hello good morning good morning everyone am I live am I visible give me a thumbs up in the chat box if I'm clearly visible audible to you guys yes anyone from the audience give me a minute to confirm if I'm clearly visible audible I will start the session ahead in next few seconds give me a minute okay I guess it's working so I welcome you all for today's session a very very good morning to all of you a refreshing morning a new morning right so today I am going to teach you a important topic from pathology from systemic pathology on huge demand of students I am going to teach you this topic and today I am going to teach you inflammatory bowel diseases so many students requested they can't understand the differences between UC and CD what is the basic difference what is the pathology how grossly they differ how microscopically they differ so that's why I have launched this session so today I am going to teach you inflammatory bowel disease right so without wasting any further time give me a minute let me start inflammatory bowel disease let me see if I can see your chat yes I can see so uh what is inflammatory bowel disease as the name indicate it's Bobble so it is a disease of the intestine of the intestine either of the large intestine either of the smaller intestine or both can be involved and there is inflammation in the bubble so the term inflammatory bowel disease is basically used for two distinct pathologies which are known as ulcerative colitis and Crohn's disease Crohn's disease is usually known as CD and ulcerative colitis is usually known as UC so both of them are inflammatory bowel disease that is known as IBD now what is the basic difference between them how to understand them grossly how the two differ microscopically how the two differ and how to diagnose them separately right so let me teach you both types of inflammatory bowel disease we will see their details one by one let's start with crohn's disease first let me finish first Crohn's disease and then I will come on the uh the second one that is ulcerative colitis the Crohn's disease right in this diagram you can see both I guess you all can see this diagram you have to understand this diagram this side you can see Crohn's disease this side you can see ulcerative colitis in both the diagrams you can see the small as well as large intestine now you have to understand the starting point of the Crohn's disease the starting point of the Crohn's diseases terminal ilium here I am marking that for you can you see this is terminal ilium it's charged from terminal helium and the on The Conjuring the starting so it is a junction of small and large intestine you can say The Junction at which small and large intestine are meeting that is the terminal ilium right that is the starting point of Crohn's Disease and in ulcerative colitis the starting point is the rectum the end point of the large colon here you can see the difference in the starting point of the two type of diseases so here we are discussing the Crohn's disease you got it Osama jahangir you got it yes so Crohn's disease it's starting from terminal ileum the first difference you can see on the contrary when I teach you ulcerative colitis I will teach you to starting from the rectum number one the second thing you can see in the two diagrams Crohn's disease there are skip areas what do you mean by Skip areas so I guess you can see this area is involved but this complete is not involved again this is involved they are not involved this is involved not involved so you know there is alternate involved and involved involved and involved areas it is known as skip you know Skip areas are there so in Crohn's disease it is not a disease of continuity so small areas involved then our areas are involved then areas involved then uninvolved you can see in this diagram the red one or the involved one and the normal pink they are onion board so you can see skip areas are present in Crohn's disease on the contrary you can see ulcerative colitis it is starting from rectum number one and you can see it is continuous involved There Is No Escape area so here involvement is continuous so here skip areas are absent so you have to understand back to back the differences between Crohn's disease and ulcerative colitis you got it so in Crohn's disease the skipperias are present in ulcerative colitis skip areas are not present The Continuous involvement is there in Crohn's disease the starting point the starting point is the terminal ilium and in ulcerative colitis the starting point is the rectum I guess everyone got it yes Sachin yes Osama you got it okay but the same thing is written here in Crohn's disease it is starting from terminal ileum and its extend backward into the and sometimes an ascending colon and Skip areas are present so let me tell you six points in the gross in Crohn's disease and then we will discuss ulcerative colitis let me discuss Crohn's disease currently I am teaching you Crohn's disease in detail the growth of the Crohn's disease so I have already explained you what do you mean by Skip area skip areas is bubble inboard with intervening onion ball so there is alternating area involved uninvolved involved uninvolved so this is known as skip area right now the area which is involved the area which is involved that portion of the Bobble that portion of the intestine become thick and hard like a pipe you know pipe it is known as hose pipe you got my point so can you see in Crohn's disease this area is involved this area is involved this area is involved this area this area and remaining is not involved so I can say the skip areas are present on the contrary in ulcerative colitis I I can't see any skip areas it is starting from the rectum and in continuity so skip area is absent means continuous involvement is present and here skip present continuous absent you can see back to back differences number one and number two due to the uh involvement here the Bob will become thick hard it is known as hose pipe this type of bubble is known as host pipe actually the Lumen of the Bob will get narrowed here the Lumen is narrow if you see the Lumen it is a narrow Lumen from inside because of the involvement of the bowel but if you see in ulcerative colitis the Lumen here the Lumen is white the ball will get dilated not narrowed here the Lumen will get white because the ball will get dilated it also looks like a pipe but a dilated pipe so such pipe is known as Garden pipe so both are looking like a pipe but this one is a narrow pipe the narrow pipe is known as hose pipe and this one is a dilated pipe the dilated pipe is known as guardian pipe everyone give me a thumbs up I'm trying hard to see the differences between the two actually the difference are important if you understand them Burns now you will never forget so what is host pipe host pipe is such a pipe in which the limit is narrow and what is Garden pipe garden pipe is such a wipe and with the in which the Lumen is white so we can correlate the two type of the pipes with the two type of diseases in Crohn's disease the Lumen get narrowed it is known as host pipe appearance and an ulcerative colitis will human get wide that's why it is known as Garden pipe appearance give me a thumbs up Vikram Sachin Osama jahangir give me a thumbs up I can't see others name right can we go ahead same you can see here also can you see can you appreciate can you say this is Crohn's disease can you say this is ulcerative colitis yes what can you notice here you can notice here skip areas are there you can see clearly hip areas are present right and in ulcerative colitis you can see the continuous involvement it's not Skip it's continuous involvement is present I guess everyone can appreciate the change right so this is how you have to see you have to say the starting point here the starting point is terminal ilium here the starting point is rectum you have to say whether it is Skip involvement or continuous involvement number two number three you have to correlate the Lumen Lumen is narrowed or white if it is narrowed it is horse pipe in Crohn's disease and if it is wide it is known as Garden pipe in ulcerative colitis so till now we have learned three points right you have to understand all three points the starting point skip areas and horse pipe right now the next point I'm teaching a CD currently right and next we will see the UC right so this is Crohn's disease if you cut the Lumen and open the intestine from inside so you can see this is the cut portion I have already cut you can see this see this diagram I have cut I have with a scissor I have opened the terminal area and opened it from inside so can you see this this portion is terminal area this is colon this is the junction of the ilium and the colon the starting point of the colon so inside that I can see the ulcers I can see the ulcers the what is the shape of the ulcers the shape of this ulcers is like a snakes you know small small snakes it is known as Serpentine genus ulcer so serpentigenous ulcers are present give me a thumbs up what type of ulcers are present I am talking about CD currently so here's serpentigenous ulcers are present right and these ulcers are the shape is like a snake but they are very deep you know there are four layers in the intestine mucosa sub mucosa muscularis propria and um advantageous so ulcer starts from the yesterday taught you the definition of the ulcer the preach in the mucosa so it starts from the mucosa go deep deep deep ulcer get converted into fissures so they become deep deep they become Fisher you got no point so you can see the ulcers so let me draw a portion of intestine for you to explain you something I want to explain you here something so let me draw this as a portion of small intestine right or large intestine whatever here and I'm teaching you CD right now this is CD so here the ulcers are serpentigenous right so they are snake shaped right and initially they are superficial but they go deep deep deep deep deeper and they can involve all four layers they start from mucosa they start from the mucosa here but they go deeper into submucosa musculus property and serosa they go deeper right now what I want to teach you here the remaining intestine between two ulcers between any two ulcers the remaining intestines swelled up the remaining uninvolved what I am saying please mind my words the remaining uninvolved intestines swells up between the two ulcer it swells up so it gives up Cobalt Stone appearance you know the remaining surviving mucosides swelled up between two ulcers it gives a Coba what do you mean by Cobalt Stone let me tell you this this appearance is known as Cobalt Stone this is cobal Stone these Stones you know small small stones have you seen it these are known as Cobalt Stone so actually the intestine is looking like that white is looking like that the stones are the swellon mucosa which is uninboard but between the stones if you can notice the fissure these are the ulcers the serpentigenous ulcer which go deep you got my point so here you can see these are the D pulses the Deep pictures and the onion bald mucosa swells up so actually the stones is very few students can understand in depth you got my point yes yes yes Osama Ram Vikram Sachin yes he got it so what is it you can compare you can compare the normal intestine you can see Crohn's disease intestine see the change see the Cobalt Stone appearance see the onion ball mucosa how it swiped up how it's swelled up and between the two between the two swelled up there is a deep fissure the Deep fissure or the ulcer so this typical appearance is known as Cobalt Stone appearance right see again the same diagram I have drawn this is Cobalt Stone this is endoscopic appearance so uh you are a doctor now whenever patient will complain you git related complaints you will do a endoscopy so actually endoscopy is colonoscopy here so you are doing endoscopy on the endoscopy this typical appearance you are finding so looking at the endoscopy you can make a straightforward diagnosis it is a typical case of CD because on endoscopy you are getting typical Cobalt Stone appearance in the Cobalt Stone appearance again I am repeating you should know what is a stone you should know what is the stone and between the stones what is this deep fissure so the Deep fissure is the ulcer and actually the stones are the surviving mucus of which dwells up so actually again you can see this is the gross if I cut the intestine it looks from inside like this so it is the cross cobal Stone appearance I guess everyone got it everyone got it so there are serpentigenous ulcer inside which Cobalt Stone appearances there right the next point the ulcer sometimes become very deep and they become formed the fistula and the sinus tract they become Verity very deep so they become very deep they form adhesions they form fistula they pump tracks so again I would like to draw the intestine this is the intestine this is intestine the various Loops of intestine so here also we have ulcers here also we have ulcers right so actually between the ulcers adhesions takes place between various Loops so adhesions are there number one in Crohn's disease we are talking everything about the Crohn's disease additions are there the ulcer become deep deep deep they convert into fistula they convert into sinus right they become deeper deeper deeper right so initially they are ulcer but once they become deeper they convert into fistula and sinuses so fistular sinuses deep ulcers serpentigenous ulcer everything is a feature of CD adhesions it is a feature of CD in UC nothing will be present like this I will tell you everything what about the UC right and sometimes the strictures are there you know what a scripture please appreciate this portion I've told you now the Lumen become narrow here I told you initially that's why it is known as hose pipe a pipe with a human narrow right host pipe a pipe with a lumen Lumen which is narrow so can you appreciate this portion this portion is very narrow because this portion is involved and the remaining are n involved skip areas right so the involved portion become very narrow it results in structures so structures are present in CD but not in UC in UC the Lumen become dilated on the contrary not constructed you got my point give me a thumbs up the next Point multiple granulomas are there non-caseating these are non-casiating in tuberculosis we also have granuloma but in tuberculosis we have caseinating granulomas here case 18 necrosis is not there but granulomas are there so complete understand multiple granulomas if you feel now we can't see granulomas actually but if you feel hard hard nodules are there all of them are genues they are to be felt so these are the gross findings now let me come on the microscopy before that I would like to revise gross of CD can you help me to revise the gross of CD Ram can you help me Osama yes Vikram Sachin others Dr dharnashi anyone please can you help me with the points number one tell me the starting point from which point CD starts in the colon tell me the starting point number one who will tell me number two you tell me whether it is continuous involvement or skip involvement the starting point here is ilium to be exact the junction of the small and large intestine the terminal area of the best answer yes so the starting point is terminal ilium very good number two tell me whether it is continuous or skip so everyone knows it's skip involvement continuous is not there it's skip involvement number three tell me the shape of the ulcers ulcers are there we all know ulcers are present but what is the shape of the ulcers everyone yes yes priyanshi is such an animal what is the shape of the ulcers dreamer what is the shape of the ulcers it's makeshift it is known as serpentigenous Serpentine yes very good Ram very good it's Serpentine also now the ulcers become deep deep deep so ulcers become convert into what ulcers become convert into Fishers number one stula number two and sometimes sinus tract number three so ulcers become deep deep they convert into Fisher fistula and sinus so Fisher present in CD fistula present in CD sinus present in CD and sometimes between the ulcers additions are formed between adjacent Loops of intestine so it is known as adhesion additions are present in CD everything will be absent in UC these all are present in CD Now between two ulcers the surviving mucosa the onion board mucosa swells up it gives what appearance the typical appearance known as yes the typical appearance known as Cobalt Stone appearance Cobalt Stone appearance made the swelled up mucosa can be seen with the help of the it looks like a stone so these all points you have to end uh what happens to the lumen in CD in CD the Lumen of the intestine Narrows or widens I'm giving you two options does the Lumen Narrows or does the lumen widens in CD yes the Lumen of the intestine Narrows because of the narrow Lumen it is giving appearance of stricture so structure are present in CD but not in UC because when you see the Lumen dilates not Narrows here strictures are present and it gives a typical appearance yes padmavati it is host pipe I want to hear this name host pipe a pipe with narrow luminous hose pipe and a pipe with wider luminous Garden pipe so Garden pipe will be seen in UC but here it's it's you know uh its hose pipe in CD so these are the points in Gross you have to mug up or you have to learn you have to understand I have shown diagrams on each and every Point can I move ahead so after the gross we would like to discuss the microscopy of CD now everyone give me a thumbs up yes you know all these points write down one 1 2 3 4 5 6 and draw the diagrams to explain all these each point have a diagram the last one I forgot granulomas are present write down the next granulomas multiple granulomas which are non case eating they are also present so basically let me summarize in CD in Crohn's disease number one fissures present fistula present sinus present granuloma present adhesions present scripture present these all will be absent in UC right but here ulcers are deep in you see the ulcers will be superficial here Escape areas are present in UCS is not their continuous involvement is there so everything will be opposed there here horse pipe appearances there their Garden pipe appearances there so everything will be opposite there you got my point so that is the cross after the cross let me discuss the microscopy of CD then we will move to UC TK microscopically you have to learn Four Points everything is visible in this diagram don't learn the Four Points all the Four Points I will show you this in this diagram can you see this diagram how many layers are there in intestine there are four layers musculosis say yes yes so see the mucosa let me draw the mucus I'll start with mucosa so I'm drawing mucosa mucosa mucosa oh my God mucosa is discontinuous here and again continuing from here here here here it's like continuous everywhere till end I guess no no it's not continuous till end uh I got discontinuity again here right so basically I got two ulcers so discontinuity in mucosa it is Ulcer here and it is a ulcer here so wherever you wish you can draw multiple ulcers so I got two ulcers what is Ulcer a bridge in mucosa I got two in this diagram I got two you can get any any number uh given in the book yes now see yes see the ulcer is deep it is going deep from the mucosa it is going to submucosa may be up to muscular dysropriate you can see the breach here you can see the bridge here also so basically the ulcers are deep which are converting into fissures so safe pass there are ulcers and they convert into deep fissures number one can you see here yes you can see as well as you can draw you can draw right after that number two you can see what the next finding I can notice here in the submucosa what is this thing in the sub mucus I am drawing a circle here what is this what is this these two circles what are these two things if you notice you will see ma'am inside this there is a giant cells and multiple epithelial cells so a collection of giant and epithelial cell is a granuloma but no necrosis here also giant cell and multiple epothyroid cells so basically these are granulomas so we find the D pulses we find the fissures we find the non-kinesiating granulomas say yes can you see the granulomas yes this one is spare patches it is a normal finding a collection of lymphocyte is normal finding in intestine that is known as pear patches this is not abnormal but a collection of epithelloid cells and the giant cell is a granuloma right I can see granuloma but without necrosis so I will say non-case it in general is a finding right number three you can see all four layers listen everyone here you can see all four layers you can see the mucosa submucosa this one is muscular dysropia this one and behind that the last one is the sirosa right you can see all polias in all poor layers I can find lymphocytes lymphocytes and neutrophils basically lymphocytes not neutrophils I'm sorry all of them are lymphocytes so I can find the lymphocytes in submucosa in muscularis propria and serosa so inflammation is present but in which layer all code layer so I will use the word transmural what do you mean by trans all the layers mural all four layers May mononuclear inflammation mononuclear Matlab it is not a neutrophil neutrophils are poly polymorphonuclear cells the mononuclear is the lymphocyte so I am getting lymphocytes in all four layers but say this in a catchy language say mononuclear cell transmural inflammation in pathology you have to say like this and apart from that you in the background you can see the eating that's it the pore findings can you tell me what are the four findings initially the ulcers are there the ulcers converting to deep fissure they are deep they converge into fissures into all foliers number one number two the granulomas are there but they are non-case eating number two number three the inflammation is present in all four layers that's why known as transmural information right and it is made up of lymphocytes basically no neutrophils right that's why mononuclear inflammation and the last one edema is there can you enumerate the four findings in this diagram don't learn enumerate that if you're a second floor student you should be able to draw it and if you have already passed second prop now just enumerated to identify an ibq this ibq can come in your exam what are the four findings come on four microscopic findings of CD can you tell me anyone help me priyanshi Osama Sachin padmavati Ram anyone would like to help me the four findings number one the ulcers are there ulcers is deep breach and mucosa they get into deep fissures they get converted into deep fishes gradually right number two granulomas are there but granulomas are non-case eating number three inflammation is there now Ray two things of the inflammation two things for the inflammation number one it is transmutal transmural it involves all four layers now this transmural is typical of CD in UC inflammation is not transmural only in superficial layer not in deep layers right so in UC I will show you the diagram now uh you will get information only in mucosa and submucosa there is no inflammation in muscularis property and serosa here inflammation in all folias which is typical of CD right and inflammation is mononuclear that is basically lymphocytes are there in contrast to UC where inflammation will have neutrophils okay both things will be opposite in UC you got my point and last one is edema last one is edema give me a thumbs up come on you got it can be more ahead okay so I guess we are done with uh CD you can see the diagram the various diagrams these diagrams are from Robin's you can see the transmural inflammation if I zoom you can see all of them are lymphocytes right and here you can see the granulomas so these are the diagrams from the robins showing the same findings right the next the next Point uh if I take the blood sample of such a patient I will get antibodies in the blood sample which antibodies the actually the patient with CD have a infection of a fungus the name of the fungus is sakeromycity services this is the name of a fungus actually a yeast yeast the antibodies are formed against the fungus it is known as anti-saccharomycities antibody so in a patient of CD you will get these antibodies that's all about CD let me pack CD so we are done with CD we are done with CD let me start you see now can you first enumerate CD everything about CD the six gross findings one two three four five six and four microscopic findings one two three four and one blood finding in the blood you get antibodies right so serology findings only one one type of antibody so if you can enumerate all these TDS back you can write everything about the CD can you do that for me I will try so in the grass write down it starts with terminal ilium right starting point then right skip areas are present not continuous right then right serpentigenous Serpentine ulcers are there which convert into fissures fistula sinus adhesions everything is due to ulcer right all are present right granulomas are present the next is granulomas they are present what was the next finding Cobalt Stone appearance you can understand so I guess these are the gross findings right and the pipe it's narrow humor which is known as host primer host pipe so these are the six seven points in the gross you have to mug up right in the microscopy you understand and only Port points only four points number one initially ulcers are there which get convert into fissures I have shown you in the diagram the T pulses the fissures number one number two granulomas are present but they are non-keys eating number three inflammation is there but inflammation is transmural involving all folias and only lymphocytes are there mononuclear is there no no neutrophils and last one is edema right in the blood you get only one antibody it is known as anti-saccharolytic cervicized antibody which is a fungus that's all that's all yeah Stringer test Ram you are asking about the string test now so as I've told you yes your strictures are present due to horse pipe appearance that is known as string test so if you do the barium enema in this patient you will get a stricture the stricture there this that structure on the barium is known as string test so that's all about CV so let me start the next one you see any doubt in that any doubt in that just a second okay why I am unable to write give me a minute yes but let me start with you see give me a thumbs up now right can I move ahead the UC the next the next type of IBD is used you know everything will be opposite right in UC it starts with rectum not with terminal lillium the starting point is wrapped up you all can notice the starting point is rectum and the involvement is continuous the second thing you can see the involvement is continuous there is no skip areas compare it with series the starting point is terminal ilium and Skip areas are present here here there is no skip areas The Continuous environment sometimes due to continuous involvement it will move backward backward backward and involve the complete colon starting from rectum it will move fast to descending colon and then transverse colon and then ascending colon so all the colons are involved if all the cologne is involved it is known as pancholitis sometimes it leads to pancolitis but after that so it is starting from rectum going to descending colon going to transverse colon going to ascending colon after that sometime it can move to ilium also right for from the terminal helium it will enter in the ilium and start involving ilium in continuation only so once it involves ilium it is known as backwash iliitis ilium is involved but from the backwards it is known as back partialitis so it starts with rectum it will grow grow in continuation it will involve complete rectum when complete colon is involved it is known as pancolitis after colon it can move into ilium and ilium can also be involved in severe cases it is known as back partialitis give me a thumbs up so start from rectum move to pancolitis then back postulated this is the progression of the disease right no Escape areas everything is continuous give me a thumbs up right compare it can you compare yes you can compare CD it's keep areas compare you see it's continuous right so initially rectum then descending colon then transverse colon then ascending colon and then ilium so it is known as pancolitis followed by backward iliitis I guess everyone got it if everyone got it give me a thumbs up let me tell you four or five points in the cross here you already got its continuous involvement right uh if CD occurs now the patient have symptoms continuously but in UC the symptoms are not continuous it is remission and exhibition for few months or few days patients have symptoms for the next few days the patient don't have any symptoms so at separation and remissions are common here here uh the Lumen get widened in contrast to CD where Lumen get narrowed so here Lumen get widened that's why it is known as garden hose pipe appearance or pipe stem appearance it is a widened pipe you got my point compare the two can you compare the two this one a CD I guess this one is UC I guess you all can compare so you can see the skip areas here you can see the continuous involvement here you can see here Lumen is narrow that's why known as hose pipe such a pipe is known as hose pipe and here Lumen is widened so such a pipe is either known as Garden pipe or it is known as pipe stem both the same one and the same I guess you got it right here also ulcers are there but the ulcers are superficial never deep no fissure no fistula no sinus no no ulcers are superficial I will show you in the diagram also the ulcers are typically superficial in contrast to CD where ulcers go deeper deeper deeper and convert into fistula fissure and sinus here no fistula no fissure no sign us no addition because ulcers are not at all deep they are just superficial you got my point so see see here the ulcers are superficial can you make out yes you can make out the ulcers they are very superficial they are superficial they are not deep not so I am cutting the rectum and opening it to show you the ulcers there I have cut the terminal ilium to show you the serpentigenous ulcer here also I am cutting you the rectum not the terminal because the starting point here is rectum so you will get the ulcers and reactor the ulcers are there but the point is that the ulcers are very superficial right the ulcers are very superficial now the again same thing between two adjacent ulcers the normal mucus are swelled up here also the intervening intact mucosa swelled up and it it looks like a polyp it is known as pseudopolyp actually it is not a polyp it it's swelled up yeah can you see here okay let me explain you you can see here is a superficial ulcer between The Superficial this is also a superficial ulcer so between The Superficial ulcer the normal mucosa just swelled up can you see the swelled up mucosa the sweat up so it's look like a polyp but actually it's not polyp so that's why it is known as pseudopolitan and the same thing they are in cereal it was known as Cobalt Stone appearance here the same thing is known as pseudopolis so don't say Cobalt Stone appearance here here say pseudopolyps are present so pseudopolyps are typical finding of UC not CD give me a thumbs up and what is pseudopolyp water pseudopolyp you got it so that is known as pseudopolitan that is the meaning see if you open the rectum sometimes you can get this picture come on on endoscopy you can get this picture you are getting multiple polyps all of them are pseudo-polars they are not real polished they are pseudo polyps actually between two polyps between two adjacent polyps these are the superficial ulcers because of the ulcers the intervening mucosa between adjacent also swelled up I guess and Crystal Clear in my concept right this is known as pseudopolitan right so the same image from the robins also you can see the pseudo polyps you can see the pseudo polyps right so these are the pseudo polyps right in severe cases what happens uh uh due to the pseudopoly the complete colon when pancolysis is there the complete colon is involved and neuromuscular it is just shut up the colon stop working the colon just swells up it is known as toxic megacolon the complete colon just shut up it is not working at all it just swelled up it is known as toxic megacolon and sometimes it can result in carcinoma so UC can result in carcinoma but CD can never be malignant CD can never result in carcinoma you see sometimes can result in carcinoma only in one person cases only in one person cases UC can proceed to carcinoma of colon after pancolitis it can result in toxic Mega colon you can read the word Mega colon Mega colony is complete colon complete colonies pancolitis I guess you can make it all give me a thumbs up give me a thumbs up now we have so can you can you enumerate the gross finding of CD and UC can you enumerate the gross then we will compare the microscopy can you enumerate yes tell me the starting point here starting point here the starting point here is terminal ilium and starting point here is rectum right everyone knows it the next here we have skip areas present here we have continuous involvement not skip areas right the next Point what is the progression here so here uh okay before coming to the ulcers let me tell you okay here we have Serpentine ulcers Serpentine ulcers which become deep after becoming deep they convert into fissure they convert into fistula they converge into sinus and they convert into adhesions right here the ulcers are there but they are not Serpentine the first thing the ulcers are there but the ulcers are very superficial so no Fisher no fistula uh no sinus tract and no additions everything is absent here so what is the course here here after involvement of rackdown it will go in continuity it will involve complete colon the complete colon involvement is known as pancolitis pancholitis pancolitis leads to toxic megapolon toxic Megapolis you got my point and after that it can involve the ilium also backward it is known as backward iliitis so backward iliitis is seen in UC you have to take the words right backward eliitis you got my point so these are the findings you should take in consideration now one more important point we are going to write here between two ulcers the intervening intervening mucosa swells up in both right here it gives Cobalt Stone appearance that that appearance Cobalt Stone appearance and here that appearance is known as pseudopolic you got my point what is Cobalt Stone and pseudopoly one and the same thing between two ulcers the anion Bond mucosa swells up so that appearance here it is known as Cobalt Stone here it is known as pseudo polyps you've got my point right the next is the Lumen size Lumen size is narrowed or widened what is it is it narrowed or is it widened in CD the Lumen is narrow that's why known as host pipe and here the Lumen is white that's why known as Garden pipe I guess you all got the difference am I missing something or I have written all the differences between them so that's how yeah granulomas one more finding granulomas granulomas are present non-case it in granulomas are a finding in CD but not in UC now let's see the microscopic differences with in them so I've already taught you the microscopy of CD let me teach you the microscopy the four features of microscopy of UC don't learn it see in the diagram I always prefer to teach you the things in the diagram not in theory right okay again we will do the same thing we will do the same thing we will start with mucosa we will see where is the mucus are discontinuous so start with mucosa mucosas continuous I guess everywhere it is continuous till it is continuous continuous continuous continuous continuous oh here it is discontinuous here it is discontinuous so I got a ulcer I got a ulcer right so this ulcer but this time this is the ulcer this ulcer is very superficial it is not going deep in contrast to uh Siri it is a superficial answer give me a thumbs up on this point the ulcer is there what is Ulcer that is continuation in mucosa so mucosa is discontinuous but submucosa muscles they are continuous ulcer is not going deep it is not converting into fistula Fisher and blindness no it is not converting right number one number two you can get inflammation here also number two but inflammation is present only in submucosa you can see the inflammation here the complete safe mucosa the cells are there all the cells are neutrophils no if you zoom it out you can see the multi-lobited nucleus they all are neutrophils they are not lymphocyte so inflammation is there but inflammation is also superficial it is not transmural involving all layers I can't see inflammation in muscular dysropia and serosa no inflammation inflammation present only in mucosa and submucosa give me a thumbs up so inflammation is superficial in contrast to Siri where inflammation is transferable give me a thumbs up you got my point sometimes you know what are Crypts these These are known as Crypts Crypts you know Crypts and Belize Krypton Villa I guess you can get it the elevation is the Villi and the depression is the Crypt so elevation is the Villi and depression is the you got it so see the depression where is the depression I can see this is one of the depression so at one of the crypt I got a collection of neutrophone collection of neutrophil is the pus you know so in that CD I have shown you in the diagram granuloma if you remember you can find a collection of epithelioid cell here you are finding a collection of neutrophils so there we find the granulomas here we are finding the abscess what is known as Crypt abscess what it is known as typical finding of UC Crypt abscess so in the Crypt where is the depression wherever the depression is there on the depression we are finding a collection of neurotroper right here only one is shown so it is known as Crypt abscess or cryptitis [Music] itis means inflammation so cryptitis or crypt inflammation is a feature so these are the features of UC so say ulcer is present but it is superficial only mucosa not in DPS right number one number two Crypt abscess is present because of which cryptidus or trip Distortion is there so all these findings are related to using cryptapsis cryptidus Crypt Distortion right right the second binding and third finding you will find the inflammation only superficial not The Superficial inflammation that's it so these are the findings so we are done with CD and using the cross the microscopy everyone give me a thumbs up everyone give me a thumbs up come on do you have any doubt in that I guess no none of you have doubt so see I'm going to explain you something here can you see this is CD this is UC uh everyone knows this point now it is starting with terminal ilium it is starting with rectum I guess everyone knows it and uh here skip areas are there and here continuous involvement is now take a cross section here and take a cross section here you can see the cross section come on everyone here see the cross section see how many ulcers you can find here I can find one answer two other and three other but all the answers are deep going in output can you notice the four layers here notice this is mucosa just below the mucosa there is fat and notice the same four layers here also the four poor layers are shown if you zoom the diagram you can see the folias here see the ulcers are deep and here if you see the ulcers are superficial they are widened but superficial they are wide widths are there but you know depth coming the depth is less I guess I am able to explain you I'm trying hard give me a thumbs up so see the ulcers are deep in CD and the ulcers are superficial in using give me a thumbs up yes yes so here the intervening mucosa swells up and it gives Cobalt Stone between two ulcers the intervening mucous are swells up it gives Cobalts to an appearance here also the intervening mucosa between two ulcers swells up and it gives pseudo polyp appearance I guess I am clear yes so this is how you have to understand the things right can we move ahead can we have you appreciated it yes here also the same skip areas and continuous involvement you can see it right now see back to back uh microscopic picture the CD picture and the UC picture try to appreciate the four layers of the intestine in both of them try to appreciate try to appreciate here see the ulcer is deep the ulcer is deep and here see the ulcer is superficial it is widened but superficial first of all see the answer the second thing see the inflammation here I can find information in all four layers and they all are neutral they all are lymphocytes right here I can find information only in submucosa not in all four years and all of them are neutrophil so see the inflammation here it is transmural here it is superficial also deep converting into fistula fissure sinus ulcer is superficial no fistula no pressure no sinus give me a thumbs up here transmural inflammation lymphocyte here superficial information you got my point one one special finding you can't miss here we can see granulomas and here we can see abscess compare it compare it granuloma is a collection of epithelioid cells and giant cells and abscess is a collection of neutrophils if you zoom out you can make it out and you can draw also in your exam if you're a second of student you have to draw all these things in your exam so this is granuloma but non-case it in granuloma and here we can find crypt capsules script titles script Distortion give me a thumbs up so I guess these features are more important and you can learn this you can excel in your exam yes can we do now the same comparative diagram from the Robles we will finish it up you will tell me all the points so this is CD this is UC now you tell me the Bobble involvement here it start with terminal illium and goes into the colon here it involves with colon and rarely it will come to the ilium back postulated here distribution is skipped here it is continuous pictures can't be present okay where the structures will be present in CD or UC pictures are present structures are present in CD they are absent in UC yes yes absolutely right yes and the ball will become thick or thin as I've told you in Crohn's disease in Crohn's disease the ball become thick that's why the Lumen is narrow the ball the ball of the intestine becomes thick that's why women become narrow host pipe appearance but on the contrary and you see the ball become thinned out that's why darling and it gives Garden pipe so you have to learn the ball whether it is thick or thin right now tell me the next point the inflammation inflammation in which layer here all four layers in CD transmural and here it is limited to mucosa mucosa submucosa that's it so inflammation is transmural it's superficial say yes are present in UC Cobalt Stone appearance is present in Syria but in UC it's pseudopolis right tell me about ulcers here ulcers are deep here ulcers are superficial but broad superficial but brought the witness more say yes say yes uh you tell me where is the granulomas the granulomas fistula sinus Fisher all these things are present in CD but they all are absent in UC yes apart from which adhesions due to additions there is ferocytes fibrosis all these things are present in CD but absent or mild amusing you got my points malignant potential malignant one person get malignant it happens only in UC but there is no malignant potential in CD yes or no toxic Mega colon toxic Megapolis colonies involvement of complete colon pseudo polyps it happens in UC but not in CD so say which things are present in UC which presents are things in present and Theory so this is how you have to differentiate them grossly and as well as microscopically so I'm having few questions for you you have to answer those questions can you tell me the answer of this question easy one I guess it's easy I guess it's easy everyone can answer skip granulomas are a feature of the poor options are in front of you is it UC CD Ripple's disease or reader now the question is only between A and B who will say who will say so yes Osama Ram padmavati everyone is saying the answer is TD yes everyone agrees with them the answer is CD so skipping lessons as well as granulomas two things are asked in the question so yes both things occurs on CD in CD we have skipped lesion also and we have granulomas also both things fit here so yes everyone is right he has priyanshi padmavati everyone Osama is not a it's B I guess you got it yes you realized your mistake it's it's Crohn's disease it's not ulcerative colitis and answer is Crohn's disease can you tell me the next answer so I'm asking about the pseudo polyp so is it CD or UC what you will say TD or UC answer is a or b what is the correct answer pseudopolit in one of them I told you Cobalt Stone appearance and one of them I told you pseudopolyp so yes everyone is right yes everyone is right so the correct answer is you see so you see you will find pseudo polyps so actually between two adjacent ulcers the the non-involved um intervening mucus are swelled up it looks like polyp but it is not a real polyp that's why known as pseudo polyp and it is a feature of UC the same thing happens in CD also but here we don't give the term pseudo polyp we give the term Cobalt Stone appearance right so the correct answer here is B yes yes everyone is right right the next question is in front of you can you tell me the answer toxic Mega colon is read options chronic non-specific ulcerative colitis or Crohn's disease or colonic diabetic losses what do you say toxic the toxic Mega colon is involvement of complete colon with pseudopolypsy so yes you all are right it happens in UC it happens in ulcerative colitis so this is how these are your pyqs from various exams can you tell me the next question skip involvement along with caller studied ulceration right along with that's it so collar stud ulceration is deep ulceration deeper so skip involvement with deep ulceration it is a feature of TB intestine ulcerative colitis intestinal amoebar Crohn's disease now currently the answer is very easy for all of you for all of you the answer is very easy because currently you have just read it but once you will be reading all these diseases now you will get confused so I'm telling you yes the answer will be D yes very good now I'm sorry Paul understood okay skin involvement it was not skipped I misread it actually it is not skip it is skin involvement actually uh in ulcerative colitis along with intestine the extra intestinal manifestation of skin involvement the skin is also involved I've misread it I am sorry it is not skip involvement it is skin involvement yes so skin involvement along with collar stud ulceration color stud is superficial ulceration so answer is B I misread it the answer is B naughty you got it answer is B is it clear to you the answer is B yes yes yes you see my skin involvement so can you tell me the next question true about ulcerative colitis all except so what is not true about ulcerative colitis what is false about ulcerative colitis can you tell me the answer read it rectum involvement is it true or false I guess it is true rectum involvement happens in ulcerative colitis pseudopolip is it true or false it is also true pseudopolyps are formed in ulcerative colitis pancolitis yes it is a also true the complete colon gets involved it is pan collages after that back partially items but non-case no no no no it is false it is a feature of CD not COC so I will go with d yes what about you what about you so yes everyone will go with the D Ram you are saying C or D I guess the answer is D yes pancolitis happens and you see yes yes it's D right the next one try this one try this one all the best for this one so which of the following is true about UC which of the following is true about you see tell me one of them is true so about you see I'm asking it start with rectum and then involve the whole colon backward is it true or it involved colon only is it true skip lesions are seen is it true or ilium not involved what is true what is true I'm asking what is true about ulcerative colitis so ulcerative colitis knows separations are not seen they are a feature of CD ilium not involved it doesn't happen sometime backwards happens I told you rarely rarely in one person cases but it happens so it starts from rectum go backward backward backward backward backward involve the descending colon transfers colon ascending colon and then after tranquilizers it moves to the ilium it is known as backwash so ilium not involved this is this is not true it involves okay it involves only colon no it is also not true sometime it involves ilium also so I will go with it I guess everyone will go with it it circuits okay uh if you're doing mistake here now Ram I'm happy that you are doing the mistake here if you do the mistake here now you will not repeat the mistakes they mistaken exam so whatever mistakes you want to do do it here only it is your practice session right so you will commit mistakes here you will learn from your mistakes once you will do your mistake now it will fit in your permanent memory I have done this question wrong and this time I have to do it right okay so don't worry if you're doing the mistakes stay happy you are learning from it that is more important anyways the next question can you tell me anti-sacchus attack Services antibodies are senior so it is a fungus so antibodies against fungus are seen in CD Scleroderma SL your geography yes where you can see yes correct so the correct answer here is a everyone is right yes yes very good very good so thank you very much for being with me and I would like to stop here yes everyone is right so if you still have any doubt you can contact me on my personal contact number it's 9833-032948 if you have any study related doubt regarding your timetable regarding patho Pharma micro PSM any doubts so you can ask me there don't forget to tell me your college name your University and your probable exam dates what exam you are targeting you are targeting second prop exam or you are targeting some competitive exam or both so kindly let me know I can tailor I can give you a tailored Dr gram for you you know a specific program just for you so I can help you for that so once you send me the message either on the WhatsApp or on telegram don't call just send a message so I will get back to you maybe it will take a day or two but definitely I will get back to you as soon as I will get the time right you can contact me regarding study related doubts here and uh yeah on huge demand of students throughout the country throughout the globe many students previously I taught PSM also in multiple batches but currently last few months I'm not taking sessions on PSM so many students are upset especially those who are on third prop who have already studied from me in the second prop and now they passed second prop with good gold medal distinction and now they move to the third prop now they demanded me that I should teach PSM also to them so I'm launching a new free batch the free batch for the PSM next week so if you all are interested you can attend the session of PSM also right many of you maybe heard prop or finally are preparing for the competitive exam if your second prop and currently you are not interested for studying PSM from me next year you will be interested so you can give this information to your seniors at least all those students who are and third prop so in this free batch of PSM I am going to cover all the short questions all the long questions important topics of PSM for their University exams number one and also for the competitive exam all the mcqs will be covered so both ways it is useful so if you are preparing for your need PG next inicity you know USMLE any of the competitive exam PSM is a major subject you guess at least 35 to 40 questions come from this this subject the only subject right so I'm going to take this complete batch for you all uh okay so okay done so we can do that so please help me in uh spreading this information to all your seniors colleagues batchmates Juniors all the Medicals who are interested to study PSM from me you can send me a list of the topics of the PSM which you want to be launched in three sessions on YouTube you are free to do that so I will I will make a WhatsApp group so I will send you a link the WhatsApp link the invite link you're on on the or wherever you are all are there I will send you on your WhatsApp group that the new link and uh on the telegram let us PSM by Dr Priyanka you have to share that link with all the Medicals who are interested to study PSM from me and the batches are starting from Monday that is 3rd October right so from third October I will send the schedule also thank you very much for being with me here in the comment section there is one more link given that is the link tree so I am available on Instagram on telegram on WhatsApp on Facebook everywhere you can join me all the links are given there on WhatsApp groups also so you can join me wherever you want thank you very much God all the buzz wishing you all the best for your exams and today is a new day every new Day Day brings new Energy new homes so study hard whatever is your target for today now just finish it before sleeping that's the only message I want to give you today bye bye I'm ending this session