Inflammatory Bowel Diseases(IBD) Ulcerative colitis and Crohn’s disease

Inflammatory Bowel Diseases

Inflammatory Bowel DiseaseOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... » (I BD) is an idiopathic and chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » intestinal inflammation.

• It is of 2 major types :
  • Ulcerative colitis UC)
  • Crohn’s diseas (C.D)
• The factors associated with increased incidence of IBD are smoking, oral contraceptive, family history, ge­netic predisposition, hypogammaglobulinaemia, emo­tional stress.
• The term for a number of chronic, relapsing inflammatory diseases of the gastrointestinal tract of unknown etiology.
• The two most common types are ulcerative colitis and Crohn’s disease.
• UC affects the colon, whereas CD can involve any component of the gastrointestinal tract from the oral cavity to the anus.
• Age of onset is 15-30 years and 60-80 years.
• It is equally common in males and females.

Inflammatory Bowel Diseases(IBD) Ulcerative colitis and Crohn’s diseas

Clinical features of Crohn’s disease

• There is pain in right lower quadrant of abdomen, diarrheaFicus Religiosa Pipal tree Ayurvedic Medicine Ficus religiosa Pipal Medicine of gastric problems diabetes diarrhea. Read more ... », palpable mass sometimes, feverThyrotoxic crisis or Thyroid storm. Read more ... », anorexia, fear of eating.
• Afl inflammatory mass is palpable in right lower quad­rant sometimes.
• There is bowel obstruction due to progressive nar­rowing and stricture.
• There may be pain after meals. ~Fistulas are common due to perforation.

DIAGNOSTIC APPROACH —

• The diagnosisOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... » of IBD involves five steps.
• The first two are typically performed by the general pediatrician, and the last three are performed by the pediatric gastroenterologist.
• ClinicalOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... » suspicion of the illness based upon history,
• examinationHow to take good medical history & examination. Read more ... » and screening laboratory data Exclusion of other illnesses that have a similar presentation
• Establishment of the diagnosis of IBD, with differentiation between CD and UC
• Localization of the region of the disease Identification of extraintestinal manifestations

Pathology in Ulcerative colitis

• Involves the rectum and extends upwards.
• The mucosa is ede’r\1atous, haemorrhagic and ulcer­ated.
• Pseudopolyps may be present.
• The colon becomes narrowed and shortened.
• There may be perforations. There may be crypt abscesses.
• There may be pseudopolyps or carcinomaArbuda or Cancer Ayurvedic Review. Read more ... » in colon. Stricture and obstruction may occur, seen on endos­copy.

In X-ray with barium there is string sisn of narrowed lumen of intestine.

Summary of findings in Ulcerative colitis

• Gross blood in stools
• The onset of symptomsOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... » may be insidious, with non-bloody diarrhea and sometimes poor weight gain.
• Mucus in stools
• ANCA (Antineutrophil cytoplasmic antibody) positive Rectum is usually involved
• Patients with UC have colitis affecting the rectum and extending proximally to a variable degree
• The lesions are continuous   Strictures are rarely found.

Summary of findings in Crohn‘s disease

• Systemic symptoms are common
• Any part of GI tract, usually terminal ileum and/or colon; transmural inflammation, bowel wall thickening, linear ulcerations,
• Blood and mucus usually not present in stools Abdominal pain is common
• Abdominal mass usually palpable
• There is significant perianal and perineal disease Fistulas are common
• Strictures are frequent
• Intestinal obstruction is common Colonic obstruction is common Responds to antibiotics
• May recur after surgery
• AS CA (Anti Saccharomyces cerevisiae antibody) Rectum is spared
• Fever, abdominal pain, diarrhea (often without blood), fatigueFatigue diagnosis medicine and treatment. Read more ... », weight loss, growth retardation in children;
• There is cobblestoning in endoscopy (cobblestones are large cricket ball size stones used for paving paths)
• There may be granuloma on biopsy
• Small bowel may be involved
• There is segmental colitis.

Treatment of Ulcerative colitis

• TreatmentOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... » for inflammatory bowel disease is Sulphasalazine (4-8 g/day) and other 5-ASA agents dose 2-4 gjday).
• 5 ASA agents are Sulfasalazine, Olsalazine, Asacol, Pentasa.
• For distal disease 5-ASA oral and enema is given. IV glucocorticoidsAdrenal Gland Steroids. Read more ... », glucocorticoid enemas.
• IV CSA (cyclosporin), Azathioprine, 6 Mercaptopurine.

Treatment of Crohn’s disease

• 5 -ASA oral or enema Metronidazole
• Ciprofloxacin
• Oral or IV glucocorticoids Azathioprine
• Infliximab
• Total parenteral nutrition (TPN).

Newer therapies

• Anti TNF antibody
• Newer immunosuppressive agents like tacrolimus Surgical therapy for haemorrhage, obstruction, fis­tula, stricture.