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INFLAMMATORY BOWEL DISEASES

INFLAMMATORY BOWEL DISEASES. SWAROOP.K.RAJ 2002 MBBS. INFLAMMATORY BOWEL DISEASES. TWO MAIN FORMS ULCERATIVE COLITIS - AFFECTS LARGE BOWEL ONLY CROHN’S DISEASE- AFFECTS ANY PART OF GIT. INFLAMMATORY BOWEL DISEASES. INFLAMMATORY BOWEL DISEASES.

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INFLAMMATORY BOWEL DISEASES

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  1. INFLAMMATORY BOWEL DISEASES SWAROOP.K.RAJ 2002 MBBS

  2. INFLAMMATORY BOWEL DISEASES • TWO MAIN FORMS ULCERATIVE COLITIS- AFFECTS LARGE BOWEL ONLY CROHN’S DISEASE- AFFECTS ANY PART OF GIT

  3. INFLAMMATORY BOWEL DISEASES

  4. INFLAMMATORY BOWEL DISEASES • BOTH IDIOPATHIC BOWEL DISEASES– IT IS PROBABLE THAT ENVIORNMENTAL FACTORS OPERATE IN A GENETICALLY PREDISPOSED INDIVIDUAL • DISRUPTION OF THE INTESTINAL INTEGRITY ALLOWS BACTERIA & LUMINAL ANTIGENS TO TRIGGER AN IMMUNE RESPONSE

  5. ULCERATIVE COLITIS

  6. ULCERATIVE COLITIS • DIFFUSE ULCERO-INFLAMMATORY DISEASE LIMITED TO THE COLON & AFFECTING ONLY THE MUCOSA & SUB MUCOSA EXCEPT IN MORE SEVERE CASES. • EXTENDS IN A CONTINOUS FASHION PROXIMALLY FROM RECTUM. • NO SKIP LESIONS

  7. ULCERATIVE COLITIS • PROCTITIS • PROCTOSIGMOIDITIS • LEFT SIDED COLITIS • PAN ULCERATIVE COLITIS

  8. AETIOLOGY • REMAINS UNKNOWN. • INCREASED PREVALENCE AMONG FIRST DEGREE RELATIVES. • MICROBIAL AGENTS. • MILK PROTEIN. • SMOKING PROTECTIVE. • STRESS.

  9. AETIOLOGY • 3 MAIN HYPOTHESIS- 1.MUCOSAL IMMUNOLOGICAL REACTION 2.WEAKENED MUCOSAL BARRIER 3.DEFECTIVE METABOLISM OF BUTYRATES

  10. EPIDEMIOLOGY • SEX RATIO IS 1:1. • UNCOMMON BEFORE 10 YRS • USUALLY DIAGNOSED BETWEEN 20&40. • WESTERNISATION OF DIET & SOCIAL HABITS.

  11. PATHOLOGY • MOSTLY CONFINED TO MUCOSAL & SUBMUCOSAL LAYERS OF COLON. • 95%CASES STARTS IN RECTUM & SPREADS PROXIMALLY. • CONFINED TO COLON ,RECTUM ALWAYS INVOLVED. • IN 10% BACKWASH ILEITS(30 cm)

  12. MACROSCOPICALLY • INFLAMMED MUCOSA • PSEUDOPOLYPS- (20%). • UNDERMINED EDGES. • ULCERS ALIGNED ALONG LONG AXIS. • PROGRESSIVE MUCOSAL ATROPHY. • SEVERE CASES-TOXIC DAMAGE TO MUSCULARIS&NEURAL PLEXUS.

  13. PSEUDOPOLYPS

  14. PSEUDOPOLYPS

  15. MACROSCOPICALLY

  16. POLYPS IN ULCERATIVE COLITIS

  17. MICROSCOPICALLY • MONONUCLEAR INFLAMMATORY INFILTRATE IN LAMINA PROPRIA. • CRYPT ABSCESSES. • CRYPTS REDUCED & ATROPHIC. • GOBLET CELL DEPLETION. • WITH REMISSION GRANULATION TISSUE FILLS ULCER CRATER. • SUBMUCOUS FIBROSIS,ARCHITECTURAL DISARRAY-RESIDUA OF HEALED DISEASE.

  18. INFLAMMATORY INFILTRATE

  19. CRYPT ABSCESS

  20. ULCERATIVE COLITIS

  21. ULCERATIVE COLITIS

  22. MICROSCOPICALLY • EPITHELIAL DYSPLASIA 1.LOW GRADE. 2.HIGH GRADE. • REGENERATIVE & DYSPLASTIC CHANGES DIFFICULT TO DISTINGUSH.

  23. LOW GRADE DYSPLASIA

  24. SEVERE DYSPLASIA

  25. CLINICAL FEATURES • BLOODY DIARRHEA. • BLOOD STAINED OR PURULENT RECTAL DISCHARGE. • LOWER ABDOMINAL CRAMPS. • COURSE- 1.RELAPSES & REMISSIONS. 2.FULMINANT COLITIS.

  26. CF(PROCTITIS) • STOOL FORMED OR SEMIFORMED. • TROUBLED BY TENESMUS & URGENCY. • RISK OF CANCER IS LOW. • 5-10% SPREAD TO REST OF COLON.

  27. CF( LEFT SIDED & TOTAL COLITIS) • DIARRHOEA IMPLIES ACTIVE DISEASE PROXIMAL TO RECTUM. • 15% LEFT SIDED COLITIS • 25% TOTAL COLITIS. • RECURRENT SEVERE BLOODY DIARRHOEA(20 times/day). • DEHYDRATION,FLUID & ELECTROLYTE LOSS. • ANAEMIA & HYPOPROTEINAEMIA.

  28. DISEASE SEVERITY • MILD RECTAL BLEEDING OR DIARRHOEA WITH 4 OR FEW MOTIONS/day.NO SYSTEMIC SIGNS. • MODERATE MORE THAN 4 MOTIONS/day.NO SYSTEMIC SIGNS. • SEVERE MORE THAN 4 MOTIONS/day.SIGNS OF SYSTEMIC ILLNESS.

  29. COMPLICATIONS • ACUTE -TOXIC DILATATION. -PERFORATION. -HAEMORRHAGE. • CHRONIC -CANCER -EXTRACOLONIC MANIFESTATIONS.

  30. TOXIC MEGACOLON

  31. CANCER RISK IN UC • OVERALL RISK – 3.5% • RISK INCREASES WITH AGE&DURATION. • MORE WITH PANCOLITIS. • MULTICENTRIC. • COLON > RECTUM. • REGULAR COLONOSCOPIC CHECKS IN DISEASES > 10 YEARS. • EPITHELIAL DYSPLASIA – SURGERY.

  32. EXTRA COLONIC MANIFESTATIONS

  33. EXTRA COLONIC MANIFESTATIONS • ARTHRITIS -LARGE JOINT POLYARTHROPATHY. -SACROILITIS & ANKYLOSING SPONDYLITIS. • BILE DUCT CANCER • SKIN LESIONS -ERETHYMA NODOSUM,PYODERMA GANGRENOSUM,APTHOUS ULCERATION. • EYE PROBLEMS-IRITIS. • LIVER DISEASE-SCLEROSING CHOLANGITIS IN 70%.

  34. INVESTIGATIONS

  35. INVESTIGATIONS • PLAIN X-RAY ABDOMEN • OFTEN SHOWS THE SEVERITY. • COLON DIAMETER > 6 cm TOXIC MEGACOLON. • MUCOSAL ISLANDS MAY BE SEEN. • SMALL BOWEL LOOPS IN RIGHT LOWER QUADRANT INDICATES SEVERITY.

  36. X-RAY The colon appears shorter than normal and has lost its haustral pattern.

  37. TOXIC MEGACOLON

  38. INVESTIGATIONS • BARIUM ENEMA PRINCIPAL SIGNS ARE • LOSS OF HAUSTRATIONS. • MUCOSAL CHANGES. • PSEUDOPOLYPS. • NARROW CONTRACTED COLON.

  39. BARIUM ENEMA GRANULAR MUCOSA

  40. BARIUM ENEMA PSEUDOPOLYPS OF DESCENDING COLON

  41. BARIUM ENEMA SHORT COLON , SMOOTH HAUSTRATIONS & NARROW LUMEN

  42. BARIUM ENEMA Inflammation of the transverse and descending colon - The haustration of the colon became smooth.The lumen of the descending colon is narrow.

  43. SIGMOIDOSCOPY • EARLY CASES & MILD DISEASE. • INITIAL FINDINGS ARE OF PROCTITIS- -HYPARAEMIC MUCOSA,BLEEDS ON TOUCH,PUS LIKE EXUDATE. • LATER-TINY ULCERS WHICH APPEAR TO COALESCE.

  44. COLONOSCOPY & BIOPSY • ESTABLISH EXTEND OF INFLAMMATION. • DISTINGUSH UC & CROHN’S DISEASE. • MONITOR RESPONSE TO TREATMENT. • ASSESSMENT OF MALIGNANT CHANGE. NOT USUALLY DONE IN ACUTE CASES.

  45. TREATMENT • DIETARY MANAGEMENT • PHARMACOLOGICAL MANAGEMENT • SURGICALMANAGEMENT

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