Zuhir PBL-I (Inflammatory Bowel Disease)

7/31/2019 Zuhir PBL-I (Inflammatory Bowel Disease)

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PBL-IZuhir Bodalal

Libyan International Medical University

www.limu.edu.ly
http://www.limu.edu.ly/http://www.limu.edu.ly/


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Disclaimer

The following is a collection of medical

information from multiple sources, both

online and offline. It is to be used for educational purposesonly.

All materials belong to their respective owners

and the authors claims no rights over them.


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Right Iliac Fossa Pain


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Differences between Crohnsand UC


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Characteristic Features in Diarrhea


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Diarrhoea

increased liquidity or decreased consistency of

stools

acute: usually due to drugs or infections

Non-inflammatory: Watery, nonbloody diarrhea

Inflammatory: The presence of fever and bloody

diarrhea Enteric: severe systemic illness


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Diarrhoea

Chronic:Osmotic: results when poorly absorbed osmotically

active solutes are present in the gut lumen

Mal-absorptiveSecretory: Increased intestinal ion secretion or

decreased ion absorption

Inflammatory

Motility disorders: abnormal intestinal motilitysecondary to systemic disorders or surgery

Chronic infections: Giardia and E histolytica


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Rectal Bleeding


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Relax and Take a Break


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Inflammatory Bowel Disease


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Inflammatory Bowel Disease

Ulcerative colitis - nonspecific inflammatorybowel disease of unknown etiology that effectsthe mucosa of the colon and rectum

Crohnsdisease - nonspecific inflammatory boweldisease that may affect any segment of thegastrointestinal tract

Indeterminate colitis

15% patients with IBD impossible todifferentiate


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High

Medium

Low

Global Prevalence of IBD


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Clinical Features

All sites:

Diarrhoea, abdomenal pain, and Wt loss

Fever, malaise, anorexiaWt loss alone


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Clinical Features

Small intestine:

Aphthous ulcers

Duodenal ulcersAbdominal pain

Malnutrition

Malabsorption

Abdominal mass


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CrohnCrohnssDisease:Disease:Anatomic DistributionAnatomic Distribution

Small bowelSmall bowelalonealone

((3333%)%)

Colon aloneColon alone

((2020%)%)

IleocolicIleocolic

((4545%)%)

LeastLeastMostMost

Freq of involvementFreq of involvement


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DISTINGUISHING FEATURES OF

CROHNS DISEASE


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Clinical features

Peri-anal disease

Associated with ileo-colonic disease

Recurrent abscesses and fistulaeAnal or rectal stenosis


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Normal Ulcerative Colitis


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DD

Infective diarrhoea( Salmonella, Shigella,Compylobacter, entamoeba histolytica)

Ischaemic colitis

Radiation colitis

Pseudomembranouscolit its

Diverticular disease

Irritable bowel syndrome


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Investigations

Routine bloodCBC, ESR, CRP,LFT, U&C, electrolytes Iron, B12 and folate

Barium enema Small bowel radiology Sigmoidoscopy Colonoscopy and biopsies

Capsule endoscopy Ultrasound scan Technitium or Indium Labelled WC scan


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Investigations

Stool

Laparotomy


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Radiological Features of Crohns Disease

Strictures, fistulae, dilatation, mass effect,

pseudo-diverticulae

Aphthous ulcers, cobblestoning,pseudopolyps, linear ulcers and thickened

mucosa


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Crohns DxString Sign


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Radiological Features of Ulcerative Colitis

Mucosal ulceration and inflammation

Loss of fold in affected areas (especially

sigmoid)


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Ulcerative Colitis - Ulcerations


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Ulcerative Colitis Lead Pipe


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Management

Nutrition

No restrictions, but eat balanced diet

Important for children and adolescents

Oral is better

Parenteral or elemental diet


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Treatment

Mild attacks

Oral steroids 20mg /day

Rectal steroids

5ASA ( aminosalicylic acid)

Failure to improve after 2 weeks is an indicationfor treatment as a moderate disease


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Treatment

Moderate attack

Oral prednisolone 40mg/day

Steroid enemas

5ASA

Admit if no improvement


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Treatment

Severe attack

Immediate admission if necessary

IV hydrocortisone 100mg four time a day for 5days

Rectal steroids twice a day

Sips of fluids only by mouth

IV fluidsBlood transfusion


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Treatment

Severe attack

Regular assessment

Regular blood tests ( CBC, ESR, electrolytes)

Monoclonal antibodies ( Infliximab)

Surgery if no response is to be considered

If improved: oral steroids, 5ASA, and antibiotics


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Emergency Surgery

Toxic megacolon

Perforation

Massive haemorrhage Failure of a severe attack to resolve


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Mortality of CD

Twice of that of population

If Crohnsdisease diagnosed before the age of 20years there is 10-fold increase in mortality


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Prognosis of UC

25% have proctitis, 50% left-sided disease and

25% total colitis

25% have surgrey 12-15% with pan-colitis for 20 years develop

colonic cancer


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Thank you


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Any Questions?

Zuhir PBL-I (Inflammatory Bowel Disease)

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