This document discusses inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). It covers the clinical presentation, causes, diagnostic evaluation and treatment of IBD. Key points include that IBD causes abdominal pain, diarrhea, weight loss and possible extraintestinal manifestations. Diagnostic tests include bloodwork, imaging and endoscopy. Treatment involves supportive care, medications and surgery for complications.
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This document discusses inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). It covers the clinical presentation, causes, diagnostic evaluation and treatment of IBD. Key points include that IBD causes abdominal pain, diarrhea, weight loss and possible extraintestinal manifestations. Diagnostic tests include bloodwork, imaging and endoscopy. Treatment involves supportive care, medications and surgery for complications.
This document discusses inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). It covers the clinical presentation, causes, diagnostic evaluation and treatment of IBD. Key points include that IBD causes abdominal pain, diarrhea, weight loss and possible extraintestinal manifestations. Diagnostic tests include bloodwork, imaging and endoscopy. Treatment involves supportive care, medications and surgery for complications.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
This document discusses inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). It covers the clinical presentation, causes, diagnostic evaluation and treatment of IBD. Key points include that IBD causes abdominal pain, diarrhea, weight loss and possible extraintestinal manifestations. Diagnostic tests include bloodwork, imaging and endoscopy. Treatment involves supportive care, medications and surgery for complications.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as PPT, PDF, TXT or read online from Scribd
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Inflammatory Bowel Disease
CLINICAL History CD with gastroduodenal involvement may mimic: peptic ulcer disease and can progress to gastric outlet obstruction Inflammatory Bowel Disease CLINICAL History Many patients with inflammatory bowel disease (IBD) have irritable bowel syndrome, which can produce occasional:
Cramping irregular bowel habits and passage of mucus without blood or pus Inflammatory Bowel Disease
CLINICAL History Weight loss is observed more commonly in CD than in UC because of the malabsorption associated with small bowel disease Inflammatory Bowel Disease Physical Fever Tachycardia Dehydration and Pallor may be noted, reflecting anemia
The magnitude of these factors is related directly to
the severity of the attack
► Evaluate for signs of localized peritonitis
Inflammatory Bowel Disease CLINICAL Physical ► Patients with toxic megacolon appear septic. They have: high fever lethargy chills tachycardia increasing abdominal pain tenderness and distention Inflammatory Bowel Disease
CLINICAL Physical Patients with CD may develop a mass in the right lower quadrant
The rectal examination often reveals bloody stool on:
gross or hemoccult examination Inflammatory Bowel Disease CLINICAL Physical Complications e.g.: perianal fissures or fistulas abscesses rectal prolapse may be observed in up to 90% of patients with CD Inflammatory Bowel Disease
CLINICAL Physical Include in the examination a search for extraintestinal manifestations, such as: iritis episcleritis arthritis and dermatologic involvement Inflammatory Bowel Disease
Illustration (episcleritis) Inflammatory Bowel Disease Causes The etiology of IBD is unknown Environmental smoking infectious genetic autoimmune and host factors have been suspected
Interactions among these factors may be more important
Inflammatory Bowel Disease
Causes The risk of developing UC is higher in nonsmokers and former smokers than in current smokers
On the contrary, patients with CD have a higher incidence of
smoking than the general population, and those patients with CD who continue to smoke appear to be less likely to respond to medical therapy Inflammatory Bowel Disease
Differential diagnosis
Appendicitis, Acute
Diverticular Disease
Endometriosis
Pelvic Inflammatory Disease
Lab Studies CBC with differential
Anemia may result from:
1) acute or chronic blood loss
2) or malabsorption ▼ Iron Folate vitamin B-12 3) or may reflect the chronic disease state Inflammatory Bowel Disease Lab Studies CBC with differential ► Leukocytosis, anemia, and thrombocytosis are common
A modestly elevated WBC is observed in active
disease
but a marked elevation suggests the presence of an
abscess or other suppurative complication Inflammatory Bowel Disease
Lab Studies Serum chemistry Hypokalemia reflects the severity of the diarrhea
►Abnormal liver function test results may represent:
pericholangitis or sclerosing cholangitis Lab Studies Serum chemistry Hypoalbuminemia resulting from protein-losing enteropathy, suggests extensive colitis
Decreased serum calcium
may reflect reduced serum albumin
Erythrocyte sedimentation rate
is typically elevated Inflammatory Bowel Disease
Imaging Studies Upright chest radiography and abdominal series Evaluate for an edematous irregular colon with "thumb printing." Occasionally, there may be pneumatosis coli (air in the colonic wall) Inflammatory Bowel Disease Imaging Studies ► Upright chest radiography and abdominal series. Associated findings include:
nephrolithiasis
cholelithiasis
arthritis of the:▼ spine or the sacroiliac joints Inflammatory Bowel Disease Barium enema In UC, a barium enema (BE) may reveal: 1) a shortened colon 2) with loss of haustrations and 3) destruction of the mucosal pattern lead-pipe colon Inflammatory Bowel Disease
Barium enema Skip areas and rectal sparing are noted in CD
BE is contraindicated in patients with moderate-to-
severe colitis because it risks: perforation or precipitation of a toxic megacolon Inflammatory Bowel Disease • Endoscopic differentiation: UC CD Distribution rectum always rectal sparing Inflammation diffuse and uniform asymmetrical, focal Skip areas continuous diffuse disease yes Granularity, friability ++++ +
Ulceration small ulcers in a diffuse aphthoid ulcer
inflamed mucosa
Stricture uncommon common
Cobblestoning uncommon common Inflammatory Bowel Disease
• Illustration: cobblestone street and in CD
Inflammatory Bowel Disease • Illustration: aphthoid ulcer (ulcer over a lymphoid follicle)
(earliest radiographic sign in Crohn,s colitis)
Inflammatory Bowel Disease
Complications
Pseudopolyps
Stricture
Cancer
Perianal complications Inflammatory Bowel Disease
TREATMENT Initiate supportive care with: bowel rest nasogastric suction and intravenous (IV) fluids containing electrolytes Inflammatory Bowel Disease TREATMENT Admit for:▼ toxicity Obstruction hemorrhage or localized peritonitis ► Laparatomy TREATMENT ► Monitor severe cases for fat malabsorption Treat perirectal disease Sitz baths
Soap and water after stooling
Surgical drainage of perirectal abscesses
Surgical treatment of recurrent fistulas if medical
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