Lect 9 Disorders of Large intestine .pdf

Disorders of the Large Intestines Inflammatory Bowel Disease, Diverticulosis, Ostomies (Lower GI Surgeries), and SBS Chapter 15 Lecture # 9 Disorders of the Small Intestines • • • • Inflammatory Bowel Disease - IBD Diverticulosis Ostomies (Lower GI Surgeries) Short Bowel Syndrome - SBS Inflamma...

Disorders of the Large Intestines Inflammatory Bowel Disease, Diverticulosis, Ostomies (Lower GI Surgeries), and SBS Chapter 15 Lecture # 9 Disorders of the Small Intestines • • • • Inflammatory Bowel Disease - IBD Diverticulosis Ostomies (Lower GI Surgeries) Short Bowel Syndrome - SBS Inflammatory Bowel Disease (IBD) • Definition – Autoimmune, chronic inflammatory condition of GI tract • 2 Types – Crohn’s Disease – Ulcerative Colitis • Factors – Environmental – Genetic Inflammatory Bowel Disease Crohn’s Ulcerative Colitis • • • • • • • • • • • Any part of the GI tract Segmental All layers of the mucosa Steatorrhea Strictures or obstruction Fistula Slow progression Involves the colon Continuous Inflamed mucosa Rectal bleeding & bloody diarrhea • Strictures & fistulas rare • Remissions & relapse • Malignancy common Disease Pathogenesis of IBD Inflammatory Bowel Disease (IBD) • Signs and Symptoms – – – – – – – – Abdominal pain Food intolerances Diarrhea, bloody diarrhea more common in UC Fever Urgency for defecation (tenesmus) Weight loss Malnutrition Growth failure Inflammatory Bowel Disease (IBD) • Labs – serum levels to assess for inflammation, anemia and other markers – – – – Cytokines (IL or TNF) C-reactive protein WBC Anemia • Imagining – CT, MRI, ultrasound • Endoscopic procedures ‫إجراءات باملنظار‬ For Ulcerative colitis – Upper endoscopy or colonoscopy IBD Medical Treatment Crohn’s • Medications – – – – Anti-inflammatory Immunosuppressive Corticosteroids Antibiotics • Surgery – Ileostomy – No cure Ulcerative Colitis • Medications – – – – Anti-inflammatory Immunosuppressive Corticosteroids Antibiotics • Surgery – Total colectomy – Problem solved Diverticulosis/Diverticulitis • Definition – Abnormal presence of outpockets or pouches (diverticular) on surface of SI or colon – Inflammation of the diverticula • Historically associated with: – low fiber intake, history of constipation, increased colonic pressure • Other risk factors - LIFESTYLE – obesity, sedentary, steroids, alcohol and caffeine intake, cigarette smoking Diverticulosis Diverticulosis/Diverticulitis • Development of pouches • Fecal matter trapped, excessive pressure against walls of colon • Diverticulitis: pouches become inflamed • Bleeding abscess, obstruction, fistula, perforation ‫تصبح األكياس ملتهبة‬ ‫ ثقب‬,‫ ناسور‬,‫ انسداد‬,‫خراج نزيف‬ Diverticular Disease • Diverticulosis – An abnormal presence of outpockets or pouches (diverticula) on the surface of the SI or colon – S/S • Asymptomatic • Dx’d with Diagnosis with… colonoscopy • Diverticulitis – Inflammation of the diverticula • Bleeding • Perforation • Obstruction • Infection • Sepsis ‫تسمم الدم‬ – S/S • Fever, abdominal pain, GI bleed, elevated WBC Diverticular Disease • Medical Treatment – Acute – NPO with bowel rest – Antibiotics – Surgical resection ‫استئصال الجراحي‬ …‫ماهي أسباب العمليات الجراحية في‬ Lower GI Surgeries • • • • • • Crohns UC Diverticulitis Colon Cancer SBS Volvulus Short bowel syndrome ‫التواء األمعاء‬ – twisting of the bowel Lower GI Surgeries Small opening Creation of a Stoma • Ileostomy – Removal of colon and rectum – An opening or outlet for intestinal waste created to bring a portion of the ileum through the abdominal wall ‫تم إنشاؤها لجلب جزء من اللفائفي من خالل جدار البطن‬ • Colostomy – Removal of rectum – An opening or outlet for intestinal waste created to bring a portion of the colon through the abdominal wall Surgical Options for Treatment of Ulcerative Colitis Short Bowel Syndrome • Definition – Decreased digestion and absorption that results from large resection of the small intestine • Etiology ‫قطع كبير لألمعاء الدقيقة‬ – Extensive loss of surface area with malabsorption of nutrients, fluids, electrolytes Etiology of Short Bowel Syndrome in Children and Adults Children Necrotizing Necrosis - ‫موت الخاليا‬ enterocolitis ‫التهاب األمعاء‬ Volvulus Trauma Crohn’s disease Radiation enteritis It is characterized by in ammation and damage to the tissues of the intestine, speci cally the colon and small intestine. NEC can lead to tissue death (necrosis) and perforation of the intestinal wall Adults Crohn’s disease Radiation enteritis Massive surgical resection Cut a part of organ or tissue Malignancy Trauma Volvulus SB Fistulas Small bowel stula Clinical Consequences of SBS < 60 cm Short Bowel Syndrome ‫تخمني مسار املرض‬ • Prognosis depends on length of remaining small bowel, health of remaining GI, any comorbid conditions • Major vitamin and mineral losses • Fat malabsorption affecting vitamins A, D, E, K • Sodium, magnesium, iron, zinc, selenium, calcium loss ‫ وأي أعراض مشتركة‬،‫ وصحة الجهاز الهضمي املتبقية‬،‫طول األمعاء الدقيقة املتبقية‬ ‫الظروف املرضية‬ Short Bowel Syndrome • 7-10 days after surgery: extensive fluid and electrolyte losses, large volume of diarrhea, TPN • Months after surgery: reduced diarrhea volume, adaptation of remaining bowel, enteral nutrition transition to oral diet • One to two years after surgery: continued adaptation of bowel, intestinal tract increases in length and diameter, and villous height ‫يزداد حجم املسالك املعوية في الطول والقطر واالرتفاع الزغبي‬ Short Bowel Syndrome - Treatment • Manage fluid and electrolytes • Oral rehydration solutions • Medications for motility and diarrhea and gastric hypersecretion Motility is decreased ‫فرط إفراز املعدة‬ Summary • Inflammatory Bowel Disease can be one of two different diseases – CD and UC • Many people aren’t even aware that they have Diverticulosis until it becomes Diverticulitis • Many disorders of the lower GI require surgery to resolve. • Knowing how much of the bowel remains after surgery will be important for nutritional recommendations