Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD)

• Chronic inflammation of the GI tract, typically affecting the intestines
• More prevalent in women, Caucasians, individuals of Jewish descent, and smokers
• Crohn's disease and ulcerative colitis are the two main types of IBD
• Characterized by exacerbations and remissions
• Believed to be caused by a genetically-associated autoimmune response triggered by an infection
• Immune cells in the intestinal mucosa release inflammatory mediators, altering function and neural activity of secretory and smooth muscle
• Fluid, electrolyte, and pH imbalances may result from diarrhea and constipation
• Colonoscopy is necessary to differentiate between Crohn's disease and ulcerative colitis

Crohn's Disease

• Can affect the full thickness of the intestinal wall
• Can skip areas, meaning it doesn't have to be continuous
• Can affect anywhere from the mouth to the anus
• Common between the large and small intestine
• Highly associated with anal fissures

Ulcerative Colitis

• Affects only partial thickness of the intestinal wall
• Always continuous, doesn't skip spots, unlike Crohn's disease
• Always involves the rectum and large intestine
• High risk for colon cancer
• Patients need to get a colonoscopy eight years after diagnosis to screen for colon cancer

Complications of IBD (Both Crohn's and Ulcerative Colitis)

• Malnutrition due to malabsorption
• Anemia, often caused by bloody diarrhea
• Intestinal obstruction due to inflammation
• Anal fissures
• Delayed growth and development, particularly in children
• Fluid and electrolyte imbalances due to diarrhea
• Increased risk for colorectal cancer (primarily Ulcerative Colitis)

Manifestations of IBD

• Similar for both Crohn's and Ulcerative Colitis
• Abdominal cramping and pain are common
• Diarrhea
• Melena, or dark stools
• Weight loss
• Indications of inflammatory markers

Diagnosis & Treatment of IBD

• Diagnosis is through stool sample, but the main diagnostic tool is colonoscopy with biopsy
• Treatment includes a low-residue, high-calorie, high-protein diet
• Supplements such as multivitamins are recommended
• Anti-inflammatory medications are commonly used

Irritable Bowel Syndrome (IBS)

• A chronic non-inflammatory GI condition
• Characterized by exacerbations associated with stress
• Alteration in bowel pattern and abdominal pain
• Not explained by any structural or biochemical abnormalities
• More common in women
• Thought to be triggered by stress, certain foods, alcohol, dairy, chocolate, carbonation, high-fiber foods, hormone changes, or GI infections
• Less serious than inflammatory bowel disease, does not cause permanent intestinal damage

Clinical Manifestations of IBS

• Change in stool pattern and consistency, diarrhea constipation, diarrhea and or constipation
• Symptoms exacerbated by eating
• Symptoms relieved by defecation

Diagnosis & Treatment of IBS

• No specific tests or exams come back positive
• Diagnosis is based on history and physical examination
• Rome III criteria are used to determine if someone has IBS
• Rule out any other conditions
• Criteria involves abdominal pain or discomfort for 12 weeks within 12 months, not necessarily consecutive, with two of three features: relieved by defecation, onset associated with changes in stool frequency, or stool form/appearance
• Treat symptomatically and psychologically

Diverticular Disease

• Conditions related to the development of diverticula
• Characterized by outward bulging pouches of the intestinal wall
• Occurs when mucosal sections or large intestine submucosa layers herniate through a weakened muscle layer
• Can be congenital but often acquired through a lifetime
• Caused by a low-fiber diet and poor bowel habits that result in chronic constipation and straining
• More common in developed countries where processed foods are common and low-fiber diets aren't unusual
• Muscular wall can become weakened from prolonged effort to move hard stools

Diverticulosis

• Asymptomatic diverticular disease
• Typically multiple diverticuli are present

Diverticulitis

• Diverticuli become inflamed, usually because fecal matter gets stuck in them
• Can result in potentially fatal obstructions, infection, abscess, perforation, peritonitis, hemorrhage, and shock
• Often asymptomatic until the condition becomes serious

Manifestations, Diagnosis & Treatment of Diverticular Disease (Diverticulosis and Diverticulitis)

• Abdominal cramping, possible low-grade fever
• Abdominal tenderness, usually in the left lower quadrant
• Abdominal distension, constipation
• Nausea and vomiting
• Palpable abdominal mass if large enough
• Abdominal CT scan is how it is found
• Increase fiber intake, decrease food intake
• Hydration and stool softeners
• Diverticulitis includes antibiotics for infection and analgesics for the pain
• Colon resection is sometimes necessary

Appendicitis

• Inflammation of the vermiform appendix
• Most often caused by fecal impaction
• Fluid builds inside the appendix
• Microorganisms proliferate
• Appendix fills with purulent exudate, or pus
• blood vessels become compressed
• Ischemia and necrosis develop
• If not treated, pressure inside the appendix escalates and bacteria and toxins are forced out to other structures
• Can have severe complications if not treated, including abscess, peritonitis, gangrene, and death
• Common in young boys

Manifestations of Appendicitis

• Abdominal pain that develops gradually and intensifies over 12-18 hours
• Pain is usually located in the lower right quadrant of the abdomen
• Pain may radiate to anywhere in the abdomen and temporarily subside if the appendix ruptures
• Nausea, vomiting, bowel pattern changes, fever, chills, and leukocytosis
• If the appendix bursts, symptoms of peritonitis may appear

Diagnosis & Treatment of Appendicitis

• Diagnosis by history and physical examination, complete blood count, and abdominal ultrasound (if pregnant)
• Abdominal CT scan is commonly used
• Surgery is required, either laparoscopic or open