Crohn’s Disease, IBS, Ulcerative Colitis Flashcards
Crohn’s disease
Definition-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. Consists of skip areas
Etiology-unknown
Signs and symptoms
- Abdominal pain
- Chronic diarrhea
- Bleeding
- Anal Fistulas
- Anorexia
- A right lower quadrant mass or fullness
Extraintestinal manifestations
- Weight loss
- Fever
- Anemia
- Peripheral arthritis
- Ophtalmic diseases (Episcleritis)
- Aphthous stomatitis
- Erythema nodosum
- Pyoderma gangrenosum
Criteria for crohns disease
- Small bowel is involved
- Rectosigmoid is often spared; colonic involvement is usually right-sided.
- Gross rectal bleeding is absent
- Fistula, mass, and abscess development is common
- Perianal lesions are significant
- On x-ray, bowel wall is affected asymmetrically and segmentally, with “skip areas” between diseased segments.
- Endoscopic appearance is cobblestone , with discrete ulcerations separated by segments of normal-appearing mucosa
- Microscopic inflammation and fissuring extend transmurally; lesions are often highly focal in distribution.
- Epithelioid (sarcoid-like) granulomas detected in bowel wall.
Diagnostic and treatment of crohn’s diseases
CBC may reveal anemia casued either by blood loss or vitamin B12 deficiency.
• Inflammatory markers: ESR and C-reactive protein measurements can be useful to check the degree of inflammation. TH1 Mediated so granulomatous inflammation.
• Testing for Anti-Saccharomyces cerevisiae antibodies ( ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammation of the intestine.
• CT scan shows Crohn’s disease in the fundus of the stomach.
• Endoscopic image shows deep ulceration.
• Also colonoscopy helps in the visualization of the colon and terminal ileum.
•fecal calproctectin level
On barium swallow there are strings of kantor with thickened walls
Treatment for crohns -Diet № 4 Immunosuppressant- azathioprine- 2.5mg/kg/day Aminosalysilates-3-6g/day Metronidazole 1-1.5g/day Treat diarrhea with loperamide
Irritable bowel disease
Increased sensitivity of large bowel with no organic cause. Clinical features; abdominal pain, bloating, altered bowel habits Criteria of abdominal pain Relief by defecation Altered stool form Altered bowel frequency Incomplete evacuation Classes Constipation dominant Diarrhea dominant Diagnosis Blood and stool test Treatment Osmotic laxative for constipation- sodium hydroxide Antispasmodic- papaverine Animotility- loperamide Anticholinergics to reduce motility- for diarrhea
Ulcerative colitis
Definition-A chronic, inflammatory, and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea and affects the rectum mostly and it is a uniform and diffuse inflammation.
Etiology-unknown Signs and symptoms -Bloody diarrhea -Abdominal pain -Fever -Anorexia -Weight loss -Malaise
Extracolonic problems
- Peripheral arthritis
- Ankylosing spondylitis
- Sacroiliitis
- Anterior uveitis
- Erythema nodosum
- Pyoderma gangrenosum
- Episcleritis
- Primary sclerosing cholangitis
CLASSIFICATION OF ULCERATIVE COLITIS a)mild course -Defecation frequency :<4 -bleeding : mild -fever : absent -hemoglobin g/l : > 110 -ESR mm/hour : <30 -Albumin g/l : norm Treatment -Aminosalicilates (Sulfasalazine, Salofalk)
b) moderate course
-Defecation frequency :>6
-bleeding : profuse
-fever : > 37,5 degree c
-hemoglobin g/l : 105-110
-ESR mm/hour : > 30
-Albumin g/l : 30-40
Treatment-Immunosuppressive drugs (Azathioprine)
C) severe form -Defecation frequency :>10 -bleeding : continuous -fever : > 38,8 degree c -hemoglobin g/l : <105 -ESR mm/hour : > 50 -Albumin g/l : <30 Treatment - IV Corticosteroid therapy (Budesonid, Prednizolon) and biological agents -Remicade (infliximab)
Complication -bleeding -toxic megacolon -perforation -colon cancer Diagnosis Blood, stool test, colonoscopy, endoscopic biopsy Pseudopolyps are isolated islands of regenerating mucosa bulging into lumen
