<ref name=pmid10048734>{{cite journal |author=Tanaka M, Riddell RH, Saito H, Soma Y, Hidaka H, Kudo H |title=Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn's disease from ulcerative colitis |journal=Scand. J. Gastroenterol. |volume=34 |issue=1 |pages=55–67 |year=1999 |month=January |pmid=10048734 |doi= |url=}}</ref> | ||
#Basal inflammation, i.e. crypt base, plasmacytosis with severe chronic inflammation. | |||
#Crypt architectural abnormalities. | |||
#*Includes: | |||
#**Atrophy = less glands ~ 3-4 glands/mm (normal = 7-8 glands/mm). | |||
#**Branching = common (normal = very rare branching). | |||
#**Distortion = bent glands, marked size variation (normal = "rack of test tubes"). | |||
#Distal Paneth cell metaplasia. | |||
**Paneth cells should ''not'' be in the left colon<ref name=pmid11851832>{{cite journal |author=Tanaka M, Saito H, Kusumi T, ''et al'' |title=Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease |journal=J. Gastroenterol. Hepatol. |volume=16 |issue=12 |pages=1353–9 |year=2001 |month=December |pmid=11851832 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0815-9319&date=2001&volume=16&issue=12&spage=1353}}</ref> - if you see 'em think of IBD and other long-standing injurious processes. | **Paneth cells should ''not'' be in the left colon<ref name=pmid11851832>{{cite journal |author=Tanaka M, Saito H, Kusumi T, ''et al'' |title=Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease |journal=J. Gastroenterol. Hepatol. |volume=16 |issue=12 |pages=1353–9 |year=2001 |month=December |pmid=11851832 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0815-9319&date=2001&volume=16&issue=12&spage=1353}}</ref> - if you see 'em think of IBD and other long-standing injurious processes. | ||
**Some claim that (friendly right colonic) paneth cells and paneth cell metaplasia look quite different and can be distinguished.<ref name=pmid12655793>{{cite journal |author=Rubio CA, Nesi G |title=A simple method to demonstrate normal and metaplastic Paneth cells in tissue sections |journal=In Vivo |volume=17 |issue=1 |pages=67–71 |year=2003 |pmid=12655793 |doi= |url=}}</ref> | **Some claim that (friendly right colonic) paneth cells and paneth cell metaplasia look quite different and can be distinguished.<ref name=pmid12655793>{{cite journal |author=Rubio CA, Nesi G |title=A simple method to demonstrate normal and metaplastic Paneth cells in tissue sections |journal=In Vivo |volume=17 |issue=1 |pages=67–71 |year=2003 |pmid=12655793 |doi= |url=}}</ref> | ||
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# If you see architectural distortion (e.g. crypt branching) in the left colon, look for Paneth cells. | # If you see architectural distortion (e.g. crypt branching) in the left colon, look for Paneth cells. | ||
# The hepatic flexure is considered the divider for normal paneth cells and abnormal paneth cells, i.e. paneth cells proximal to the hepatic flexure are normal; paneth cells distal to the hepatic flexure are abnormal.<ref>STC. 14 December 2009.</ref> | # The hepatic flexure is considered the divider for normal paneth cells and abnormal paneth cells, i.e. paneth cells proximal to the hepatic flexure are normal; paneth cells distal to the hepatic flexure are abnormal.<ref>STC. 14 December 2009.</ref> | ||
# Stretching of tissue may mimic atrophy; tip-off it is artefact: thinning of mucosa.<ref>RK. 13 December 2010.</ref> | |||
===Grading=== | |||
*Several systems exists.<ref>RK. 13 December 2010.</ref> | |||
*One that is often cited is by Gupta et al..<ref name=pmid17919486>{{cite journal |author=Gupta RB, Harpaz N, Itzkowitz S, ''et al.'' |title=Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study |journal=Gastroenterology |volume=133 |issue=4 |pages=1099–105; quiz 1340–1 |year=2007 |month=October |pmid=17919486 |pmc=2175077 |doi=10.1053/j.gastro.2007.08.001 |url=}}</ref> | |||
====Grading schemes for IBD in a table==== | |||
{| class="wikitable" | |||
| | |||
| '''Nil''' | |||
| '''Mild''' | |||
| '''Moderate''' | |||
| '''Severe''' | |||
|- | |||
| "A grading scheme"<ref>RK. 13 December 2010.</ref> | |||
| - | |||
| cryptitis | |||
| PMN abscesses | |||
| erosions | |||
|- | |||
| Gupta<ref name=pmid17919486/> | |||
| "0" (nil) | |||
| "1" (<50% of crypts <br>have PMNs) | |||
| "2" (>50% of crypts <br>have PMNs) | |||
| "3" (presence of <br>ulcers or erosions) | |||
|- | |||
|} | |||
==Crohn's disease vs. ulcerative colitis== | ==Crohn's disease vs. ulcerative colitis== | ||