Inflammatory Bowel Disease (IBD) Overview

Inflammatory Bowel Disease (IBD)

• Chronic inflammation of the GI tract, especially the intestines.
• More prevalent in women, Caucasians, individuals of Jewish descent, and smokers.
• Encompasses Crohn's disease and ulcerative colitis.
• Characterized by periods of exacerbation and remission.
• Believed to stem from genetically-linked autoimmune reactions triggered by infection.
• Immune cells within the intestinal mucosa release inflammatory mediators.
• These mediators impact secretory and smooth muscle function and neural activity.
• Can result in fluid, electrolyte, and pH imbalances due to diarrhea and constipation.
• Colonoscopy is essential to differentiate between Crohn's disease and ulcerative colitis.

Crohn's Disease

• Affects the full thickness of the intestinal wall.
• Can affect any part of the GI tract from mouth to anus.
• Often presents with anal fissures.
• Inflammation can occur in discontinuous patches, "skipping" areas.
• Common in both the large and small intestines.

Ulcerative Colitis

• Involves partial thickness inflammation, affecting only the innermost layers.
• Inflammation is continuous, without skipping areas.
• Always involves the rectum and large intestine.
• Associated with a higher risk of colon cancer, necessitating screening colonoscopies eight years post-diagnosis.

Complications of IBD

• Both Crohn's and Ulcerative Colitis:
  • Malnutrition due to malabsorption.
  • Anemia, often due to bloody diarrhea.
  • Intestinal obstruction.
  • Anal fissures.
  • Delayed growth and development (particularly in children).
  • Fluid and electrolyte imbalances.
• Ulcerative Colitis also carries a risk of colorectal cancer.

Manifestations & Diagnosis of IBD

• Manifestations:
  • Abdominal cramping and pain.
  • Diarrhea.
  • Melena (dark, tarry stools containing blood).
  • Weight loss.
  • Inflammatory markers.
• Diagnosis:
  • Stool sample analysis.
  • Colonoscopy with biopsy is the primary diagnostic tool.

Treatment of IBD

• Dietary adjustments:
  • Low-residue diet.
  • High-calorie intake.
  • High-protein intake.
• Supplements:
  • Multivitamins.
• Medications:
  • Anti-inflammatory drugs.

Irritable Bowel Syndrome (IBS)

• Chronic non-inflammatory GI disorder.
• Characterized by flare-ups linked to stress.
• Involves altered bowel patterns and abdominal pain.
• Not caused by structural or biochemical abnormalities.
• More common in women.
• Triggers include stress, food, alcohol, dairy, chocolate, carbonation, high fiber foods, and hormonal changes.
• May be linked to GI infections.

Clinical Manifestations of IBS

• Changes in stool pattern and consistency.
• Symptoms exacerbated by eating.
• Symptoms relieved by defecation.

Diagnosis and Criteria for IBS

• Diagnosis is made primarily through a history and physical exam.
• Rome III criteria:
  • Recurrent abdominal pain or discomfort for at least 3 months, with onset at least 6 months prior to diagnosis.
  • Associated with two or more of the following:
    • Improvement with defecation.
    • Onset associated with a change in stool frequency.
    • Onset associated with a change in stool form (appearance). Symptoms that support diagnosis:
  • Abnormal stool frequency (more than 3 bowel movements/day or less than 3 bowel movements/week).
  • Abnormal stool form (lumpy/hard or loose/watery).
  • Abnormal stool passage (straining, urgency, feeling of incomplete evacuation).
  • Mucus in stool.
  • Bloating or abdominal distension.
• Treatment focuses on symptom management and psychological support.

Diverticular Disease (Diverticulosis & Diverticulitis)

• Diverticula are outward bulging pouches in the intestinal wall.
• Occur when mucosal sections herniate through weakened muscle layers.
• Can be congenital but is often acquired.
• Risk factors include low-fiber diet and poor bowel habits leading to chronic constipation.
• More common in developed countries with diets low in fiber and high in processed foods.
• Diverticulosis is asymptomatic with multiple diverticula present.
• Diverticulitis involves inflamed diverticula, often due to trapped fecal matter
• Diverticulitis can lead to obstructions, infection, abscess, perforation, peritonitis, hemorrhage, and shock.

Diverticular Disease Manifestations

• Often asymptomatic.
• Abdominal cramping.
• Blood in stool.
• Low-grade fever.
• Abdominal tenderness, often in the left lower quadrant.
• Abdominal distension.
• Constipation.
• Nausea and vomiting.
• Palpable abdominal mass.
• Leukocytosis.
• Diagnosis involves history, physical exam, stool analysis, and abdominal CT scan.
• Treatment involves increasing fiber, decreasing food intake, hydration and stool softeners.
• Diverticulitis requires antibiotics and analgesics; severe cases may need colon resection.

Appendicitis

• Inflammation of the vermiform appendix.
• Linked to impaction.
• Fluid and microorganisms proliferate inside the appendix.
• Appendix fills with purulent exudate (pus), compressing blood vessels.
• Leads to decreased perfusion, ischemia, and necrosis.
• If untreated, escalating pressure inside appendix can force bacteria and toxins into other structures.
• Severe complications include abscess, peritonitis, gangrene, and death.
• More common in young males.

Appendicitis Manifestations

• Can vary from asymptomatic to severe.
• Sharp abdominal pain develops gradually, intensifying over 12-18 hours.
• Pain localizes to the right lower quadrant (McBurney's point).
• Pain may temporarily subside if the appendix ruptures, then return and escalate.
• Nausea, vomiting, bowel pattern changes.
• Signs of inflammation: fever, chills, leukocytosis.
• Peritonitis if the appendix ruptures.
• Urgent diagnosis and treatment are crucial.

Appendicitis Diagnosis and Treatment

• Diagnosis involves:
  • History and physical exam.
  • Complete blood count (CBC).
  • Abdominal ultrasound (if pregnant).
  • Abdominal CT scan.
• Treatment requires surgical removal of the appendix (appendectomy) via laparoscopic or open surgery.