Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD)

• IBD is a chronic inflammatory condition affecting the gastrointestinal (GI) tract, predominantly the intestines
• It is more common in women, Caucasians, people of Jewish descent, and smokers
• IBD includes Crohn's disease and ulcerative colitis, both marked by exacerbations and remissions
• The believed cause is a genetically-linked autoimmune response triggered by infection
• Immune cells within the intestinal mucosa release inflammatory mediators that disrupt neural activity and alter secretory and smooth muscle function
• The condition leads to imbalances in fluids, electrolytes, and pH due to diarrhea and constipation, causing pain and possibly life-threatening complications
• A colonoscopy is necessary to differentiate between Crohn's disease and ulcerative colitis

Crohn's Disease

• Affects the full thickness of the intestinal wall, from the mucosa to the visceral layer
• The inflammation can skip areas, not necessarily continuous
• It can affect any part of the GI tract, from mouth to anus
• It is commonly found between the large and small intestines
• Is highly associated with anal fissures

Ulcerative Colitis

• Causes partial thickness inflammation, affecting only the superficial layers of the mucosa and submucosa
• The inflammation is continuous, without skipping areas
• Always involves the rectum and large intestine
• Associated with a high risk for colon cancer
• Patients should undergo a screening colonoscopy eight years after diagnosis to check for colon cancer, regardless of age

Complications of IBD

• Malnutrition due to malabsorption syndrome
• Anemia, resulting from bloody diarrhea
• Intestinal obstruction
• Anal fissures
• Delayed growth and development, especially in children
• Fluid and electrolyte imbalances, due to diarrhea
• In ulcerative colitis, risk of colorectal cancer

Manifestations of IBD

• Include abdominal cramping and pain
• Diarrhea, bloody stool
• Weight loss
• Elevated inflammatory markers
• Diagnosed via stool sample analysis
• Colonoscopy with biopsy is the primary diagnostic tool
• Treatment involves a low-residue, high-calorie, high-protein diet
• Supplementation with multivitamins
• Various anti-inflammatory medications are available

Irritable Bowel Syndrome (IBS)

• Is a chronic, non-inflammatory GI condition, characterized by flare-ups associated with stress
• Includes altered bowel patterns and abdominal pain not explained by structural or biochemical abnormalities
• Less severe than IBD and doesn't cause permanent intestinal damage
• More common in women
• Can be triggered by stress, certain foods (alcohol, dairy, chocolate, caffeine, high-fiber foods), hormonal changes, and GI infections
• Clinical manifestations of IBS include changes in stool pattern and consistency (diarrhea, constipation)
• Symptoms are exacerbated by eating and relieved by defecation
• Diagnosis is based on history and physical examination
• Rome III criteria helps determine diagnosis, involving 12 weeks within 12 months of abdominal pain or discomfort with two of three features: relief by defecation, onset associated with changes in stool frequency, or changes in stool form/appearance
• Other symptoms supporting diagnosis include abnormal stool frequency, abnormal stool form, abnormal stool passage (straining, urgency), mucus, bloating, and abdominal distention
• Treatment involves managing symptoms and addressing psychological factors like stress and depression

Diverticular Disease

• Relates to diverticula, outward bulging pouches in the intestinal wall, formed when mucosal or submucosal layers herniate through weakened muscle
• Can be congenital but often acquired
• Caused by low-fiber diets and poor bowel habits leading to chronic constipation and straining
• The muscular wall weakens due to prolonged effort to move hard stools
• More common in developed countries with processed foods and low-fiber diets

Diverticulosis

• Asymptomatic diverticular disease characterized by the presence of multiple diverticula
• Can be detected via abdominal CT scans both inside the colon with a colonoscopy, and on the outside with an abdominal CT scan

Diverticulitis

• Inflammation of diverticula, usually caused by trapped fecal matter
• Can result in obstructions, infection, abscess, perforation, peritonitis, hemorrhage, and shock.
• Often asymptomatic until the condition becomes serious
• Manifestations include abdominal cramping, bloody stools, low-grade fever, abdominal tenderness (usually in the left lower quadrant), abdominal distension, constipation, nausea, vomiting, and a palpable abdominal mass
• Leukocytosis is common due to inflammation or infection
• More common in older populations
• Diagnosis involves history, physical exam, stool analysis, and abdominal CT scan
• Treatment includes increased fiber intake, decreased food intake during bleeding, hydration, stool softeners
• Antibiotics for diverticulitis infection
• Analgesics for pain
• Colon resection may be necessary in severe cases

Appendicitis

• Inflammation of the appendix, often caused by fecal impaction
• The appendix fills with fluid, leading to microorganism proliferation
• Decreased perfusion can lead to ischemia and necrosis
• Pain develops, possibly excruciating
• If untreated, pressure escalates, forcing bacteria and toxins out, leading to abscess, peritonitis, gangrene, and possibly death
• More common in young males
• Manifestations range from asymptomatic to sudden, severe abdominal pain that intensifies over 12-18 hours
• Pain localizes to the lower right quadrant of the abdomen (McBurney's point)
• Pain may subside temporarily if the appendix ruptures, then returns severely
• Additional symptoms include nausea, vomiting, bowel pattern changes, fever, chills, and leukocytosis
• Rupture can lead to peritonitis, abdominal rigidity, tachycardia, and hypotension, potentially causing obstruction
• Urgent diagnosis and treatment are crucial
• Diagnosed through physical examination, complete blood count, abdominal ultrasound (especially in pregnancy), and abdominal CT scan
• Requires surgical intervention, either laparoscopic or open appendectomy