IBD.ppt_20231116_185424_٠٠٠٠.pdf

Inflammatory Bowel Disease Dr. Husham Aldaoseri 15.Nov. 2023 Inflammatory Bowel Disease Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease Pretest 1: What % of IBD is regarded to be intederminate: A.90% B. 70% C.10%. D.20%. E.0%. Pretest 2: Appendisectomy...

Inflammatory Bowel Disease Dr. Husham Aldaoseri 15.Nov. 2023 Inflammatory Bowel Disease Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease Pretest 1: What % of IBD is regarded to be intederminate: A.90% B. 70% C.10%. D.20%. E.0%. Pretest 2: Appendisectomy in crease the risk of: A.UC B. CD C. Both. D. Neither. Pretest 3: Smoking: A. Increase the risk of UC. B. Protect against UC. C. Protect against CD. D. ALL. E. None. Inflammatory Bowel Disease Two chronic diseases that cause ulceration & inflammation of the intestines Ulcerative Colitis Crohn's Disease. Inflammatory Bowel Disease They have some features in common but there are some important differences 20% of patients have clinical picture that falls in between (indeterminate colitis) Epidemiology Most numbers are North American Pathophysiology Current Theory: There is a genetic defect that affects the immune system, so that it attacks the bowel wall in response to stimulation by an offending antigen, like a bacteria, a virus, or a protein in the food Ulcerative Colitis An inflammatory disease of the large intestine Recurring Inflammation and ulceration of the mucosa of the large intestine Almost always involve the rectum and extend proximally Ulcerative Colitis It extends in a continuous fashion 40-50% of patients have disease limited to the rectum and rectosigmoid 30-40% of patients have disease extending beyond the sigmoid 20% of patients have a total colitis Ulcerative Colitis Macroscopic Appearance Erythematous mucosa, has a granular surface, looks like sand paper In more severe diseases hemorrhagic, edematous and ulcerated In fulminant disease a toxic colitis or a toxic megacolon may develop Ulcerative Colitis Ulcerative Colitis Ulcerative Colitis Presentation The major symptoms of UC are: Diarrhea (4 to more than 10) Rectal bleeding Tenesmus & Passage of mucus Crampy abdominal pain & Fever Exam is often normal unless complications occur. Ulcerative Colitis Complications Hemorrhage Toxic megacolon Perforation Stricture Cancer Ulcerative Colitis Extra-intestinal manifestations Uveitis and Episcleritis Erythema Nodosum and Pyoderma Gangrenosum Arthritis Ankylosing Spondylitis Sclerosing cholangitis Oral signs of IBDs including pyostomatitis vegetans chronic stomatitis aphthous ulcerations cobblestone appearance of the oral mucosa oral epithelial tags and folds Gingivitis persistent lip swelling lichenoid mucosal reactions granulomatous inflammation of minor salivary gland ducts candidiasis angular cheilitis Ulcerative Colitis Treatment Mainly medical treatment Ulcerative Colitis Treatment Mainly medical treatment Surgical treatment: Failure of medical management Treating complications Prophylaxis for cancer Cure after colectomy Crohn’s Disease An inflammatory disease that affects any part of the GI tract Recurring transmural Inflammation of the bowel About 80% have small bowel involvement, mostly the terminal ileum Crohn’s Disease Characterized by skip lesions 30-40% of patients have small bowel disease alone 40-55% of patients have both small and large intestines disease 15-25% of patients have colitis alone Crohn’s Disease Macroscopic Appearance Mild disease has aphthus or small superfecial ulcers In more severe diseases there is the characteristic cobblestone appearance Thickening of the bowel wall with creaping fat Crohn’s Disease Crohn’s Disease Crohn’s Disease Microscopic Appearance Transmural inflammation Focal ulcerations Acute and chronic inflammation Granulomas may be noted in up to 30 percent of patients Crohn’s Disease Presentation The major presentations of CD are: Crampy abdominal pain Diarrhea Weight loss Colitis and Perianal disease Dudenal Disease Crohn’s Disease Complications Abcesses Fistulas Stricture Malabsorption Perianal disease Cancer risk Crohn’s Disease Extra-intestinal manifestations Uveitis and Episcleritis Erythema Nodosum and Pyoderma Gangrenosum Sclerosing cholangitis Renal stones Gall stones Amyloidosis Laboratory Rise in acute-phase reactants [C-reactive protein (CRP)], platelet count, erythrocyte sedimentation rate (ESR), and a decrease in hemoglobin. Fecal lactoferrin is a highly sensitive and specific marker for detecting intestinal inflammation. Fecal calprotectin levels correlate well with histologic inflammation, predict relapses. Laboratory In severely ill patients, the serum albumin level will fall rather quickly. Leukocytosis may be present but is not a specific indicator of disease activity. Crohn’s Disease Treatment Mainly medical treatment: Oral 5-aminosalicylates (sulfasalazine) Antibiotics (Cipro, Metronidazole) Glucocorticoids (Prednisone) Immunomodulators (Azathioprine) Biologic therapies (infliximab) Crohn’s Disease Treatment Mainly medical treatment Surgical treatment: Failure of medical management Treating complications Not a Cure Inflammatory Bowel Disease UC Crohn’s disease Blood in stool Yes Occasionally Mucus Systemic symptoms Pain Abdominal mass Perineal disease Yes Occasionally Occasionally Frequently Occasionally Frequently Rarely Yes No Frequently Inflammatory Bowel Disease Fistulas Small intestine obstruction Colonic obstruction Response to antibiotic Recurrence after surgery UC Crohn’s disease No Yes No Frequently Rarely Frequently No Yes No Yes Inflammatory Bowel Disease UC Crohn’s disease Rectal sparing Rarely Frequently Continuous disease Yes Occasionally „cobblestoning” No Yes Granuloma on biopsy Occasionally No Questions?