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DISEASES OF LARGE INTESTINE Lykhatska G.V.

DISEASES OF LARGE INTESTINE Lykhatska G.V. IRRITABLE BOWEL SYNDROME. IRRITABLE BOWEL SYNDROME -functional disorders , which characterized by abdominal pain , defecation disorders without specific organic pathology which last more than 12 weeks per year. Risk factors. Violations on diet

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DISEASES OF LARGE INTESTINE Lykhatska G.V.

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  1. DISEASES OF LARGE INTESTINE Lykhatska G.V.

  2. IRRITABLE BOWEL SYNDROME

  3. IRRITABLE BOWEL SYNDROME -functional disorders,which characterized by abdominal pain,defecation disorders without specific organic pathology which last more than 12 weeks per year

  4. Risk factors • Violations on diet • gynecological diseases • violation intestinal microbiocenosis • In the pathogenesis, the main role – • intestinal dysmotility and visceral hypersensitivity

  5. Clinical features of IBS

  6. Rome criteria for the diagnosis of IBS

  7. IBS: SUMMARY

  8. Treatment IBS • Diet 4 and regimen • Antidepressants(amitriptyline 25-50 mg at bedtime) • Spasmolytic drugs (dyspatalin 200mg 2 times a day;ditsetel 10-50 mg 3 times per day during 2-4 weeks or more • Laxatives(mukofalk,laktuloza,forlaks)individually • Antidiarrhea drugs(loperamyd,smekta)individually • Psychotherapy(hypnotherapy,acupuncture) • Correction of bowel microflore injuries(probiotics-bifi-form,linex,symbiter)

  9. IBS treatment scheme (with prevailing diarrhea) • Antidiarrhea drugs (loperamid 2-12 mg daily, • Cytoprotective drugs (smekta 1-2 packs 3 times), • Enterosorbents(enterosgel,poliferan 1spoon 3 times a day) • psychotherapy

  10. IBS treatment scheme (with prevailing constipation) • Osmotic laxatives (laktuloza 10-30 ml 1-2 times a day, mukofalk 1-2 packs 1-3 times a day during meals) • Prokinetic drugs(domperidon,primer 10mg 3 times a day) • Antidepressants or antagonists (5-HT4 receptors 1 tab(6mg)2 times a day before meals)

  11. IBS treatment scheme (with pain syndrom prevailing) • Spasmolytic drugs(duspatalin 200mg 2 times a day,ditsetel 50-100mg 3 times a day); • Antidehressants(amitryptylin 25-50mg before sleep,fluoksetyn 20mg once a day)

  12. ULCERATIVE COLITIS

  13. Etiology • The cause of ulcerative colitis is unknown

  14. Definition • ULCERATIVE COLITIS -A chronic, inflammatory, and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea

  15. ULCERATIVE COLITISClinical picture • Bloody diarrhea • The stools may be watery, may contain mucus, and frequently consist almost entirely of blood and pus • Abdominal pain • Fever • Anorexia • Weight loss • Malaise

  16. The endoscopic spectrum of ULCERATIVE COLITIS includesa) mucosal edema, erythema, loss of vasculature;b) granular mucosa with pinpoint ulceration and friability;c) regenerated (i.e., healed) mucosa with distorted mucosal vasculature;d) regenerated mucosa withtypical postinflammatory pseudopolyps

  17. It’s air-contrast radiograph of ULCERATIVE COLITIS, the mucosal pattern is granular with loss of normalhaustrations in a diffuse, continuous pattern

  18. ULCERATIVE COLITIS

  19. ULCERATIVE COLITISExtracolonic problems • Peripheral arthritis • Ankylosing spondylitis • Sacroiliitis • Anterior uveitis • Erythema nodosum • Pyoderma gangrenosum • Episcleritis • Primary sclerosing cholangitis

  20. Erythema nodosum on the skin

  21. Pyоderma gangrenosum seen in UC

  22. Episcleritis in UC

  23. CLASSIFICATION OFULCERATIVE COLITISaccording to thedegree of expressiveness of clinical manifestations

  24. DIFFERENTIALDIAGNOSIS

  25. DIFFERENTIALDIAGNOSIS

  26. DIFFERENTIALDIAGNOSIS

  27. ULCERATIVE COLITISTreatment • Diet № 4 • Aminosalicilates (Sulfasalazine, Salofalk) • Corticosteroid therapy (Budesonid, Prednizolon) • Immunosuppressive drugs(Azathioprine) • Antidiarrheal drugs - loperamide, Anticholinergics, digestive enzymes, transfusions, vitamin therapy

  28. DISEASES OF SMALL INTESTINE

  29. CROHN’S DISEASE

  30. Definition • CROHN’S DISEASE A nonspecific chronic transmural inflammatory disease that most commonly affects the distal ileum and colon but may occur in any part of the GI tract.

  31. CROHN’S DISEASE (CD) Etiology and Epidemiology of CROHN’S DISEASE Pathology of CROHN’S DISEASE Clinical picture of CROHN’S DISEASE Diagnosis of CROHN’S DISEASE Differential Diagnosis of CROHN’S DISEASE Prognosis of CROHN’S DISEASE Treatment of CROHN’S DISEASE PLAN

  32. Etiology • The fundamental cause of Crohn's disease is unknown

  33. DISEASES OF SMALL INTESTINE

  34. The spectrum of CROHN DISEASE presentations includes gastroduodenitis, jejunoileitis and ileitis, ileocolitis, colitis 7% 33% 45% 15%

  35. CROHN’S DISEASEClinical picture • Abdominal pain (77%) • Chronic diarrhea (73%) • Bleeding (22%) • Anal Fistulas (16%) • Anorexia • A right lower quadrant mass or fullness

  36. CROHN’S DISEASEExtraintestinal manifestations • Weight loss (54%) • Fever (35%) • Anemia (27%) • Peripheral arthritis (16%) • Ophtalmic diseases (Episcleritis, 10%) • Aphthous stomatitis • Erythema nodosum (2%) • Pyoderma gangrenosum

  37. Endoscopic spectrum of CD includesa) aphthous ulcerations amid normal colonic mucosalvasculature;b) deeper, punched-out ulcers in ileal mucosa; c)a single colonic linear ulcer;d) deep coloniculcerations forming a stricture.

  38. CROHN’S DISEASEDIAGNOSIS • x-ray:Barium enema x-ray may show reflux of barium into the terminal ileum with irregularity, nodularity, stiffness, wall thickening, and a narrowed lumen. A small-bowel series with spot x-rays of the terminal ileum usually most clearly shows the nature and extent of the lesion. An upper GI series without small-bowel follow-through usually misses the diagnosis.

  39. X-ray showing abnormal terminal ileum in Crohn's disease

  40. Laboratory findings • Laboratory findings are nonspecific: -anemia, -leukocytosis, -hypoalbuminemia, - ↑ESR, C-reactive proteins. Elevated alkaline phosphatase and γ-glutamyltranspeptidase accompanying colonic disease often reflect primary sclerosing cholangitis.

  41. CROHN’S DISEASEDIFFERENTIALDIAGNOSIS • Ulcerative colitis • Acute appendicitis • Pelvic inflammatory disease • Ectopic pregnancy • Ovarian cysts • Cancer of the cecum • Lymphosarcoma • Systemic vasculitis • Radiation enteritis • Ileocecal TB • AIDS-related oppor­tunistic infections (cytomegalovirus)

  42. DIFFERENTIALDIAGNOSIS

  43. The typical perianal skin tag of Crohn's Disease

  44. DIFFERENTIALDIAGNOSIS

  45. DIFFERENTIALDIAGNOSIS

  46. Enterocutaneous fistulae in Chrohn'sdisease

  47. CROHN’S DISEASETreatment • Diet № 4 • Aminosalicilates (Sulfasalazine, Salofalk) • Corticosteroidtherapy (Budesonid, Prednizolon) • Immunosuppressive drugs(Azathioprine) • Antibacterial drugs (metronidazole, Nifuroxazide • Symptomatic treatment(antidiarrheal drugs - loperamide, Anticholinergics)

  48. THANK YOU FOR ATTENTION !

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