Inflammatory Bowel Disease (IBD). * Definition: a chronic condition characterized by intestinal inflammation and ulceration that has no exact identifiable cause; may be genetic, immulogical or environmental. * Course of the IBD:
* Definition: a chronic condition characterized by intestinal inflammation and ulceration that has no exact identifiable cause; may be genetic, immulogical or environmental.
* Course of the IBD: The inflammatory bowel disease is a chronic disease (lasting a long time), show periods of exacerbations in which the disease flares up and causes symptoms alternating with areas of remissions in which symptoms disappear or decrease.
* Symptoms include the followings: • Abdominal cramps and pain. • Bloody diarrhea. • Fever. • Loss of appetite . • Weight loss. • Anemia (due to blood loss). • Extra-intestinal manifestations: arthritis, eye problems.
* Two common types of IBD: • Ulcerative colitis. • Crohn’s disease.
* Morphological features of UC: • Site: Ulcerative colitis involves the rectum and extends proximally in a retrograde fashion to involve the entire colon ("pancolitis") in the more severe cases. • The affected segment is diffusely inflamed and shows; • Marked inflammatory cellular infiltrate of the mucosa by lymphocytes, plasma cells and neutrophils. • Ulcerations.
Psudopolyps formation: hyperplastic surface mucosal cells without fibrovascular cores. • Cryptitis and crypt abscess: presence of neutrophils inside colonic glands. • Dysplasia of the colonic glands: which is precancerous.
* Complications of UC: 1. Bleeding:Rectal bleeding and bloody diarrhea are two of the hallmark symptoms of ulcerative colitis. 2. Anemia: In ulcerative colitis, this is usually the result of chronic blood loss. 3. Malnutrition: Symptoms such as diarrhea and rectal bleeding can lead to a loss of fluids and nutrients.
4.Intestinal Stricture and obstruction:due to fibrosis. 5. Cancer colon:Ulcerative colitis patients have a higher risk of developing colon cancer. The risk increases when ulcerative colitis for a prolonged period of time.
6. Perforation:Extensive inflammation can lead to a tear in the intestinal wall, resulting in leakage of bowel contents outside the intestine. 7. Toxic megacolon:when inflammation spreads from the mucosa to involve the entire intestinal wall which temporarily stops the normal contractile movements of the intestine, and the large intestine may greatly expand.
* Morphological features of Crohn's disease: * Site: any part of G.I.T, but the most common site is the terminal ileum. • The affected part of the intestine show skip areas i.e. areas free from the lesions. • The intestinal wall is thick and rubbery, caused by edema, inflammation, and fibrosis. • Cobble stone appearance due to edema of the mucosa with interrupting fissuring ulcers.
Fissuring of the wall with formation of fistulae. • Microscopically there is: transmural involvement of the bowel by mixed inflammatory cells and the presence of non-caseating granulomas.
Gross appearance of Crohn's disease. There is a sharp demarcation between the involved and the uninvolved areas.
Crohn's disease; showing marked inflammatory changes and the formation of a fissure.
* Complications of crohn’s disease: 1. Intestinal obstruction: Blockage occurs because the disease tends to thicken the intestinal wall by inflammation and finally fibrosis occurs. 2. Fistulas: intestino-intestrinal, intestino-abdominal and perianal fistulae.
3. Malabsorption syndrome: deficiencies of proteins, calories, and vitamins deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption.