INFLAMMATORY BOWEL DISEASE
By- Dr. Armaan singh
Crohns and Ulcerative colitis
IBD
CROHN’S DISEASE
Anatomic Distribution
Bimodal Distribution
Prevalence of Crohn’s Disease
Immune Dysregulation in Crohn’s Disease
Potential Risk Factors
Diet NSAIDS Smoking Infections Oral Contraceptives Psycho social factors
Etiology
Gut structure
Intestinal defences
Pathogenesis
Pathogenesis
Tumor Necrosis Factor (TNF)
TNF induced apoptosis
TNF actions
Patterns of Crohn’s Disease
Chronic abdominal pain
Imaging in Crohn’s Disease
Aphthoid Ulceration
Aphthoid Ulceration
Endoscopic view
Crohn’s Ileitis
Chronic Subserositis
Granuloma
Post stenotic Dilatation
Enteroenteric Fistula
Enterocutaneous Fistula
Perianal Fistula
Mechanism of Perianal Fistula
Carcinoma in Crohn’s Disease
Acute Inflammatory Presentation
Chronic Inflammatory Presentation
Scarring and Narrowing
Enteroenteric Fistula
Enterovesical Fistula
Localised Phlegmon
Presentation
Clinical Presentations
CHRONIC INFLAMMATORY DISEASE: fever, malaise, weight loss, abdominal pain, RLQ mass
INTESTINAL OBSTRUCTION: Post prandial bloating, cramping, borborygmy
FISTULIZATION: Internal, external ABSCESS: Fever, chills, tender mass PERIANAL DISEASE: Fissure, abscess, fistula EXTRAINTESTINAL: Oral, skin, joints, eye, gall
stones, nephrolithiasis, liver
Laboratory Diagnosis
CBC
Albumin
ESR, CRP
Stool RE
P-ANCA: 10% crohns, 70% UC
ASCA (antibody to yeast S cerevisiae): 70% crohn, 10% UC
Radiological Diagnosis
Endoscopic Diagnosis
Differential Diagnosis:Appendiceal Abscess
Differential Diagnosis:Carcinoma
Differential Diagnosis:Carcinoid
Differential Diagnosis:Lymphoma
Differential Diagnosis:Tuberculosis
COMPLICATIONS
ABSCESS
INTESTINAL OBSTRUCTION
FISTULAS
PERIANAL DISEASE
CARCINOMA
HEMORRHAGE
MALABSORPTION
TREATMENT:Aminosalicylic acid
TREATMENT: Corticosteroids
Dramatically suppress clinical symptoms Do not alter underlying disease process Prednisone 40-60 mg/day, taper slowly Side effects: Osteoporosis, others Ileal release preparation: Budesonide 9mg/day, 50-
70% remission in mild to mod Persistent symptoms need ASA, AZA,MTX
TREATMENT:Immunosuppressents
TREATMENT:Immunosuppressents
TREATMENT:Immunosuppressents
TREATMENT:Immunosuppressents
Biologicals
Mechanism of action
TNF binding
Summary of medical treatment of Crohn’s disease
Aminosalisylic acid: ASACorticosteroids: Pred, BudesonideImmunosuppressents: AZA, MTX,
CycAntibiotics: Metronidazole, CiprofloxTNF antibody: Infliximab
SURGICAL TREATMENT
ENDOSCOPIC TREATMENTBalloon Dilatation
MANAGEMENT
Life long illness, exacerbations, remissionsPsych social support: patient educationNo specific therapy exists: supportive care;
diarrhea, steatorrhea, painNutritional support: enteral, parenteral; Fiber,
iron, B12, low fat, MCT supplements well balanced diets
PROGNOSIS
Prolonged illness
Proper medical and surgical care help cope with disease
Anticipate complications and manage
Avoid side effects of drugs
Few die of direct effects of disease
ULCERATIVE COLITIS
Ulcerative Colitis: Forms
Ulcerative Colitis:Gross Appearance
Endoscopic Appearance
Microscopic Features
Crypt Abscess
Radiological Features
Pakistani scenario
Endoscopic extent: KPK
Hameed et al. JCPSP 2001;11:551-4.
Severity of disease: KPK
Khan et al. J Med Sci 2010;18:67-70
Shifa Experience
85 patients with 8 years follow up Diarrhea with blood 100% Raised ESR 80% Mild disease 55% Left sided colitis in 60% Medical Treatment response nearly 100%
Khokhar N. Rawal Med J 2005;30:12-15
THANKS
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