Inflammatory Bowel Disease Flashcards
Inflammatory Bowel Disease
Characterized by chronic, recurrent inflammation
of the intestinal tract
Clinical manifestations are varied for both
conditions
Long periods of remission interspersed with
episodes of acute inflammation
Both diseases can be debilitating
Causes
Cause is unknown Possible causes: Infectious agent (virus, bacteria) Autoimmune reaction Food allergies Heredity
Ulcerative Colitis
Characterized by inflammation and ulceration of the colon and rectum May occur at any age Peaks between ages 15 and 25 years Equally affects both sexes
Pathophysiology of Ulcerative Colitis
Diffuse inflammation
Involves mucosa and submucosa
Alternate periods of exacerbations and
remissions
Usually begins in the rectum and sigmoid colon and
spreads up the colon in a continuous pattern
Mucosa is hyperaemic and oedematous in the
affected area
Pathophysiology (cont.)
Multiple abscesses develop in the
intestinal glands
Abscesses break through into the
submucosa, leaving ulcerations
Ulcerative Colitis
Etiology and Pathophysiology
Ulcerations destroy the mucosal epithelium, causing bleeding and diarrhoea Fluid and electrolyte losses Protein loss Pseudopolyps
Ulcerative Colitis
Etiology and Pathophysiology continued…
Granulation tissue develops
Mucosa musculature becomes thickened,
shortening the colon
Ulcerative Colitis
Clinical Manifestations
Most commonly presents as a chronic disorder
with mild-to-severe acute exacerbations that
occur at unpredictable intervals over many years
Major symptoms:
Bloody diarrhoea
Abdominal pain
Ulcerative Colitis
Complications
Complications may be classified as: Intestinal – haemorrhage, strictures, perforation Extra intestinal – may be non-specific complications mediated by a disturbance in the immune system
Crohn’s Disease
Description
A chronic, nonspecific inflammatory bowel disorder
of unknown origin that can affect any part of the
GI tract from the mouth to the anus.
Can occur at any age
Most often between ages 15 and 30 years
Both genders are affected
Similar to ulcerative colitis
Crohn’s Disease
Etiology and Pathophysiology
Characterized by inflammation of segments of
the GI tract
Can affect any part of the GI tract but is most
often seen in the terminal ileum, jejunum, and
colon
Inflammation involves all layers of the bowel wall
Ulcerations are deep and longitudinal and
penetrate between islands of inflamed
oedematous mucosa, causing the classic
cobblestone appearance
Crohn’s Disease
Etiology and Pathophysiology, continued…
Thickening of the bowel wall
Narrowing of the lumen with stricture development
Abscesses or fistula tracts that communicate with
other loops of bowel, skin, bladder, rectum, or
vagina may develop
Crohn’s Disease
Clinical Manifestations
Onset is usually insidious Nonspecific complaints: Diarrhoea (non-bloody) & abdominal pain are the major manifestations Fatigue Weight loss Fever
Crohn’s Disease
Clinical Manifestations, continued…
Pain (severe and intermittent) Abdominal cramping and tenderness Abdominal distension Arthritis Finger clubbing
Crohn’s Disease
Complications
Strictures and obstruction from scar tissue Fistulas Peritonitis Fat intolerance Gluten intolerance
Compare and contrast ulcerative colitis and
Crohn’s disease under the following headings: Age at onset and Location of disease?
Age at onset
Young to middle age with ulcerative colitis
Young in Crohn’s disease
Location of disease
Ulcerative colitis, the disease starts distally and spreads
in a continuous pattern up the colon
Crohn’s, the disease occurs anywhere along the GI tract.
Most frequent site is terminal ileum
Peptic Ulcer Disease is a condition characterised by?
Condition characterized by
Erosion of GI mucosa resulting from the digestive
action of HCl and pepsin
Any portion of GI tract that comes in contact with
gastric secretions is susceptible to ulcer development
including lower oesophagus, stomach, & duodenum
Includes gastric and duodenal ulcers
Aetiology & Pathophysiology
Develop only in presence of acid environment
Excess of gastric acid not necessary for ulcer
development
Person with a gastric ulcer has normal to less than
normal gastric acidity compared with person with a
duodenal ulcer
Peptic Ulcer
Some acid does seem to be essential for a gastric
ulcer to occur
Under specific circumstances the mucosal barrier can
be broken and HCL freely enters the mucosa & injury
to tissues occurs
This results in cellular destruction & inflammation
Histamine is released
Vasodilation, ↑ capillary permeability
Further secretion of acid and pepsin
Peptic Ulcer - Agents known to destroy the mucosal barrier include:
H. Pylori - causes chronic inflammation making
mucosa more vulnerable to noxious agents
Drugs (aspirin, NSAIDs, corticosteroids) – cause
abnormal permeability
Identify risk factors for the development of
peptic ulcers
H Pylori Alcohol Smoking Stress Use of NSAIDs
Compare and contrast gastric and duodenal
ulcers under the following headings: Location of lesion and Gastric secretion incidence?
Location of lesion Gastric ulcers found predominantly in the antrum but also the body and fundus of stomach. Duodenal ulcers found in the first 1-2 cm of the duodenum B. Gastric secretion incidence Normal to decreased in gastric ulcers Increased in duodenal ulcers
Compare and contrast gastric and duodenal
ulcers under the following headings:
Clinical Manifestations
Gastric ulcers burning or gaseous pressure in high left
epigastric region, back & upper abdomen. Pain occurs
1-2 hrs after meals & may experience aggravation of
discomfort with food. Occasional nausea & vomiting
and weight loss
Duodenal ulcers burning, cramping, pressure like pain
across the mid-epigastric region & upper abdomen.
Pain occurs 2-4hrs after meals & middle of the night.
Pain can be relieved by antacids & food. Occasional
nausea & vomiting
