1 / 132

Inflammatory Bowel Diseases: Symptoms, Diagnosis & Management

Learn about Ulcerative Colitis & Crohn’s Disease, including causes, symptoms, diagnosis, and complications. Find out about treatment options and preventive measures.

shardison
Download Presentation

Inflammatory Bowel Diseases: Symptoms, Diagnosis & Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related