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Inflammatory Bowel Disease (Pathophysiology (Inflammatory mediators (Th-1 …
Inflammatory Bowel Disease
Overall
Idiopathic disease
Dysregulated immune response to host intestinal microflora
More prone to malignancy
Divided into
Ulcerative collitis
Limited to colon
Always involving rectum
Depth
Mucosa
Submucosa
Crohn disease
Skip lession from GI tract from mouth
Extraintestinal manifestation
Oral aphthae
Erythema nodosum
Large-joint arthritis
Episcleritis
History
Abdominal symptoms
Diarrhea
Faeces with mucus without blood or pus
Hve symptoms of Inflammatory Bowel Syndrome
Cramping
Irregular bowel habits
Recurrent abdominal pain
Right lower quadrant - Chron's disease
Periumbilical/left lower quadrant - Moderate to severe UC
Systemic symptoms
Weight loss
Fever
Sweats
Malaise
Arthralgias
Low grade fever --> Flare
Anemia
Recurrence occur with
Emotional stress
Infections
Pregnancy
Dietary problems
Use of cathartics or antibiotics
Physical examination
Depends on Severity
Tachycardia
Dehydration
Toxicity
Pallor --> anemia
Fever
Toxic megacolon
Septic
High fever
Lethargy
Chills
Tachycardia
Increasing abdominal pain
Ternderness
Distension
Crohn's disease
Mass in right lower quadrant
Perianal complication - 90% prevalence
Perianal fissures
Fistulas
Abscessess
Rectal prolapse
Differential diagnosis
Pathophysiology
Disruption of epithelial barrier integrity
Deficits in autophagy
Deficiencies in innate pattern recognition
Problem with lymphocyte differentiation
Inflammatory mediators
Th-1 --> Crohn disease
Th-2 --> Ulcerative collitis
Types
Ulcerative colitis
Inflammation
Begin in rectum, isolated in rectum 25%
Extends proximally
Uninterupted lesion
Until proximal colon - Pancolitis (10%)
No skip lesion,unless pretreated
Depth: Mucosa and submucosa
Chronic appearance
Rigid tube - lead pipe appearance (Barium enema)
Crohn disease
Affect any portion of gastrointestinal tract
From mouth
to anus
Area
By prevalence
Ileum and colon (35%)
Solely in colon (32%)
Small bowel (28%)
Gastroduodenal region (5%)
3 pattern of involvement
Inflammatory disease
Strictures
Fistulas
Nonspecific granulomatous inflammatory process
Depth: transmural
Discontinuous - skip areas
Late appearance - Cobblestone appearance
Symptoms
Above location
Diarrhea
Cramping
Abdominal pain
Gastroduodenal region
Anorexia
nausea
vomitting
Complications
Cholelithiasis
Malabsorption of fat and bile salts
Increased cholesterol concentration in bile
Nephrolithiasis
Crohn disease with
Ileal disease
Ileal resection
Fat malabsorption
Bind calcium in the lumen
Etiology
Mechanism
Altered, dysregulated immune response
Altered response to gut microorganism
Genetic predisposition
Protective
High fiber intake
High intake of fruits and vegetables
Risky
Intake of high protein
Meat
Fish
Prognosis
Crohn disease
Mortality 1.4 - 5 times general population (Crohn disease)
Relapse rate over 10 years = 90%
Require surgery in 10 years = 38%
Stricture
Stenosis
Obstruction
Fistula
Bleeding
Abscess
QOL lower than UC
Ulcerative collitis
Mortality rate = general population
50% chance progressing in over 10 years
7.5% colectomy over 5 years
Prone to malignancy
UC - 8-10 years of disease (Colonic malignancy)
Screen in 1-2 year intervals
Treatment
Symptomatic
Avoid
Drugs
Loperamide
Diphenoxylate/atropine
Induce Toxic megacolon
Diarrhea
Due to bile salt malabsorption
Treated with: bile binding resins (Cholestyramine)