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Problem 5: "A change in bowel habits", image, image - Coggle…
Problem 5: "A change in bowel habits"
Anatomy of the L. intestine
Midgut
Hindgut
L. intestine
Innervation
Pelvic nerve S2-S4
Splanchnic nerve L1-L2
Blood supply
I. mesenteric Artery
Left colic
Sigmoidal
S. rectal
S. mesenteric Artery
Right Colic
Ileocolic
Posterior Caecal
Appendicular Artery
anterior Caecal
Middle colic
Foregut
Inflammatory Bowel Diseases
2 main types
Ulcerative Colitis
limited to the colon
Affect mucosa and submucosa
inflammation usually extend from the rectum upwards
can affect ilium in rare cases (BWI)
Cont. inflammation of the colon
TH2 type is well recognized in Ulcerative colitis
Crohn’s Disease
Etiological theories
Dysbiosis
Defective mucosal barrier function
Persistent specific infection
Immune system in the intestine becomes activated for UK reason
CARD15 gene mutation
Any part of the GI tract
Transmural
Skip lesions
TH1 type is well recognized in Crohn disease
that it has a strong link with tobacco
management of IBD
maintanenece of remession
azathioprine \ 6 mercaptopurine
methotrexate with anti TNF alpha in CD
induction of remission
5 aminosalicylate family
steroids
steroid refractory
methotrexate
anti TNF alpha
azathioprine \ 6 mercaptopurine
surgery
other biological treatment
anti IL 12\ IL 23
jak kinase inhibitors
anti- integrin
s1p receptor inhibitor
Diagnosis
Clinical presentation
Crohn’s
Abdmoinal pain in RLQ
Diarrhea
Perianal skin ta
Oral ulcers
Arthritis
Skin lesions
Uveitis
Ulcerative colotis
Abdominal pain in LLQ
Bloody diarrhea
Urgency
Tenesmus
Dyspnea
Palpations
Physical examination
Check for clinical presentation + digital rectal exam
Investigations
Lab investigations
blood tests
CBC
Iron panel
CRP and ESP
Vit b12, d, folate
Stool tests
Fecal calprotectin stool test
C. difficile testing
Imaging
X-ray
MRI
CT
Endoscopy/ colonoscopy
the remnants lol
role of family in informal care system
DALY = YLD + YLL
YLD = no. of yrs with disease * disability weight
YLL = years lost due to premature death
point prevalence
period prevalence
incidence risk and incidence rate
direct and indirect standardization
Labna Zar's method
Physiology of Large Intestine
Absorption
Happens in
Ascending Colon
Transverse Colon
Storage
Happens in
Sigmoid Colon
Rectum
Descending Colon
Transverse Colon
Bacterial Digestion and Fermentation
act on
Carbohydrates
Vitamins
Proteins
Bile Acids
Defecation
By
Mass movements
stimulated by
Gastrocolic reflex and Duodenocolic Reflex
Spinal Reflex
Initiated by
Distention of the rectum
Contraction of
Rectum and Sigmoid Colon
Relaxation of
External and Internal Anal Sphincter
Colorectal cancer
Third leading cause of death from cancer in both males and females
2nd most frequent cancer in developed
countries
Median age of diagnosis 60 years, begins increase at age 40, and rises with age
identical in men and women
Etiology
Genetic
factors (only
5%
of cases):
HNPCC
(mut.MLH1,MSH2,6) -Lynch Syndrome
FAP
(Familial Adenomatous Polyposis), (mut APC)
Adenomatous
polyps
Inflammatory bowel disease
,
Environmental
factors,
Diet
(rich in fat and chol.),
Cancer
history
Complications of UC
Toxic megacolon
Haemorrhage
Ca: CRC in 15% W/ pancolitis @ 20yrs
Complications of crohn disease
Fistulae
Strictures
Abscesses
Malabsorption
