Chronic diseases of the bowel

Question 1

What are the 2 distinctive disorders included in IBS, and what is the difference?

Answer 1

Crohns disease and ulcerative colitis

The main difference between Crohn’s disease and ulcerative colitis is the location and the nature of the inflammatory changes

Question 2

What is Crohns disease and what areas of the bowel does it affect?

Answer 2

Chronic inflammatory condition non-specific to a single area of the gastrointestinal system, affecting the whole bowel well resulting in transmural lesions. The most common sites affected are the terminal ileum, jejunum and colon

Question 3

What do the lesions created from Crohns lead to?

Answer 3

• These lesions lead to thickening of the intestinal wall

* Leads to the intestinal wall lumen narrowing and associated stricture development

Question 4

What are some symptoms of Crohns?

Answer 4

o	Increased frequency of bowel motions
o	Abdominal pain
o	Rectal bleeding (rare)
o	Weight loss 
o	Reduced appetite 
o	Faecal incontinence 
vomiting
constipation

Question 5

What is ulcerative chollitis?

Answer 5

• Chronic disease of the bowel that affects the mucosa and sub-mucosa of the colon and rectum
• Confined to the rectum and sigmoid colon
• Inflamed mucosa become oedematous abscesses form and eventually the bowel mucosa becomes ulcerated

Question 6

What are the symptoms of ulcerative chollitis?

Answer 6

• lower abdo cramping, urgency
• Fatigue, weakness, nausea and anorexia
• Typically the symptoms may last for weeks or days, followed by a period of remission
• rectal bleeding, elevated temperature, elevated ESR and a drop in haemoglobin

Question 7

What other body systems can be involved in IBD?

Answer 7

• the dermatological system, ocular system, joints or the hepatobiliary system

Question 8

What complications can arrise from IBD?

Answer 8

• small bowel obstruction, toxic megacolon, fistulas and fissures, perforation and gastrointestinal blood loss, colonic carcinoma

Question 9

What are the risk factors of IBD?

Answer 9

• Gender: females tend to a predominance of crohn’s disease, whereas males have a higher incidence of ulcerative colitis
• Age: both CD and UC are commonly diagnosed in late adolescence and early adulthood: however, the diagnosis may occur at any age
• Race/ethnicity: studies comparing the prevalence of IBD among different ethnic groups suggests genetic predispositions.
• Cigarette smoking
• Diet
• Non-steroidal anti-inflammatories
• Psychological factors

Question 10

What Pharmacological treatment can be done for IBD?

Answer 10

• Anti-inflammatory and immunosuppressant agents
• Amino salicylic drugs
• Antibiotic therapy
• Corticosteroids
• Immunomodulators

Question 11

What is the central focus in treatments for IBD?

Answer 11

Nutritional therapy

Question 12

What surgical procedures can be done for those with IBD?

Answer 12

• Stop bleeding
• Close fistulas
• Bypass obstructions
• Remove affected areas of the intestine

Question 13

What is irritable bowel syndrome?

Answer 13

Chronic functional bowel disorder characterised by the relapse and remission of abdominal pain or discomfort, bowel dysfunction and abdominal bloating.
• Bowel dysfunction associated with IBS may occur in four different forms
o Constipation predominant (sluggish)
o Diarrhoea predominant (hyperactive)
o Alternating between constipation and diarrhoea

Question 14

What is the treatment of irritable bowel syndrome?

Answer 14

Non-pharmacological 
•	Diet modifications
•	Relaxation therapy 
•	Cognitive behavioural therapy 
Pharmacological 
•	Provide partial relief of symptoms depending on the patient’s symptom pre-sensation