An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative...
-
Upload
randolf-rogers -
Category
Documents
-
view
219 -
download
2
Transcript of An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative...
![Page 1: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/1.jpg)
Inflammatory Bowel Disease
An Introduction To
![Page 2: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/2.jpg)
Inflammatory Bowel Disease
Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease
![Page 3: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/3.jpg)
Inflammatory Bowel Disease
Two chronic diseases that cause ulceration & inflammation of the intestines Ulcerative Colitis Crohn's Disease.
![Page 4: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/4.jpg)
Inflammatory Bowel Disease
Two chronic diseases that cause ulceration & inflammation of the intestines
They have some features in common but there are some important differences
20% of patients have clinical picture that falls in between (indeterminate colitis)
![Page 5: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/5.jpg)
Epidemiology
Most numbers are North American
Increasingly diagnosed in Saudi Arabia
![Page 6: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/6.jpg)
Pathophysiology
Unclear
A number of factors may be involved.
Host Factors
Environmental Factors
![Page 7: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/7.jpg)
Pathophysiology
Host Factors
Genetics (Twins, Relatives, & children)
Obesity
Appendectomy
![Page 8: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/8.jpg)
Pathophysiology
Environmental Factors
Smoking (Crohn’s Vs Ulcerative)
Infection
Oral Contraception
![Page 9: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/9.jpg)
Pathophysiology
Current Theory:
There is a genetic defect that affects the immune system, so that it
attacks the bowel wall in response to stimulation by an offending antigen, like a bacteria, a virus, or a protein in
the food
![Page 10: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/10.jpg)
Ulcerative Colitis
An inflammatory disease of the large intestine
Recurring Inflammation and ulceration of the mucosa of the large intestine
Almost always involve the rectum and extend proximally
![Page 11: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/11.jpg)
Ulcerative Colitis
It extends in a continuous fashion
40-50% of patients have disease limited to the rectum and rectosigmoid
30-40% of patients have disease extending beyond the sigmoid
20% of patients have a total colitis
![Page 12: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/12.jpg)
Ulcerative Colitis
Macroscopic Appearance
Erythematous mucosa, has a granular surface, looks like sand paper
In more severe diseases hemorrhagic, edematous and ulcerated
In fulminant disease a toxic colitis or a toxic megacolon may develop
![Page 13: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/13.jpg)
Ulcerative Colitis
![Page 15: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/15.jpg)
Ulcerative Colitis
![Page 16: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/16.jpg)
Ulcerative Colitis
Microscopic Appearance
Crypt abscesses
Branching of crypts,
Atrophy of glands
Loss of mucin in goblet cells
![Page 17: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/17.jpg)
Ulcerative Colitis Presentation
The major symptoms of UC are:
Diarrhea (4 to more than 10)
Rectal bleeding
Tenesmus & Passage of mucus
Crampy abdominal pain & Fever
Exam is often normal unless complications occur.
![Page 18: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/18.jpg)
Ulcerative Colitis Complications
Hemorrhage
Toxic megacolon
Perforation
Stricture
Cancer
![Page 19: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/19.jpg)
Ulcerative Colitis
Extra-intestinal manifestations Uveitis and Episcleritis Erythema Nodosum and Pyoderma
Gangrenosum Arthritis Ankylosing Spondylitis Sclerosing cholangitis
![Page 20: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/20.jpg)
Ulcerative Colitis Treatment
Mainly medical treatment
![Page 21: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/21.jpg)
![Page 22: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/22.jpg)
Ulcerative Colitis Treatment
Mainly medical treatment
Surgical treatment:
Failure of medical management
Treating complications
Prophylaxis for cancer
Cure after colectomy
![Page 23: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/23.jpg)
Crohn’s Disease
An inflammatory disease that affects any part of the GI tract
Recurring transmural Inflammation of the bowel
About 80% have small bowel involvement, mostly the terminal ileum
![Page 24: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/24.jpg)
Crohn’s Disease
Characterized by skip lesions
30-40% of patients have small bowel disease alone
40-55% of patients have both small and large intestines disease
15-25% of patients have colitis alone
![Page 25: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/25.jpg)
Crohn’s Disease
Macroscopic Appearance
Mild disease has aphthus or small superfecial ulcers
In more severe diseases there is the characteristic cobblestone appearance
Thickening of the bowel wall with creaping fat
![Page 26: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/26.jpg)
Crohn’s Disease
![Page 27: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/27.jpg)
Crohn’s Disease
![Page 28: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/28.jpg)
![Page 29: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/29.jpg)
Inflammatory Bowel Disease
![Page 30: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/30.jpg)
Crohn’s Disease
Microscopic Appearance
Transmural inflammation
Focal ulcerations
Acute and chronic inflammation
Granulomas may be noted in up to 30 percent of patients
![Page 31: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/31.jpg)
Crohn’s Disease Presentation
The major presentations of CD are:
Crampy abdominal pain
Diarrhea
Weight loss
Colitis and Perianal disease
Dudenal Disease
![Page 32: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/32.jpg)
Crohn’s Disease Complications
Phlegmons & abcesses Fistulas Stricture Malabsorption Perianal disease Cancer risk
![Page 33: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/33.jpg)
Crohn’s Disease
Extra-intestinal manifestations Uveitis and Episcleritis Erythema Nodosum and Pyoderma
Gangrenosum Sclerosing cholangitis Renal stones Gall stones Amyloidosis
![Page 34: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/34.jpg)
Crohn’s Disease Treatment
Mainly medical treatment:
Oral 5-aminosalicylates (sulfasalazine)
Antibiotics (Cipro, Metronidazole)
Glucocorticoids (Prednisone)
Immunomodulators (Azathioprine)
Biologic therapies (infliximab)
![Page 35: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/35.jpg)
Crohn’s Disease Treatment
Mainly medical treatment Surgical treatment:
Failure of medical management
Treating complications
Not a Cure
![Page 36: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/36.jpg)
Inflammatory Bowel Disease
UC Crohn’s disease
Blood in stool Yes Occasionally
Mucus Yes Occasionally
Systemic symptoms
Occasionally Frequently
Pain Occasionally Frequently
Abdominal mass Rarely Yes
Perineal disease No Frequently
![Page 37: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/37.jpg)
Inflammatory Bowel Disease
UC Crohn’s disease
Fistulas No Yes
Small intestine obstruction
No Frequently
Colonic obstruction
Rarely Frequently
Response to antibiotic
No Yes
Recurrence after surgery
No Yes
![Page 38: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/38.jpg)
Inflammatory Bowel Disease
UC Crohn’s disease
Rectal sparing Rarely Frequently
Continuous disease
Yes Occasionally
„cobblestoning” No Yes
Granuloma on biopsy
No Occasionally
![Page 39: An Introduction To. Outline What is the Disease? Epidemiology Pathophysiology Ulcerative Colitis Crohn’s Disease.](https://reader036.fdocuments.us/reader036/viewer/2022081519/56649da15503460f94a8dae8/html5/thumbnails/39.jpg)
Inflammatory Bowel Disease
Questions?